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ESSENTIALS OF THE U.S. HEALTHCARE SYSTEM 3RD EDITION PDF

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Essentials Of The U.s. Healthcare System 3rd Edition Pdf

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Fragmentation of care Difficult to coordinate between acute care, PCP, long-term care.

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Leads to redundant treatment eg multiple X-rays and lower quality Different EMRs are not cross-compatible Inefficient market Consumers cannot make fully informed decisions due to complexity of care.

These are theoretical and not explicitly mentioned by the book. This wasteful care leads to higher patient load, which depletes provider time to carefully consider root cause and further enforces automatic rapid workups.

Poor insurance rates for youth may lead to worse health outcomes when old, leading to higher costs for Medicare, leading to underfunding insurance for youth Imposing more taxes to pay for medical care may lead to less national output, which requires more welfare for citizens, which may require more taxes.

Main Takeaways from Essentials of The US Healthcare System Cost, access, quality — 3 components to measure effectiveness of a health care system These are often conflicting. Increasing access to more patients will increase total costs.

Forcibly decreasing cost may decrease quality or access. Cost is a function of price x quantity.

Price is easier because quantity risks backlash re: rationing Access is a lower class, liberal, social justice problem. Also, restricting access to high tech healthcare leads to claims of rationing. Quality is difficult to define and is in the eye of the beholder patient vs provider vs payer have different conceptions of quality.

Each side finds the other incomprehensible Determinants of individual health — lifestyle, environmental, heredity, medical access Brief history of US healthcare Healthcare began as unscientific and haphazard, practiced by barbers, clergy, and family members.

Summary: Essentials of the US Healthcare System (by Shi and Singh)

Hospitals became community-owned institutions supported by private charitable donations, starting the dominant trend today of private nonprofit hospitals. As science improved and medicine gained legitimacy anesthesia, germ theory, sterilization , people began paying out of pocket, and hospitals realized they could make profits. Hospitals became centers of research affiliated with universities.

Pressures from payers large MCOs prompt hospitals to merge and form medical systems, providing a broad range of services. First, many programs are justified as necessary to address well-understood market failures. The minimum coverage requirement individual mandate in the Affordable Care Act ACA , for example, was enacted to discourage "adverse selection"--the tendency of only unhealthy people to buy health insurance if insurers must accept all applicants.

Pharmaceuticals are regulated because few consumers have the information or ability to assess their safety or effectiveness. Second, we regulate because we are using private delivery and financing systems to accomplish public goals. Because the ACA relies on private insurers to cover uninsurable individuals, it prohibits health status-based underwriting.

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Federal law requires private hospitals to provide emergency care regardless of the ability of patients to pay, because Congress has been unwilling to provide a tax-funded public program to pay for it.

Third, regulatory programs exist because we are paying for privately provided care and insurance using public funds, and must ensure that public funds are properly spent. Finally, much of health care regulation is best understood as special interest protection.

Restrictive "scope-of-practice" laws, enacted by legislatures at the behest of special interest trade groups, protect the professional privilege of doctors and specialists while restricting public access to less expensive providers, like nurse practitioners and midwives. Our problems are exacerbated because, as the Bipartisan Policy Center's Julie Barnes pointed out in a March "America the Fixable" essay , we pay for most health care on a fee-for-service basis.

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This creates incentives for physicians to provide as many discrete services as possible to maximize payment a tendency often justified by an asserted fear of malpractice litigation. Moreover, hospitals, laboratories, imaging facilities, and drug companies are often eager to reward physicians for ordering their products and services. Attempts by the fee-for-service Medicare program to control the amount or payments physicians receive to a "sustainable growth rate" were stymied as utilization of services grew rapidly and intensive lobbying defeated attempts to reduce prices accordingly.

To combat these incentives, the federal and state governments have adopted a host of very complicated and often redundant statutes prohibiting kickbacks, self-referrals, and fraudulent and abusive claims practices, while private insurers impose pre-service approval and post-service utilization review for some procedures. Not surprisingly, we have a dysfunctional health care system. We spend far more per capita and as a percentage of our GDP than any other country in the world.

Despite this, 50 million Americans lack any certain means of paying for their health care, resulting in thousands of premature deaths and bankruptcies every year.

Finally, the quality of American health care is not exceptional--we do very well with some things, like detecting and treating some kinds of cancer, but lag behind other countries in other respects and have a poor record for patient safety and medical errors. What should be done?

A purely private system of health care financing would solve some problems, but cause others. It would make all but the most basic health care inaccessible to many, perhaps most, Americans--a result most Americans would find unacceptable.

Alternatively, we could move more toward a publicly financed system, the approach taken by all other developed nations. This solution brings its own well-documented problems, which vary from country to country--but it does allow much greater control over cost and facilitates broader access.

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The public solution runs contrary to the political culture of the United States, however, and is adamantly opposed by powerful interest and ideological advocacy groups. For the present, our mixed system must muddle along.Multiple levels of care must be considered when patients are being transitioned out of the acute care setting, all with different rules for admission and reimbursement.

Cognitive research shows that a human can handle from five to nine facts in a single decision Miller, Moreover, despite the potential of these technologies to improve the quality of health care, the limited integration in system design for such technologies as HIT; laboratory, radiology, and imaging systems; and monitoring and surgical equipment has allowed their misuse and overuse.

Main Takeaways from Essentials of The US Healthcare System Cost, access, quality — 3 components to measure effectiveness of a health care system These are often conflicting. Poor insurance rates for youth may lead to worse health outcomes when old, leading to higher costs for Medicare, leading to underfunding insurance for youth Imposing more taxes to pay for medical care may lead to less national output, which requires more welfare for citizens, which may require more taxes.

Rescheduling patients after a cancellation required a great deal of extra work. Challenges from the people standpoint include the prevailing culture of health care with its hierarchical, often physician-centric, and slow-to-evolve team-based approach to care. She proposed that more systematic data collection and the development of more prospective registries would lead to better-informed decisions in health care.

Collaboration with information technology enables system adjustments as the clinical model transitions.