Class 3 Sept 15 Introductions VitalDirections BitterPill

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School

Northeastern University *

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1260

Subject

Health Science

Date

Oct 30, 2023

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pdf

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Uploaded by MateMonkeyPerson4387

The American Health Care System Class 3

Today • Current event: Legal challenges to abortion bans • Recap • Vital Directions Discussion, continued • The Bitter Pill: Identification of issues

In our last class… • Current event: Pursuing friends/relatives for nursing home costs • Definition of health • Social determinants of health: Education, health care access, built environment, social/community, economic stability • Determinants of health: Environmental factors, social factors, health care, heredity, individual behaviors • Characteristics and components of health care system • Iron triangle of health care: Access, Cost, Quality • Triple Aim, Quadruple Aim, Quintuple Aim: – Improving the experience of care – Improving the health of populations – Reducing per capita costs of care – Improving the work life of health care providers – Advancing health equity • Berwick on the Six Dimensions of Quality: Safety, Effectiveness, Patient Centeredness, Timeliness, Efficiency, Equity

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Some themes of vital directions… • Providers overorder because of fear of liability • Ineffective treatment which adds costs • Prevention can be more effective than treatment – Don’t wait for problem to arise • Health is shaped by many factors other than medical care – Sociocultural reasons and genetic reasons – Concerns about equity • System is capable of a lot but not able to address the big issues challenging the public • Need to work with other organizations that promote more holistic health for all (From class discussion)

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Bitter Pill: Issues with the Health Care System • Conflicts of interest among health care providers (stake in hospitals, thinking about reputation (risky procedures), payments by pharma/device companies) • Hospital CEOs who set prices are far from patients – Hospitals see patients as moneymakers – High hospital CEO salaries • Chargemaster: Very high prices/higher than market – Not based on formula; different for different hospitals – Much more expensive than drugstore products • No information about how best to bargain around prices – Very complicated bills that no one understands – Complaining can make a difference, but how to do this? • Inconsistency in prices based on providers, insurance types • Nonprofit profitmakers • Hospitals demanding payment before patients receive treatment • Medicare is not able to negotiate prices of drugs, so monopoly pricing • Technology not making things more affordable, but instead more expensive; trying to cover costs of machine and may generate additional profits. Lead to overspending. • Overuse of drugs: Incentive to promotion. • Role of insurance in shielding patients from actual health care costs • Using technology to avoid lawsuits; going as high tech as you can • Hospital technology race: reputation • Lack of price transparency • Limits on or gaps in health insurance • Failure to provide services to low-income individuals • Importance of hospitals and other health care institutions as employers/businesses (From class discussion)

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