Week 2 notes
Week 2 notes HCA 340 -002
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HCA 340 -002
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This 6 page Class Notes was uploaded by Loretta Hellmann on Thursday February 4, 2016. The Class Notes belongs to HCA 340 -002 at Western Kentucky University taught by Steven W. Maddox in Spring 2016. Since its upload, it has received 39 views. For similar materials see HEALTH CARE ORG/MGT in Nursing and Health Sciences at Western Kentucky University.
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Date Created: 02/04/16
Week 2 Notes Tuesday, February 02, 2016 9:35 AM Chapter 2 Health Care Industry Transformation Until 1940s (pre-insurance time), the industry was dominated by physicians & hospitals Patient/MD relationships are sacred; treatments, payments confidential Mostly personal payments "No third party must be permitted to come between patient and physician in any medical matter" AMA 1934 Shift from personal payment to insurance payment Dramatic alteration in the physician/patient relationship Distanced patients from awareness of costs and responsibility for decision Created "business" of medicine Health Insurance: Historical Highlights 1800s: some employers had sickness insurance, fraternal orders, unions; fixed payments to replaced lost wages 1915: drive for mandatory insurance began in US based on Europe's insurance and companies, wanted to protect workers from lost income due to accidents Metropolitan and Prudential "industrial" policies Paid $.10-25 week, paid $50-100 on death WW1 interrupted drive for mandatory insurance AMA officially opposed compulsory insurance (1919) believing insurance would decrease MD incomes based on negative experience with arbitrary fees paid by accident insurance Great Depression: beginning of hospital insurance plans Hospitals experimented with insurance as financial woes lowered the admissions Baylor University Plan: birth of the Blue Cross Model; public teacher paid $.50/month for guarantee of 21 paid hospital days By 1937, 26 plans with 600,000 enrolled with physician and hospital endorsement No "socialized" medicine AMA continues to aggressively protest against government's involvement in insurance All insurance plans served hospital and physician interests Growth of Private Insurance Post WWII: government exempted health insurance benefits from wage/price controls and exempted workers health insurance contributions from taxable income Insurance companies raised premiums without pressure to control costs Attention focused on avoiding infringement on physicians and hospitals, had freedom to set prices Dominant Influence of Government Social Security Act of 1935: most significant US social initiative in US history: Federal aid to states for public health, welfare, maternal/child health, "crippled" children Legislative basis for most subsequent health and welfare programs including Medicare and Medicaid Medicare= elderly Medicaid= the poor Post WWII: categorical programs addressed needs unmet by states, local government, private sector Federal subsidies for hospital construction. Research, professional education Government programs are now almost 40% of total US health care expenditures Government financial involvement Physician, other professional training subsidies 50+% of all research funds, national institutes of Health Building, expanding hospitals: 1940s-1970s Student support Health planning, regulation Consumer protection-related agencies (e.g. FDA, OSHA) Political Values Shape Health Care Kennedy-Johnson Era: "Creative Federalism" Federal grants increased from $7 to $24 billion between 1961-1968 Health Professions Education Assistance Act; Nurse Training Act, Economic Opportunity Act for neighborhood health centers 1965 Medicare and Medicaid Many other "Access" related policies Nixon-Ford Era: "New Federalism" Deleted categorical programs, shifted to stat block grants HMO Act of 1973- controled costs Decentralized, shifted support from public health, social programs Legislation: unintended effects Medicare & Medicaid were made to improve access: but it skyrocketed costs with underestimations of aged population growth, technology costs and service utilization Hill-Burton Act of 1946 was to increase hospital capacity: led to vast over-capacity HMO Act of 1973 was to control costs: raised many access and quality issues Three Major Health Care Concerns Cost, quality, and access are a generations-long conundrum of US health care delivery system Attempts to control one causes problems with the other Lowering the cost: lowers quality and access Higher quality care: higher costs Efforts at Planning and Quality Control Federal government attempted to address costs, quality and access met with powerful industry influences to preserve the status quo. Federal efforts included Regional Medical Program, Comprehensive Health Planning Act, National Health Planning and Resources Development Act Managed Care Organizations 1973 Health Maintenance Organization Act funded federal demonstration projects to: Link service delivery and financing with prepaid fixed fees; expected to hold down costs Comprehensive services emphasizing prevention By 1999 managed care organizations insured that majority of all privately insured individuals Major backlashes by consumers and providers Unsuccessful in containing costs The Reagan administration 1981-1989: Reductions in government involvement and funding Block grants to states Reductions in social program support Prospective Medicare hospital reimbursement became the model for hospital reimbursement New resource-based (value scale) physician payment to contain physician fees is a model in use still today Bio-medical Advances Dramatic technology advances of 1960s and 1970s: Sabin and Salk polio vaccines Tranquilizers, anti-depressants (Librium and valium) Birth control pills- widely used Heart-lung machines and heart transplants Improved general anesthesia Computed tomography scanners- distinguish soft tissue Technological advances: New Problems Extending life versus the individual's rights to die Equal access to technology regardless of ability to pay Profit-motivated overuse of technology with no patient benefit Technology available causes overuse due to fears of litigation Government attempts solutions to the problems Roles of Medical Education and Specialization Medical schools, teaching hospitals: conduct advanced research, form values and skills of physicians, nurses, other professional Teachers as role models reinforce values to new professionals Tradition, narrow faculty expertise: obstacles to educations reforms related to population-based health care Issues persist about workforce needs and future planning for physician supply. Influence of Interest Groups (AMA, insurance, consumer groups, business and labor, pharmaceutical industries) Many problems arise from division between governments and private health care industry both seeking to protect the interest of their stakeholders Tax-funded proposals spawn well-financed lobbying by providers, insurers, consumers, business, labor unions American Medical Association AMA: est 1847 to improve medical education 217,000 members, about 17% of physicians and medical students History of opposition to government controls and advocacy for physician autonomy; supported the ACA for expanding access; but opposed on cost containment, malpractice reform, and physician autonomy
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