29 Jan Please reflect upon

Module 1 Discussion

With so many different stakeholders in the health care system, many with powerful political lobbies, it is understandable that the government has been unable, until the Patient Protection and Affordable Care Act of 2010, to effectively address the problems of cost, access, and quality. Despite this recent legislature, employers and the public have deep concerns about the ever-increasing costs of health care. Physicians, hospitals and other providers continue to voice displeasure with managed health plans’ requirements and restrictions, while employers and the insured are railing against potential huge premium increases. Should government continue to take an aggressive role in reshaping the health care system or should the economy be allowed to continue exerting market-driven reforms? Please take a stance of either pro-government or pro-free enterprise factions and explain how the public will fare in each situation. How are the problems of cost, access, and quality likely to be addressed in each circumstance?

OR

The practice of medicine, long valued for individual entrepreneurship and physician control, has undergone dramatic change. Physicians now face vexing oversight of case and utilization management and loss of control over the allocation of health care dollars. Managed care organizations control health costs by arbitrarily refusing reimbursement for certain medical procedures and reducing payments for others. Since medicine is now a less attractive career option, will fewer high performing individuals choose to become physicians? What are the implications for the quality of care?

Module 2 Discussion

As nursing has become increasingly “professionalized” through advanced degrees, specialization, and clinical practice, nurses’ salaries and responsibilities have also increased. Now, hospitals substitute non-nurses for nurses to perform all but the most technical tasks. What are the implications for the nursing profession? Have nurses lost their traditional role of hands-on patient care and, if so, is that to the profession’s and the patients’ advantage or disadvantage?

OR

With significant oversupply of hospital beds in the United States, what is the rationale for taxpayer support of the separate and costly hospital system of the Department of Veterans Affairs?

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Module 3 Discussion

Ideally, our long term care system would provide a seamless continuum of services which are accessible and affordable for all older adults, with the goal of enabling them to remain in the community for as long as possible. These “aging in place” programs (PACE and NORCs) provide such a model. Given what you now know about the components of our health care delivery system and how they are administered, delivered and paid for:

Identify health care system barriers to achieving the seamless continuum

Identify social, family or other “non-system” barriers.

Propose ways in which community organizations or the government might assist in overcoming the barriers you have identified.

OR

Hospital emergency departments continue to be used as a source of primary medical care by large numbers of the community’s medically underserved population. What are the implications of this practice for the patients, and on health care costs and quality of care? What would you propose as a means to change this situation?

Module 4 Discussion

In 1992, medical residency programs in the U.S. were described as “responsive principally to the service needs of hospitals, the interests of the medical specialty societies, the objectives of the residency program directors, and the career preferences of the medical students.” In fact, there are so many more residency programs than can be filled by American medical school graduates, that an annual influx of foreign educated physicians has been required to satisfy the service needs of many hospitals. In addition, until recently, there has been no attempt to match America’s needs for various kinds of specialty and generalist physicians with the hospital-based training programs that were producing them. In light of these facts, pose an opinion on this question:

Few graduates of medical school choose primary care, and instead flock to specialties with greater pay and prestige. Since primary care is the basis for maintaining health and early diagnosis of potential health problems, who should be responsible for rectifying this misplaced emphasis of health care……. insurers…medical schools…the government…the AMA…others?

OR

In 1992, medical residency programs in the U.S. were described as “responsive principally to the service needs of hospitals, the interests of the medical specialty societies, the objectives of the residency program directors, and the career preferences of the medical students.” In fact, there are so many more residency programs than can be filled by American medical school graduates, that an annual influx of foreign educated physicians has been required to satisfy the service needs of many hospitals. In addition, until recently, there has been no attempt to match America’s needs for various kinds of specialty and generalist physicians with the hospital-based training programs that were producing them. In light of these facts, pose an opinion on this question:

Since there are not enough American medical school graduates to fill the residencies of the smaller non-teaching hospitals, would not the employment of nurse practitioners, physician assistants, or young physicians starting practice be considered first, before recruiting foreign medical graduates?

Module 5 Discussion

Many consumer and health care advocacy initiatives are converging toward a mandate to provide public access to many types of information about managed care organization (MCO) performance, costs, and quality. In fact, employers in the many parts of the country who are the major purchasers of health insurance are now requiring MCOs to make “health plan performance data” available to subscribers to facilitate their choice of plans.

Discuss and provide the rationale for your opinion on providing data in areas such as patient outcomes, compliance with national standards for preventive and chronic care, and comparative costs to the public.

What obligation, if any, does an employer, and/or MCO have to educate subscribers in how to interpret performance data? At whose expense should such education be provided?

What are the possible benefits or disadvantages to making such performance data available to the public?

OR

Select ONE of the topics below and describe how it has affected the costs of health care in the US?

The health insurance industry

Advances in medical care technology

Changes in U.S. demographics

Government support for health care

Consumer expectations

Module 6 Discussion

After reading the WHO (2008) Copenhagen Conference document “Health systems, Health and Wealth: Assessing the Case for Investing in Health Systems”, consider the following dilemma. Health policy-makers have been under enormous pressure in recent years over concerns about financial sustainability and cost-containment. The resources available to any society are finite, but emerging evidence is recasting health systems not as a drain on those resources but as an opportunity to invest in the health of the population and in economic growth. Health systems, health and wealth are inextricably linked in a set of mutually reinforcing and dynamic relationships. This new paradigm offers an opportunity for a fundamental reassessment of the role of health systems in society. Please expound upon these three questions:

How can we improve health, wealth and societal well-being by investing in health systems?

How can we ensure that health systems are sustained in the future?

How can we monitor, manage and improve performance so that health systems are as effective and efficient as possible?

OR

It is unfortunate that it requires a new threat or epidemic to halt the demise of organized public health and restore an effective public health structure. Why does public health have so much difficulty maintaining governmental support of its central role in maintaining the health and well-being of the American people?

Module 7 Discussion

For many years, hospital accreditation bodies assumed that if the structural criteria were met, that is, that the physical plant, the qualifications of the staff, and the necessary equipment were in place, the quality of the services would automatically be acceptable. Subsequently, accreditation groups decided that they had also better look at the medical records to see how the services were being provided. They assumed that, if the necessary structure was in place, and the required services were delivered as prescribed, the quality of care would be acceptable. Now, these same accrediting groups find it necessary to look at the outcomes of care as well.

Describe “structure, process, and outcome” in the assessment of the quality of medical care, and provide examples of each dimension.

How are the three dimensions related?

Can these relationships be trusted to assure the quality of care in the complex, high-tech world of modern medicine? If not, why?

OR

Hippocrates, who admonished physicians to “first, do no harm,” also stated, “in abundance, there is lack.” Interpret the latter in regard to American health care.

Module 8 Discussion

Please reflect upon this dilemma: How should this country address the problem of the approximately 47 million uninsured or underinsured Americans?

What is society’s obligation to ensure access to a basic level of health care for all its citizens and how can it be accomplished?

Should health care be a basic individual right just as is education, police protection, and legal counsel? Why does the United States consider health care an open market commodity when all other developed countries guarantee their citizens some basic level of health care?

OR

The wisdom of depending on International Medical School Graduates (IMGs) to fill gaps in physician supply, while US medical schools hold class size constant, is questionable. In addition, the aging of the physician workforce, the decreasing hours worked by both physicians in practice and physicians in residency, and a 20 percent reduction in the effort of the increasing proportion of female physicians, will result in a significant decrease in the “effective” supply of physicians. Should the gap be filled by a major substitution of nurse practitioners, physician assistants, chiropractors, acupuncturists, and others, or are there alternatives?