Health Systems Exam 1: Part 2 Questions and
Answers(GRADED A)
What are some trends/themes/facts when comparing US health care spending and
other countries? - ANSWER--US per capita health care spending is more than twice the
average of other developed countries (OECD average ≈ $4K, whereas US is >$10K)
-Relative to the size of its wealth, the US spends a disproportionate amount on health
care. As societies are wealthier, they spend more on health care, yet the US is way
above that line.
-Levels of spending are greater in the US, but the rate of spending growth is
comparable to other countries (due to tech growth)
How does the US health care system compare to other countries, in terms of major
themes? - ANSWER--Levels of spending on health care are higher
-It's easy to oversimplify how the US is doing. (For example, the US is doing pretty well
compared to similar countries in terms of breast cancer screenings; 30 day stroke
mortality and myocardial infarction per 1,000 patients; and wait times, yet it also has a
high infant mortality rate, % of population that receives the measles immunization is
only middling, and it leads the world in use of pharmaceuticals, how much doctors are
paid, and in patients having access-related problems due to high payment rates)
Why does the US spend more on health care compared to similar developed countries?
- ANSWER--Higher prices (spend more for same drugs, physician services, etc.)
-Efficiency (not using resources as efficiently, such as imaging technology -- proton
beam therapy is super expensive)
-Administrative costs (much higher in US, in significant part due to fragmented financing
and insurance -- private insurance, hospital billing)
What are the three main spending differences between the US and Canada when
looking at hospital and physician spending? - ANSWER-1. Administration
2. Provider incomes
3. Additional procedures for hospitalized patients (not such a big difference compared
with the other two)
Describe what "off-the-curve medicine" means - ANSWER-At a certain point, when
resources dedicated to care increase, health plateaus. Right at the top of the curve is
when a country/health care system/etc. is using resources as efficiently as possible, or
maybe the whole curve is when they're using resources efficiently. The US is using
more resources dedicated to care, yet health is below the line. This could be due to
admin costs that don't make people healthier, tech, paying providers more, less access
to health care, etc.
________ represent the largest sector of the labor force
,True/False: The rate of growth in employment is slowing down for this sector. -
ANSWER-Health service professionals (includes public health jobs); False (continues to
grow faster than other groups; health care will be the fastest-growing occupation over
next decade)
_____ is the main health system expense. - ANSWER-Labor (56% of expenditures are
wages)
What proof is there that the health care industry, in terms of jobs, is Recession-proof? -
ANSWER-From 2007-2013:
-There was a growth in health care jobs, which ended at roughly 10% in 2013, whereas
there was a drop in all other industries. Even with a steady incline, the percentage job
change was still -2.8% in 2013.
-In terms of total jobs added/lost, there was a positive net change in health care jobs
added, whereas there was a negative net change for all other industries
Bodenheimer and Grumbach describe what two models of organizing health care
services? Which model does the US more closely reflect? - ANSWER--Regionalized:
Services are highly structured around the need for services, following the
primary/secondary/tertiary care pyramid
-Disbursed: Less-formal arrangement and planning of services and facilities <-- US
_____ are the dominant professional in the clinical world - ANSWER-Physicians
Why does Ezra call physicians the "Captains of the Team"? - ANSWER--Sit above
others in the health delivery hierarchy
-Decisions about diagnosis, treatment, and prescription cannot be made without
physician involvement
-Insurance companies rely on physician judgement
-Sovereign professionals: Operate free from the lay influence in exchange for self-
regulation to act on the patient/public's behalf (implicit contract between the medical
profession and society: we'll act best on your behalf if we're left alone) (their medical
licenses can be revoked, but that's happening within the medical profession and not by
society as a whole)
In what ways is medical practice characterized by uncertainty? This uncertainty opens
up variations in health care delivery. - ANSWER--Defining and then making a diagnosis
("uncertain diagnosis on uncertain science")
-Selecting a procedures
-Observing outcomes
-Assessing prognosis
-Assessing patient preferences and if the patient will act on those preferences (this is
especially difficult since sometimes we as patients can't interpret our own needs)
Understanding that tension can be caused by such roles, what are the three roles that
physicians play? What's understood to be the most important? -
, ANSWER--Agent/advocate of the patient <-- #1 (reinforced by strong professional
norms and also legal liability)
-Self-interest (financial, practice where/when/how one likes)
-Guarantor of social good (making key decisions based on society's limited resources)
What does the term "flat of the curve medicine" mean? - ANSWER-The physician falls
somewhere along the curve depending on the role they play, with "Amount or Intensity
of Care" on the x-axis and "Health" on the y-axis. For example, if they're maximizing the
health of the patient, then they fall far right on the "Amount or Intensity of Care," and
good on the health of the patient (although not above the curve). For the financial self-
interest, where they fall depends on how they're paid. For the guarantor of self-good, it
depends, since there can be a trade-off between the patient's well-being and society)
Define "Supplier-Induced Demand" - ANSWER-Expertise is kept constant (based on a
note I wrote, so I'm not sure), yet the physicians changes what treatment they give
based on incentives. If more services are provided than the patient would have wanted
if perfectly-informed, we have SID, but only if the change is due to financial incentives,
not because the physician correctly thinks that more is needed than the patient thinks.
An extreme and uncommon form would be fraud/abuse/malpractice.
True/False: Studies show that when payment incentives change, practice patterns
follow. - ANSWER-True
Describe "Downward Curving Medicine" - ANSWER-X-axis: Amount or Intensity of Care
Y-axis: Health
At some point, the more medicine delivered, the less healthy a person is (for example,
unnecessary imaging tests)
What are the types of physicians? - ANSWER--Medical practice type: Allopathy = MD's;
Osteopathy = DO's
-Specialization: Primary care/generalist; Specialist
DO's make up ≈____% of the workforce, whereas MD's make up ≈ ____% of the
workforce. - ANSWER-10; 90
How do MDs and DOs differ? - ANSWER-MD: View medical treatment as an active
intervention to produce a counteraction reaction in an attempt to neutralize the effects of
disease. Treatment focuses on acute intervention/drugs.
DO: Emphasize the musculoskeletal system of the body such as joints and tissues.
Treatment focuses on diet and the environment.
(My notes say: similar care, but historically not so much)
What does MD mean? - ANSWER-Doctor of Medicine
What does DO mean? - ANSWER-Doctor of Osteopathy
