HCMG EXAM QUESTIONS AND ANSWERS LATEST
EDITION ALREADY GRADED A+
How do we measure health?
1. self report
2. mortality and life expectancy
3. vital signs: blood pressure, pulse, respiration rate, temperature, chronic pain
4. Height, weight, BMI, body fat, wait to hip rati
5. genes and other biomarkets
6. secondary health data e.g. insurance claims, medical records
7. spillover effects e.g, productivity loss, unemployment
Proportion of individuals by health status, 2019:
31% excellent, 34% very good, 25% good, 8% fair
Key features of health care
Uncertainty and asymmetric information
Positive and negative externalities
Market power
Innovation
Payment models and incentive structures
Public and private policies
Intended and unintended consequences
Trade-offs
Incentives vs constraints
-Primary goal of government, insurance, hospital
-They are all subject to different constraints
Equity vs efficiency
-"Efforts to improve population health will inevitably differentially favor the groups that are likely to
already have better health, creating further gaps between health haves and health have nots"
-Inequality → 5% of population account for 50% of healthcare spending
Healthcare spending by age
35% of spending is by adults aged 65+
21% 55-64
,13% 45-54
9% 35-44
12% 19-34
The Iron Triangle
Access: can you find a provider? Can they be regular? How long is the wait time?
Cost: who is paying what, and how much is it?
Quality: Are you receiving care that adheres to clinical guidelines and an evidence base?
Proxies for quality include readmissions, emergency department use and process outcomes (whether a
patient received followed up care or adhered to their medication)
History of healthcare (mortality)
Life expectancy skyrocketed after 1900's
Cigarette smoking decrease had a huge impact on cardiovascular disease (1970's)
Mortality from infectious disease fell in 1920's
Postneonatal, infant and neonatal mortality rates also fell 1915-2011
History of Formal Healthcare
Most diseases wre misunderstood and mistreated
Early evidence of formal health care provision in Babylonia, Egypt, India, China, Greece
Health care was mostly paid for out of pocket or provided through charity
Health insurance popped up in late 1800s
Transition to modern medicine relied on translation of Greek, Roman and Islamic texts
Institutions like Penn hospital centralized patient care
Religious institutions and healthcare
In many places, religious institutions were the main provider of healthcare
Earliest medical text: Atharvaveda, complication of Hindu texts written in 1000 BCE
Taoist physicians developed traditional chinese medicine, some of it has been confirmed by western
medicine
Islamic golden age brought advancement in anatomy, surgery, pharmacy, mental health
, Women played a critical role in delivering care
Major scientific breakthroughs in the 19th century
paved the way for modern medicine
Hand washing
germ theory of disease
surgical advancement (due to war and hospitals)
pasteurization
infrastructure for sanitation
Breakthroughs in the 20th century
brought on "medicalization" of health
Penicillin discovered in 1928
agricultural advancement
exercise as a leisure activity
the framingham heart study
work and sedentary lifestyles
pharmaceutical advancements (statins, beta blockers)
How Insurance becomes the norm
Sickness funds first introduced in Germany in the 1880s
In the US, Baylor hospital founded blue cross (inpatient)
Blue shield (fee-for-service) launched in Pacific Northwest, and Kaiser Permanente sold insurance to
dam workers
President Johnson's Social Security act amendment launched medicare and Medicaid in 1965
This differs from most industrialized countries that set up universal coverage during the 20th century
Employer sponsored insurance in the US
Over half of Americans receive insurance through their employer, a rarity in the developed world
Wage controls during world war two; since employers couldn't give pay raises, they offered other
benefits
President truman proposed universal health care in 1945, was opposed by the AHA, the AMA and labor
union
The IRS made employer-paid premiums tax exempt
EDITION ALREADY GRADED A+
How do we measure health?
1. self report
2. mortality and life expectancy
3. vital signs: blood pressure, pulse, respiration rate, temperature, chronic pain
4. Height, weight, BMI, body fat, wait to hip rati
5. genes and other biomarkets
6. secondary health data e.g. insurance claims, medical records
7. spillover effects e.g, productivity loss, unemployment
Proportion of individuals by health status, 2019:
31% excellent, 34% very good, 25% good, 8% fair
Key features of health care
Uncertainty and asymmetric information
Positive and negative externalities
Market power
Innovation
Payment models and incentive structures
Public and private policies
Intended and unintended consequences
Trade-offs
Incentives vs constraints
-Primary goal of government, insurance, hospital
-They are all subject to different constraints
Equity vs efficiency
-"Efforts to improve population health will inevitably differentially favor the groups that are likely to
already have better health, creating further gaps between health haves and health have nots"
-Inequality → 5% of population account for 50% of healthcare spending
Healthcare spending by age
35% of spending is by adults aged 65+
21% 55-64
,13% 45-54
9% 35-44
12% 19-34
The Iron Triangle
Access: can you find a provider? Can they be regular? How long is the wait time?
Cost: who is paying what, and how much is it?
Quality: Are you receiving care that adheres to clinical guidelines and an evidence base?
Proxies for quality include readmissions, emergency department use and process outcomes (whether a
patient received followed up care or adhered to their medication)
History of healthcare (mortality)
Life expectancy skyrocketed after 1900's
Cigarette smoking decrease had a huge impact on cardiovascular disease (1970's)
Mortality from infectious disease fell in 1920's
Postneonatal, infant and neonatal mortality rates also fell 1915-2011
History of Formal Healthcare
Most diseases wre misunderstood and mistreated
Early evidence of formal health care provision in Babylonia, Egypt, India, China, Greece
Health care was mostly paid for out of pocket or provided through charity
Health insurance popped up in late 1800s
Transition to modern medicine relied on translation of Greek, Roman and Islamic texts
Institutions like Penn hospital centralized patient care
Religious institutions and healthcare
In many places, religious institutions were the main provider of healthcare
Earliest medical text: Atharvaveda, complication of Hindu texts written in 1000 BCE
Taoist physicians developed traditional chinese medicine, some of it has been confirmed by western
medicine
Islamic golden age brought advancement in anatomy, surgery, pharmacy, mental health
, Women played a critical role in delivering care
Major scientific breakthroughs in the 19th century
paved the way for modern medicine
Hand washing
germ theory of disease
surgical advancement (due to war and hospitals)
pasteurization
infrastructure for sanitation
Breakthroughs in the 20th century
brought on "medicalization" of health
Penicillin discovered in 1928
agricultural advancement
exercise as a leisure activity
the framingham heart study
work and sedentary lifestyles
pharmaceutical advancements (statins, beta blockers)
How Insurance becomes the norm
Sickness funds first introduced in Germany in the 1880s
In the US, Baylor hospital founded blue cross (inpatient)
Blue shield (fee-for-service) launched in Pacific Northwest, and Kaiser Permanente sold insurance to
dam workers
President Johnson's Social Security act amendment launched medicare and Medicaid in 1965
This differs from most industrialized countries that set up universal coverage during the 20th century
Employer sponsored insurance in the US
Over half of Americans receive insurance through their employer, a rarity in the developed world
Wage controls during world war two; since employers couldn't give pay raises, they offered other
benefits
President truman proposed universal health care in 1945, was opposed by the AHA, the AMA and labor
union
The IRS made employer-paid premiums tax exempt
