Healthcare in the US: Exam 3 Questions and Answers (RATED A+)
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Course
Healthcare
Institution
Healthcare
Healthcare Regulation -ANSWER- Regulation is "controlling human or societal behavior by rules or restrictions."
Many forms, examples include
Government imposed legal restrictions
Self-regulation by a trade organization
Social regulation (social norms)
Market regulation
Healthcare is regulated...
Healthcare in the US: Exam 3 Questions and
Answers (RATED A+)
Healthcare Regulation -ANSWER- Regulation is "controlling human or societal behavior
by rules or restrictions."
Many forms, examples include
Government imposed legal restrictions
Self-regulation by a trade organization
Social regulation (social norms)
Market regulation
Healthcare is regulated by fed, state and private entities.
Drivers of Health Care Regulation -ANSWER- Cost
Quality
Access
Cost has historically been the most important driver of regulation
History of Regulation -ANSWER- Quality assurance (the concept of inspection or
culling, throw out defective products) to quality improvement approach
TQM/CQI -ANSWER- TQM: Total Quality Management
CQI: Continuous Quality Improvement
"Don't over react to individual defects, analyze and fix the production system that
created them" and Shift the whole curve upward
Walter Shewart -ANSWER- Western Electric (1930s)
came up with TQM/CQI was ignored in US but implemented in Japan.
Quality Assurance Improvements of Healthcare. -ANSWER- QA:
Motivation: measuring compliance with standard;
Means: inspection; Attitude: required and defensive
Focus: remove outliers; Scope: medical provider; Responsibility: few
Quality Improvement in Health Care -ANSWER- QI:
Motivation: Continuously improving processes to meet standard;
Means: Prevention; Attitude: chosen, proactive
Focus: process, system; Scope: pt care; Responsibility: all
Joint Commission for Accreditation of Healthcare Organizations (JCAHO) -ANSWER-
Now uses QI approaches. State licensure for hospital regulation.
American Style of Regulation -ANSWER- State, Fed, and Private
, Regulations on Physicians (State) -ANSWER- state licensing boards (composed of
physicians)
disciplinary processes
Usually private until decisions made, and even then aren't widely publicized
Boards made up of physicians
State to state variation in rigor of enforcement
Actions usually for egregious behavior
Regulations on Physicians (Fed) -ANSWER- Coordination of discipline: National
Practitioner Database (NPDB) maintained by HRSA,(: Health Resources and Services
Administration) which is part of HHS
Workforce management
Funding of medical schools
Grants and loans for medical training
Reimbursement of hospitals for residency and fellowship training through Medicare
Physician compensation and the RBRVS
Regulations on Physicians (Private) -ANSWER- National Board of Medical Examiners
(NBME), US Medical Licensing Exams (USMLE) --> Medical Licensing
Educational Commission for Foreign Medical Graduates (ECFMG) & Accreditation
Council for Graduate Medical Education (ACGME) --> Graduate Medical Training:
Residencies
and Fellowships
Liaison Committee on Medical Education (LCME) sponsored by AMA and American
Association of Medical Colleges (AAMC) --> Medical Schools:
US & Canada
Regulations on Hospitals (State) -ANSWER- State licensure is primary oversight
mechanism for hospitals and other health organizations (i.e. Joint Commission on the
Accreditation of Healthcare Organizations (JCAHO or the "Joint Commission")
JCAHO certification can satisfy requirements for state licensure: 80% of hospitals
choose this route
The other 20% choose state mechanisms)
Economic regulation:
Hill-Burton construction funding (1946); goal was expansion
Certificate of Need (CON) programs (1974); hospitals had to get permission to build or
expand
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