1
Q
triple aim
A
improve: (1) patient experience, (2) population health, (3) value (quality/cost)
2
Q
stakeholders
A
- patients and communities
- health care providers: individuals and institutions
- insurers
- employers
- government
3
Q
attributes of health care system
A
- access, cost, quality, equity, and accountability
4
Q
Bodenheimer’s distinction
A
- integrated vs. dispersed healthcare
- driven by biomedicine, financial incentives, specialty bias, professionalism
5
Q
levels of care
A
- primary: entry
- secondary: referral
- tertiary: highly specialized
6
Q
HMO (health maintenance organization)
A
- care provided by member physicians
- limited referrals
- financed by fixed periodic payments determined in advance
7
Q
staff model HMO
A
- medical professionals are employees of HMO
- only see patients signed up for HMO
- capitation: set amount per patient
8
Q
virtual integration HMO
A
- insurance and provider functions are separate
- HMO contracts with provider groups
- focus on managing cost and price, not care
9
Q
ACO
A
- set of healthcare providers that collaborate (provider led)
- shared accountability of cost and quality
- full continuum of care
- shared savings and better metrics
10
Q
medical home
A
- comprehensive primary care
- patient-centered
- preventative
11
Q
ecological view of healthcare
A
- understand numerator vs denominator confusion
12
Q
why doesn’t function as a market good?
A
- irrational behavior
- imperfect information
- market power asymmetry/lack of choice
- externalities intrinsic to health and created by policy
13
Q
insurance mechanisms
A
- subsidy: no tax on money spent purchasing insurance
- moral hazard: allows risk
- tragedy of commons: overuse resource bc it is shared (not usually an issue)
14
Q
why was reform needed?
A
- employer-based system
- pre-existing conditions
- lower-income people
15
Q
RomneyCare
A
- everyone brings something to the table: government, employers, healthcare system, individuals
16
Q
ACA key provisions
A
- affordability (expand medicaid eligibility; sliding scale)
- accessibility
- individual requirements (mandate)
- employer requirements
- primary care (community health centers; more funding)
17
Q
comprehensive health reform
A
- coverage and access
- delivery system reform
- prevention, wellness, public health
- health in all policies
18
Q
MA vs ACA
A
- incremental vs transformational
- easier to enact reform
- bipartisan support
