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PHP 0310 (11)
Ira Wilson (11)

PHP Exam notes

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Public Health
PHP 0310
Ira Wilson

Php final Mult choice + t/f + matching +short answer + essay Lec 1  • Regulation = controlling human behavior by rules and restrcitions • Market, social regulation, trade organization, legal restrictions • Healthcare highly regulated • Market failures o Know how  Asymmetrical information, moral hazard, etc • 3 domains of healthcare o cost quality access • regulation most important on cost • approaches to regulation o TQM/CQI  Inspection to throw out bad stuff  Quality assurance • Take­home messages slide • 3 levels o fed state private  fed: manage funding to med schools + hospitals  state: licensing  private: boards/groups determining standards (like NBME, LCME) • JCAHO o EMTALA  Quality oversight of hospitals  Hospitals must provide appropriate emergency regardless of any  other factor o Regulates  quality among hospitals • Hill­burton act o Expansion of hospitals o Construction • Gov financing healthcare • Private insurance heavily regulated o States regulate indemnity + managed care o Fed applies to self­insured companies • NCQA o Private accreditation organization o Supervise quality o HMOs  Structural features  Patient satisfaction  HEDIS (clinical performance) • Slides 60­63, why we need each type of regulation P4p performance + ACO • P4p o Improve quality cost access o Pay for quality + outcomes o Mixed results o Incentive system unclear • ACO o Improve quality cost access o Simultaneous changes in delivery and quality o Provider led grp w/ strong primary care basis  Collectively responsible for quality + cost o Payments linked to quality improvements o Measurements for quality + cost improvement  Cost improvement cant be from skimping o Built on previous concepts  PCMH, HMO, P4P, HMO all combined together o Medicare mandates ACO as part of ACA  Can be government funded or private • Alternate quality contracts o Private insurance usually o Capitation o Quality incentives implemented to HMO network o Only look at outcomes o Fed + executive bureaucratic agencies • Agencies o Can make rules and judicate like courts o Authority through 5+14 amendments • HHS (under exec branch) o Medicare + Medicaid o Research o CDC o FDA • HRSA o Research  • CMS o Medicare/Medicaid + chip o Lab testing on ppl • NIH o Research • ARHQ o Healthcare policy research • FDA (1906) o Quality safety efficacy of food + drugs • Fed power growing Quality measurement 1 • 3 perspectives o patient provider payer • donabendian model for measuring quality o structure: organizational resources  staffing, facilities o process: activities constituting care  screening, diagnosis  interpersonal vs technical o outcome: result  survival, life span after disease • hard to measure quality • evidence­based medicine • knw what quality measurement entails o technical processes (most accepted) • issues o objective outcomes irrelevant • risk adjustment • NCQA/NQF o Review + certify measurement tools • Need market forces to drive quality improvement • AHRQ o Collect + disseminate data Quality 2 • Misuse overuse underuse • Underuse o Diagnostic tests underused o Screening, etc. • Overuse o Some tests done higher than necessary • Supply­sensitive 
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