SAR HP 353 Study Guide - Fall 2018, Comprehensive Midterm Notes - Medicaid, Managed Care, Health Maintenance Organization
12 Oct 2018
School
Department
Course
Professor
SAR HP 353
MIDTERM EXAM
STUDY GUIDE
Fall 2018
September 4th, 2018
Lecture 1
Introduction: the health care system
Joe: 28 year old man with Type I diabetes in the US. He does not have money, he is homeless.
He does not have a healthy diet. He is starting to lose circulation in his feet. Neuropathy:
decrease sensitivity and increase risk of trauma to his feet. Doctor recommend that he takes
insulin — he doest but he is still lacking proper living condition, housing and money. He will
need to have expensive amputations.
What is health? A state of complete physical, mental and social well-being and not merely the
absence of disease of infirmity (according to the WHO, written in the preamble to the
Constitution).
What contributes to premature death?
-Lifestyle and behaviors (50%)
-Risk behaviors
-Diet and exercise
-Smoking
-Alcohol
-Socio-economic status
-Stress
-Genetic (20%): family history
-Social and environmental factors (20%)
-Where you live, do you live in a dangerous neighborhood?
-Services and resources
-Where you work
-Medical care (10%)
-Medical benefits from employer
Affordable healthcare act: US citizens do not have to have insurance. The individual mandate
has been repealed. Federally, you do not need to have health insurance and you will not get a
penalty in your taxes. This limits your access even more to healthcare.
What is the primary goal of a health care system? To enable all individuals to access health
care that is cost effective and meets quality standards.
What are the strengths of the US Health care system?
-technology
-research
-medical training
Although there are new technologies and medicines, the cost of these new discoveries are way
too high and insurances will not pay for it.
Weaknesses of the US health care system:
-Financing is primarily employer based as a fringe benefit.
-If you have more than 50 employees you have to give them the option of having insurance
through your company.
find more resources at oneclass.com
find more resources at oneclass.com
-lack of overall planning, direction and coordination — administrative costs in US are 300%
higher than in Canada.
-Administrative costs are astronomical in the US.
-Access to health care is compromised for people with low socioeconomic status (income,
education, occupation).
-In Boston, for those that are experiencing a time of homelessness, we have temporary
shelter and housing. However, the area that people are taken to often do not have access
to public transportation (1 hour out of the city).
-Lack of long term care insurance coverage.
-Atul Gawande: “Being Mortal” talks about long term care.
-There is insurance for long term care however it is thousands of dollars per month and
comes with limitations and restrictions.
-In the Netherlands, they have a city that is set up for people who have dementia so that
they are not institutionalized.
-Only 2.9% of health care dollars, $2.5 trillion in 2015 was spent on programs that focus on
illness prevention
-We can minimize so many conditions if we focused on prevention.
-High per capita cost in contrast to low health outcomes ranking
-We spend more than most countries and our outcomes tend to be poorer than others
What did spending look like in 2017?
-Total spending health in the US in 2017 was $9892 per person
-The average annual premium for employment based on health car was $18764 in 2017. This
is the total cost of the premium for one individual.
-A premium is what you pay to have health insurance. It is the amount spent in one year to
carry the insurance card and be able to walk to the doctor with it.
-Average annual worker contribution to premiums for 2017 was $5714.
-Your employer pays a portion of the premium. It is a monthly payment that you have to
make with your employer.
Medicare is for those who are over 65, are disabled or have chronic kidney/renal disease.
When you look at what people are paying out of pocket for — dental services (which are not
covered by health insurance for most), prescription drugs.
How does the US rank in its performance compared to:
Health system efficiency (performance) ranking in 55 countries in 2018:
-Number 1 is Hong Kong
-Number 4 is South Korea
-Number 6 is Italy
-Number 9 is UAE
-Number 10 is Australia
-Number 50 is US
In terms of efficiency, we are looking at absolute cost spent per person, life expectancy. Our
absolute cost in the US is $9,403 and life expectancy is around 78 years old. In Hong Kong it is
$2,000 and life expectancy is nearly 84.
Infant mortality rates are also another indicator of efficacy of health care.
Sweden compared to the US:
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Joe: 28 year old man with type i diabetes in the us. He does not have money, he is homeless. He is starting to lose circulation in his feet. Neuropathy: decrease sensitivity and increase risk of trauma to his feet. Doctor recommend that he takes insulin he doest but he is still lacking proper living condition, housing and money. A state of complete physical, mental and social well-being and not merely the absence of disease of in rmity (according to the who, written in the preamble to the. Affordable healthcare act: us citizens do not have to have insurance. Federally, you do not need to have health insurance and you will not get a penalty in your taxes. This limits your access even more to healthcare. To enable all individuals to access health care that is cost effective and meets quality standards.
