Understanding healthcare economics: managing your career in an evolving healthcare system
"This book provides key economic facts, explains the economic concepts needed to examine the implications of these facts, and summarizes the results of empirical studies regarding our healthcare system's access, cost, and quality problems as well as identifying six key trends that are refo...
Gespeichert in:
| Beteiligte Personen: | , , |
|---|---|
| Format: | Buch |
| Sprache: | Englisch |
| Veröffentlicht: |
Boca Raton [u.a.]
CRC Press
2014
|
| Schlagwörter: | |
| Links: | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=026225778&sequence=000004&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| Zusammenfassung: | "This book provides key economic facts, explains the economic concepts needed to examine the implications of these facts, and summarizes the results of empirical studies regarding our healthcare system's access, cost, and quality problems as well as identifying six key trends that are reforming our system. The book helps readers understand the terminology, the facts, and the types of changes that are currently underway. The authors address the macro-problems, and micro-problems which will help assess practice opportunities, and identify viable strategies for adapting to the changes that will optimize the care provided"...Provided by publisher |
| Beschreibung: | Includes bibliographical references and index |
| Umfang: | XXXII, 223 S. graph. Darst., Kt. |
| ISBN: | 9781482203974 |
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Datensatz im Suchindex
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|---|---|
| adam_text | Titel: Understanding healthcare economics
Autor: Wendel, Jeanne
Jahr: 2014
Contents
Foreword........................................................................................xiii
Preface............................................................................................xix
Acknowledgments..........................................................................xxv
Introduction................................................................................xxvii
About the Authors........................................................................xxxi
SECTION I PRESSURES FOR CHANGE
1 Access..........................................................................................5
Introduction.................................................................................................5
Background: Information Available to Lawmakers during the
PPACA Debate.............................................................................................8
Proposed Strategies for Increasing Access: Impacts on the
Incidence of Uninsurance (Pre-PPACA Estimates).............................8
Public and Private Insurance Trends................................................10
Who Was Uninsured Prior to PPACA?..............................................11
Insurance Markets: Three Critical Access Issues......................................12
How Do Insurance Markets Work?...................................................13
Basic Insurance Concepts.........................................................13
Three Critical Issues..........................................................................19
Issue 1: Some Employers Do Not Offer Health Insurance.......19
Issue 2: Some Individuals Are Uninsured, Even Though
They Are Eligible for Public Insurance or ESI Because
They Do Not Take Up the Insurance Offer..............................38
Issue 3: Restrictive Insurance Company Practices Make It
Impossible for Some Individuals to Purchase Insurance.........41
Solution Options: What Do We Learn from Examining the
Three Critical Issues?.................................................................50
vii
viii ¦ Contents
Conclusion: Equitable Access to Healthcare Is an Important Social
Goal, but Health Insurance Is Just a Tool to Achieve a Larger
Goal—Health............................................................................................55
Endnotes....................................................................................................57
2 Cost............................................................................................59
Introduction...............................................................................................59
Background Information: What Does It Mean to Say, The System
Is Not Sustainable? ...................................................................................60
Diagnosing the Problem: What Is Fueling the Cost Increases?...............65
Technology................................................................................................65
Because Technological Advancement Is the Root Cause of the
Unsustainable Cost Increases, Maybe We Should Reduce Our
Investment in Research.............................................................................68
Do the New Treatments Produce Good Value for the Dollar?................69
Can We Assess Whether $1.9 Million Is Too Much (or Too Little) to
Spend in Order to Save a Life?.................................................................71
Solution Options: How Can We Make the System More Sustainable? ....74
Option 1: We Could Continue to Spend More on Healthcare
Every Year, and Accommodate This by Spending Less on
Other Goods......................................................................................75
Option 2: We Could Restrain the Quantities of Healthcare
Services That Are Utilized Annually in the United States...............75
We Could Ration by Price.........................................................75
We Could Ration by Wait Time.................................................76
We Could Ration by Setting Priorities.......................................76
Option 3: We Could Make Our Healthcare System More
Efficient..............................................................................................77
Conclusion: Given the Challenges Posed by Strategies to Ration
or Prioritize, We Should Pay Serious Attention to Strategies for
Increasing the Efficiency of Our Healthcare System........................77
Two of the Numerous Suggestions That Sound Good, but Have
Limited Potential for Solving the Problem........................................78
Modify Tax or Patent Policies to Reduce Pharmaceutical
Profits.........................................................................................78
Facilitate Importation of Prescription Drugs from Lower-
Price Non-U. S. Sources..............................................................79
General Conclusions.................................................................................79
Contents ¦ ix
3 Quality.......................................................................................81
Introduction...............................................................................................81
Background Information: Three Types of Evidence Indicate That
Quality Is Not Consistently High..............................................................82
International Comparisons Indicate That Other Countries Are
Doing More with Less.......................................................................83
What Can We Conclude about This Evidence?.........................86
Diagnosing the Root Cause of the Quality Problem................86
Evidence Documents the Occurrence of Preventable Medical
Errors.................................................................................................86
Evidence Documents Variations in Regional Treatment Patterns....88
What Is Influencing Physician Decisions?.................................89
Does Higher Utilization Reduce Mortality?...............................90
Are the Regional Differences Large Enough to Be
Important?..................................................................................90
Solution Options: How Can We Make Our Healthcare System More
Systematic?.................................................................................................91
Applying Total Quality Management Principles to Healthcare........91
Brief History...............................................................................92
Implement Systematic Protocols: Clinical Pathways and
Guidelines..........................................................................................94
Clinical Pathways.......................................................................95
Clinical Guidelines.....................................................................96
