Study Guides (248,352)
United States (123,336)
PHP 0310 (11)
Ira Wilson (11)
Final

PHP FINAL NOTES.docx

12 Pages
122 Views
Unlock Document

Department
Public Health
Course
PHP 0310
Professor
Ira Wilson
Semester
Spring

Description
PHP FINAL NOTES Lec1: intro to regulation • Wut is reg? o Controlling human or societal behavior by rules or restrictions o Many forms  Legal restrictions  Self­regulation by organization  Social regulation by norms  Market o How?  Hassle + costsx  Taxes  Fines  Public embarrassment  Legal actions  Revocation of license o How do markets fail  Development of monopoly/oligopoly  Collective action + public good  Inadequate info  Externalities • Healthcare reg o 3 domains  Cost, quality, access o Cost most important in regards to reg o Basic history  Early times: passive insurers + clueless patients = more cost  Mostly self­regulation  1970­1980s • hmo and capitation create concerns • for­profit healthcare created concerns • integration: monopoly concerns • scientific advance • development of health status measures • application of TQM/CQI  TQM/CQI (total/continuous quality measure/improvement) • Quality assurance: concept of inspection (throw out bad  stuff) • Find source of mistake o Reg necessary  Has evolved with healthcare business  Cost is biggest driver of reg  Modern quality improvement theory • Reg must evolve with society + econ o 3 levels: state, fed, private o physicians/professionals  state licensing boards issue licenses and enforce standards • also discipline • varies btwn states  fed oversight • NPD (national practitioner database) under HRSA (health  resources services administration) which is under HHS  (dept of health and human services) coordinate discipline • Manage workforce o Fund med schools, grants/loans, hospital  reimbursement for residency/fellowships, physician  compensation + RBRVS  Private oversight • FSMB (federation of state medical boards) o Collect information on state board actions • NBME (national board of medical examiners) o Uniform process for MD licensing • LCME (Liaison committee on medical education) o Sponsored by AMA and AAMC (American  association of medical colleges) o Accredits medical schools • ACGME (accreditation council for graduate medical  education o Accredits 7800 residency programs • ECFMG (education commission for foreign medical  graduates o Certifies international med grads for residency • FSMB > ACGME + ECFMG o Hospitals  JCAHO (joint commission on accreditation of healthcare  organizations)  • Certification from JCAHO satisfy reqs for state licensure  Fed • Certification of participation o Normally through JCAHO • EMTALA o Must provide emergency care regardless of factors • CLIA (clinical laboratory improvement amendments) o Quality standards • Hill­burton (1946) o Construction (expansion) funding • CON (certificate of need) (1974) o Goal: contraction o 36 states require now  private • JCAHO o Surveys (3 years) o Focus on outcomes and quality improvement o Health care financing  Gov pays for healthcare for 135 million ppl • 48 medicare • 58 medicaid • 9 federal employees benefits program • 20 in VA, DoD, indian health service • gov is rule maker and also the payer  private • private insurance heavily regulated o traditional indemnity insurance regulated o fed regulates self­insured companies • medicare and federal employees benefits program influence  private plans  regulation of managed care • HMO act of 1973 o HMO growth o First direct fed intervention in health insurance • NCQA o Supervise quality o Measure  Structural features of HMO  Patient satisfaction  HEDIS (health employer data information  set: clinical performance o PRIVATE regulating entity o Regulate plans o Lead in quality measurement + reporting Lec2 Fed Executive and Bureaucratic Agencies in Healthcare Regulation • 3 branches of gov o congress (laws) o courts (rule on laws) o executive (implementation + regulation of healthcare) • legal basis of regulatory power o agencies authorized to take executive, legislative, judicial actions o rules similar to statutes even though not issued by legislator o agencies require specialized knowledge  legislation only creates the mechanisms to address issues;  doesn't actually address • HHS (health and human services) duties  o Medicare/aid o Medical research o Prevention epidemics o Food + drug safety o Financial assistance o Maternal + infant health o Preschool  o Child abuse/domestic violence o Substance abuse o Seniors o Native American health services • CMS (Centers for Medicare & Medicaid Services) o Primary source of healthcare coverage for americans o Ensure effective, uptodate, quality healthcare o Administer medicare  Contracts w/ companies to pay claims o Administer Medicaid + chip o Regulate lab testing on ppl • NIH (National Institutes of Health) o Increase knowledge, apply new knowledge for better healthcare • AHRQ (Agency for Health Research and Quality) o Research to improve access, outcomes, quality, cost of healthcare • FDA (Food and Drug Administration) o Assess safety of various foods + drugs • Drugs + healthcare products o Drugs + tools needed for care o Fast technological improvement o Key drivers of costs o Import Drugs Act  Banned food + drug adulteration o Pure Food and Drug Act  Prohibitions against adulteration and misbranding of  food/drugs  Ingredients must be listed on package  Dangerous ingredients in drugs must be listed o Kefauver­Harris Efficacy Amendment   Required evidence of efficacy  o Medical Device Amendments  FDA authority expanded  Rules for testing devices become same as drugs o Drug Price Competition + Patient Term Restoration Act (Hatch­ Waxman Act)  Streamlined generics testing rules  Proof of equal bioavailability required o FDA Issues  What is food, what is drug?  Supplements are more like food  Consumer empowerment + internet marketing  Off­label prescribing  Direct advertising to consumer  Drugs costly to develop, but much safer • HRSA (Health Resources and Services Administration) o Provide resources and services to improve access to quality  healthcare Lec3 quality measurement • Wut is quality o Hard to define; relates to improvement of outcomes o Donabendian model  Structure: physical/organizational resources  Process: care delivery  Outcome: results/effectiveness of healthcare o Technical vs interpersonal care o Accountability  Chain of events/care for healthcare to properly function  Single weak link will crack chain o Measuring  Strong evidence of process­outcome linkage  evidence based medicine  technical care • more simple to measure • most accepted quality measures are technical measures  interpersonal care • must ask patient o surveys  issues • hard objectives (like mortality rate) often irrelevant • functional outcomes • risk adjustment always necessary o Trend of using market forces to drive quality improvement  Public reporting, pay for performance  Who drives this? • AHRQ disseminates data • New private organizations developed to meet needs of  payers Lec4  quality measurement 2 • Value: ratio of dollars to outcomes • Donabendian: structure, process, outcome • Science of quality measurement is advanced but complex • Process measures more commonly used o No risk adjustment required • Outcomes measurement: hard to use cuz of risk adjustment • Measurement science + cost o Evolution of private + public regulatory organizations o Measurement tool development and certification  NCQA  NQF (national quality forum) o Payer driven public reporting initiatives  Leapfrog  Pacific Business Group on Health • 3 Kinds of quality problems o Misuse (errors + mistakes) 
More Less

Related notes for PHP 0310

Log In


OR

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


OR

By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.


Submit