AHS330_F10_u09_PDF - Unit 9 Topics Health Planning and...

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Unformatted text preview: Unit 9 Topics Health Planning and Regulation & Health Care gy Care Technology & Research Health Care Planning Health Care Regulation Health Care Technology Health Care Research Chapters 5 & 10, PLB 11/02/2010 AHS 330 - Fall 2010 - Unit 9 1 HEALTH PLANNING & REGULATION We all plan – formally or informally Why we plan and regulate in health care 11/02/2010 AHS 330 - Fall 2010 - Unit 9 3 MACRO VS. MICRO PLANNING AHS 330 - Fall 2010 - Unit 9 Define a problem Formulate & evaluate alternatives Implement the chosen one Evaluate results AHS 330 - Fall 2010 - Unit 9 11/02/2010 4 Goals vs. Objectives Micro -- on the institutional or personal level (decentralized planning) Macro -- for nation, region, one or more states (centralized planning) (centralized planning) 11/02/2010 2 Definition of Planning: Unmet need Increasing demand, costs & expenditures Concern with the “free market” Concerns over quality AHS 330 - Fall 2010 - Unit 9 11/02/2010 Goals: Objectives 5 LongLong-range statements of ideal desired outcomes Specific measureable targets to be reached within a named time 11/02/2010 AHS 330 - Fall 2010 - Unit 9 6 1 When Planning is Supported by the Force of Law it is Called: REGULATION REGULATION 11/02/2010 AHS 330 - Fall 2010 - Unit 9 7 GOALS OF HEALTH PLANNING Improve the organization of health services Speed development of needed new health needed new health services services Discourage programs that aren’t really needed Better coordination Eliminate duplication 11/02/2010 The continuous relationship between need, demand and supply Need SUPPLY DOES NOT ALWAYS MEET DEMAND 9 11/02/2010 AHS 330 - Fall 2010 - Unit 9 10 Health Planning Involves: AHS 330 - Fall 2010 - Unit 9 Supply AND Demand -- subjective; measure of the quantity & quality of health care services that consumers want Need -- meas Need -- measure of the quantity & quality of of the of health health care services that health professionals estimate are required based on objective data 11/02/2010 Demand NOT ALL NEED TRANSLATES INTO DEMAND DEMAND VS. NEED 8 Health planning involves: Reduce fragmentation Achieve a better geographic distribution Establish priorities Identify health needs & problems -- set realistic goals Integrate health needs into physical, economic & other areas AHS 330 - Fall 2010 - Unit 9 AHS 330 - Fall 2010 - Unit 9 11/02/2010 11 Health status Use of services and demand for services Supply Organization Access Financing Quality Cost Cost Political Issues Legal issues 11/02/2010 AHS 330 - Fall 2010 - Unit 9 Quality 12 2 Model of Health Planning Simple Regulation Attempts to: If we are all alike Complicated Given differences in age, race, behavior, and codiff omorbidity 11/02/2010 AHS 330 - Fall 2010 - Unit 9 13 11/02/2010 WHY & WHEN DO WE REGULATE? AHS 330 - Fall 2010 - Unit 9 AHS 330 - Fall 2010 - Unit 9 14 Assumptions of the free-market freesystem When health & welfare of the citizenry is at stake When market failure is a possibility 11/02/2010 Prevent Fraud and Abuse Contain Costs Protect Patients Protect Employees 15 Informed consumers Individual pays full cost at the time of use and receives full benefits Large number of suppliers from which the individual can choose Suppliers bear full cost of production and can easily enter and exit market 11/02/2010 AHS 330 - Fall 2010 - Unit 9 16 Characteristics of the Health Care System Which Make Regulation Desirable ForFor-profit providers Health care a “right” Monopolies can work if you you regulate them Public purse Insurance Destructive competition MARKET FAILURE FAILURE Not rational consumers WHEN THESE CONDITIONS ARE NOT MET System of checks & balances OCCURS 11/02/2010 AHS 330 - Fall 2010 - Unit 9 17 11/02/2010 AHS 330 - Fall 2010 - Unit 9 18 3 Can Government Generate Prosperity? The Answers To Many Of These Questions Are Unclear Can Government Improve the Medical Market Place? 11/02/2010 AHS 330 - Fall 2010 - Unit 9 People Differ As To When Government Should Intervene 19 11/02/2010 20 HISTORY OF CENTRALIZED NON-GOVERNMENT HEALTH PLANNING Benefits of Competition AHS 330 - Fall 2010 - Unit 9 Innovation Cost Containment Administrative Cost AntiAnti-Monopoly Freedom of Choice Flexner Report Narrow focus (1910) Committee on the Cost of Medical Care (1932) Inadequate funds Commission on Chronic Illness (1956-1959) No legal authority American Cancer Society Political & territorial disputes March of Dimes 11/02/2010 AHS 330 - Fall 2010 - Unit 9 21 CENTRALIZED HEALTH PLANNING Social Security Act of 1935 HillHill-Burton Act (Hospital Survey & Construction Act) (1946) Regional Medical Programs (Heart Disease, Cancer & Stroke Act of 1965) Comprehensive Health Planning Program (Partnership for Health Act 1966) National Health Planning & Resource Development Act of 1974 11/02/2010 AHS 330 - Fall 2010 - Unit 9 AHS 330 - Fall 2010 - Unit 9 22 Comprehensive Health Planning Program Dawson Report – England (1920) 11/02/2010 23 Planning areas set with political boundaries Ignored the “real” market & consumer travel patterns Some ignored providers Some controlled by providers None of the plans had legal “teeth” RESULT: Little impact on cost or expenditures 11/02/2010 AHS 330 - Fall 2010 - Unit 9 24 4 National Health Planning & Resource Development Act of 1974 Why the Poor Results? Planning areas established using medical market boundaries Set measurable goals and objectives Legal authority – CON RESULT: No effect on cost or expenditures Federal mandate repealed in 1987 36 states, Puerto Rico and DC have CON still AHS 330 - Fall 2010 - Unit 9 11/02/2010 25 11/02/2010 THEORIES THAT EXPLAIN REGULATORY BEHAVIOR Profits are competitive & prices are low Assumes regulation is conducted by disinterested, all-knowing, objective allbureaucrats who are only interested in protecting the public from monopolies Capture Theory Profits are high & prices are high Assumes that regulation is proposed, supported, and unduly influences by the industry being regulated Political Economic Theory Competitive profits & monopolistic prices Assumes regulators attempt to impose some concept of public interest, but do so in an environment with uncertain, expensive and unbalanced information 11/02/2010 AHS 330 - Fall 2010 - Unit 9 27 11/02/2010 Wrongful Exclusion Price Fixing—Fee Setting Fixing— Professional Organization Standards Joint Ventures Mergers 11/02/2010 AHS 330 - Fall 2010 - Unit 9 26 AHS 330 - Fall 2010 - Unit 9 28 ADA -The Americans with Disabilities Act Sherman Antitrust (1890) AHS 330 - Fall 2010 - Unit 9 IN TRUTH, WE HAVE A HYBRID OF THESE THREE THEORIES OPERATING OPERATING IN OUR POLITICAL SYSTEM Public Interest Politics Little economic impact Legal challenges 29 Public Accommodations Definition of Disability Enforcement Discrimination in Employment Remedies 11/02/2010 AHS 330 - Fall 2010 - Unit 9 30 5 COBRA: Consolidated Omnibus Budget Reconciliation Act OSHA: Occupational Safety & Health Administration BloodBlood-borne Pathogen Standards Emphasis on Protection of Employees Identification of Employees at Risk Engineering and Work Practices Hepatitis B Vaccine Training Incident Reporting and Follow Up 11/02/2010 AHS 330 - Fall 2010 - Unit 9 31 Employers with 20 Employees Voluntary or Involuntary Termination Continuation Periods Premiums Termination of Coverage NonNon-Compliance Penalty 11/02/2010 Stark Legislation Stark I (1989) – barred self-referrals for clinical selflaboratory services regarding Medicare Stark II (1993) – expanded the range of health services and added Medicaid AHS 330 - Fall 2010 - Unit 9 AHS 330 - Fall 2010 - Unit 9 33 35 United States Department of Health Examples of U.S. Health Services Legislation 11/02/2010 RT, DME, PT, etc. 11/02/2010 32 Government Agencies Physician self-referral is the practice of a physician selfreferring a patient to a medical facility in which he has a financial interest, be it ownership, investment, or a structured compensation arrangement AHS 330 - Fall 2010 - Unit 9 Centers for Disease Control and Prevention (CDC) Health Resources and Services Administration Food and Drug Administration (Regulates Drugs and Medical Technologies) United States Census Bureau Bureau of Labor Statistics State Departments of Health Local Departments of Health (Depending on state) 11/02/2010 AHS 330 - Fall 2010 - Unit 9 34 Examples of U.S. Health Services Legislation 11/02/2010 AHS 330 - Fall 2010 - Unit 9 36 6 Health Care Technology & Research Federal Role in Biomedical Research National Institutes of Health National Funding for Health Research and Development (Millions of Dollars Through 1999; Billions of Dollars for 2007) Established in 1930 4% of total health services expenditures of total health services expenditures While medical advances certainly have benefits, they come at a high price 11/02/2010 AHS 330 - Fall 2010 - Unit 9 37 11/02/2010 Regulation of Food, Drugs, Cosmetics, and Devices The Food and Drug Administration (FDA) reviews and approves applications for new drugs Drug development AHS 330 - Fall 2010 - Unit 9 39 An average of 12 years from discovery to market 12 di Prescription drugs are about 10% of total national health expenditures 11/02/2010 FDA Approval Process for New Drugs 11/02/2010 AHS 330 - Fall 2010 - Unit 9 38 Drug Discovery 11/02/2010 AHS 330 - Fall 2010 - Unit 9 AHS 330 - Fall 2010 - Unit 9 40 Dimensions of Health Services Technology Assessment 41 11/02/2010 AHS 330 - Fall 2010 - Unit 9 42 7 NEXT WEEK Unit 10 & Review Unit 9 Unit 9 Quiz Multiple Choice and True/False Questions Covering Assigned Textbook Chapters Unit PowerPoint Assigned Textbook Chapters, Unit 8 PowerPoint Slides, Slides, & Lecture Speaker Quiz – Hamff/Health Care IT Unit 9 Discussion Question Comment on a 200 word discussion question and post a 50 word response to another student’s blog 11/02/2010 AHS 330 - Fall 2010 - Unit 9 43 8 ...
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This note was uploaded on 08/21/2011 for the course AHS 330 taught by Professor Smith during the Fall '10 term at University of Alabama at Birmingham.

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