Implications of Not Enough Science......................................................104
Conclusion: Some Strategies for Strengthening Quality Are Clear;
However, the Concept of Healthcare Quality Is Multidimensional.......104
Conclusion to Section 1...........................................................................106
Endnote...................................................................................................107
SECTION II STRATEGIES TO INCREASE EFFICIENCY
Introduction.............................................................................................109
Do Healthcare Markets Operate Efficiently?..........................................110
Two Key Market Failures in Healthcare.........................................Ill
The Principal-Agent Problem: Healthcare Providers and
Auto Mechanics.......................................................................Ill
Insurance Reduces the Incentive for Patients to Shop
Wisely.......................................................................................112
How Should Government Address These Market Failures?...........112
x ¦ Contents
4 Align Incentives via Payment System Design..........................115
Introduction.............................................................................................115
Strategies to Control Cost: Rate Design Replaced Certificate of Need
Programs.................................................................................................115
What Is the Right Price?...............................................................116
Rate Design: Setting the Level of Payments...........................117
Rate Design: Designing the Structure of Payments................118
Efficiency Incentives: Diagnostic-Related Groups (DRGs)......121
Current Issues: Two Facets of Medicare Payment Policy...............122
Bundled Payment: Eliminate Silos..........................................122
Selective Contracting...............................................................124
Measuring Quality: Pay-for-Performance and Consumer
Information......................................................................................125
Conclusion...............................................................................................128
5 Managed Care Organizations, Accountable Care
Organizations, and Patient-Centered Medical Homes..............129
Introduction.............................................................................................129
Background: Managed Care Organizations...........................................130
Managed Care: Historical Trends....................................................131
Managed Care: The Backlash.........................................................132
Current Issues: Lessons Learned.....................................................134
Lesson 1. Defining Consumer Protection Is Complex...........134
Lesson 2. Shifting to Managed Care or ACOs Focuses on a
Definition of Quality That Is New for Many Patients............138
Lesson 3. Growth of Managed Care Organizations Raised
Two Types of Market Power Issues........................................139
Lesson 4. Managed Care Organizations Also Raised
Questions about Physician Risk Taking and Solvency
Regulation................................................................................141
Lesson 5. Mental Health Parity Mandate May Constitute a
Special Case.............................................................................144
Lesson 6. Physician Rating Systems Raise Concerns..............145
Conclusion: Experiences with Managed Care Organizations Provide
Significant Lessons Learned, as Providers Begin Forming ACOs and
PCMHs.....................................................................................................147
Endnotes..................................................................................................147
Contents ¦ xi
6 Wellness, Prevention, Disease Management............................149
Introduction.............................................................................................149
Background: PPACA Focuses Increased Attention on Prevention
and Wellness...........................................................................................150
Current Issues..........................................................................................151
After We Identify Individuals Who Are Most Likely to Benefit
from Prevention Programs, Can We Design Programs to
Successfully Induce Them to Participate?.......................................153
Conclusion...............................................................................................158
7 New Types of Providers...........................................................l6l
Introduction.............................................................................................l6l
Background.............................................................................................l6l
Current Issues..........................................................................................163
New Types of Providers..................................................................164
Retail Clinics............................................................................164
Single Specialty Hospitals........................................................167
New Roles for Patients....................................................................171
8 HIT = EMR + HIE.....................................................................179
Introduction.............................................................................................179
Background: Simultaneous Public- and Private-Sector Initiatives.........181
Federal Initiatives............................................................................181
Private Sector Initiatives..................................................................184
Concerns..................................................................................................186
Provider Privacy..............................................................................186
Patient Privacy.................................................................................187
Conclusion...............................................................................................187
Conclusion to Section II..........................................................................189
Conclusion......................................................................................191
References......................................................................................193
Index..............................................................................................209
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| spellingShingle | Wendel, Jeanne O'Donohue, William T. 1957- Serratt, Teresa D. Understanding healthcare economics managing your career in an evolving healthcare system Economics, Medical Delivery of Health Care Insurance, Health Medical Informatics Quality of Health Care Gesundheitswesen (DE-588)4020775-4 gnd Management (DE-588)4037278-9 gnd |
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| title | Understanding healthcare economics managing your career in an evolving healthcare system |
| title_auth | Understanding healthcare economics managing your career in an evolving healthcare system |
| title_exact_search | Understanding healthcare economics managing your career in an evolving healthcare system |
| title_full | Understanding healthcare economics managing your career in an evolving healthcare system Jeanne Wendel ; William O'Donohue ; Teresa D. Serratt |
| title_fullStr | Understanding healthcare economics managing your career in an evolving healthcare system Jeanne Wendel ; William O'Donohue ; Teresa D. Serratt |
| title_full_unstemmed | Understanding healthcare economics managing your career in an evolving healthcare system Jeanne Wendel ; William O'Donohue ; Teresa D. Serratt |
| title_short | Understanding healthcare economics |
| title_sort | understanding healthcare economics managing your career in an evolving healthcare system |
| title_sub | managing your career in an evolving healthcare system |
| topic | Economics, Medical Delivery of Health Care Insurance, Health Medical Informatics Quality of Health Care Gesundheitswesen (DE-588)4020775-4 gnd Management (DE-588)4037278-9 gnd |
| topic_facet | Economics, Medical Delivery of Health Care Insurance, Health Medical Informatics Quality of Health Care Gesundheitswesen Management USA |
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