HCMG LATEST QUESTIONS AND ANSWERS UPDATE: A MASTERING A+ MATERIAL!

HCMG LATEST QUESTIONS AND ANSWERS UPDATE: A MASTERING A+ MATERIAL! How does health spending impact take home wages? Take home wages are different from compensation- lots of money goes into labor 56.4%, but take home wages go from 51.8 to 45.6 because of benefits In a consultant survey, what was the vote for cost driver with most influence on all costs? Hospital costs How has spending on hospitals, physicians, and prescriptions varied overtime? Varies by service- 70s led by hospital expenditures, 80s led by physicians and prescriptions; spending on hospitals and physicians has consistently grown faster than the economy What services represent half of total health spending? Hospital(34) and physician servcies(21) Why are prescription price increases not seen to be a huge problem? Prescriptions represent only 10% of health spending-- not responsible for 5.8% increase in health spending in past year The bottom line of health spending is who is at fault for so much spending? Multiple cost drivers Most experts believe persistent growth of US health care spending due to the convergence of which four factors- described as the "perfect spending storm" New technology, rising incomes (interacts with technology), expansion of insurance programs (consumers don't face the full price of medical care ate the point of care (pharmacy or doctors office), reimbursement incentives: physicians and hospitals are paid to do stuff rather than produce health How costly does new medical technology tend to be? Usually expensive Explain the chance in medical care for premature infants in the 1950s vs. now 1950s- experimentation with incubators and warming (cost- 0); Now- Neonatal units, artificial surfactant, ventilators (cost $70,000/patient); 1950s had much lower rate of effectiveness while now involves dramatic impact in mortality What new technologies came out during Little ticket items (lab tests, X-rays) What new technologies came out during Big ticket items (CABG, C-section, radiation and chemotherapy for breast cancer) What new technologies came out during early and mid 1990s pharmaceuticals What new technologies came out during 2000's Imaging, biologics What new technologies came out during 2010s proton beam accelerators (precision medicine treatments) How has healthh insurance varied in terms of health expenditures over time Increased, especially public programs; 60s-70s- public programs just starting-- now much increased- out of pocket reduced from 33 to 12% (however, recall that out of pocket costs per capita have been rising (higher per person)- but represent smaller portion of health expenditures) What fueled increase in spending from 1960 to 1980 government programs What major impact did Medicare have in 60s-80s? What occurred as a result? lowered medical care out of pocket costs for aged; triggered rise in demand for hospital and physician services; means that the aged are more likely to come- hard to keep up with doctors and grow hospitals to keep up with this demand-- resulted in dramatic increase in price and a less dramatic increase in use- costs rose from need to attract more personable which lead to an increase in price What is the difference between allowable charge and what we actually have to pay for something? Allowable charge does not actually exist, it is the value that would be billed for those without insurance- what matters is the negotiable rate between the insurer and the provider What was the original method of payment to hospitals and physicians? What was wrong with this method? What was done about it? Fee for service- reimbursements to hospitals and physicians are based on costs plus an extra fee; created few incentives for efficiency or lower cost approaches; made more incentives to do so Describe the ways that prices and usage varied over time to drive health services spending growth? Originally, in 70s and 80s, based on price, but now is a mix of both What is the engine driving increases in medical spending? New expensive technology, like new drugs, procedures, devices, and increased intensity of care Will you be able to afford health care when you get old? Yes, but Medicare may not be as comprehensive and because you can probably afford it , but a larger part of the population will not be able to afford it One will more likely be able to afford health care system if the following things reform introduce low value technology, change reimbursement to incentive value over quantity, reduce low value demand for care How has public insurance changed as a percentage of total health expenditures from 1970 to 2013 22--39% How has private insurance changed as a percentage of total health expenditures from 1970 to 2013 21---33% What does public insurance include? Medicare, Medicaid, CHIP, Veterans Administration, Department of Defense Health services spending is generally a function of what? How have these two variables related as a result of the recession? prices (dollar amount charged for a hospital stay) and utilization (number of hospital stays); Utilization has grown following the recession as prices continue to fall In 2012, how much of the population accounted for half of health spending? What did the other part of the population have to pay per year?How about the top 1%? Bottom 50% percent? 95%; 43000; 98000; other end (bottom 50%), accounted for 3%-- average spending 234/yr In 2012, people under the age of 35 accounted for how much of the population and how much of health spending? 45% of population, less than a quarter of health spending