How can system outcomes be measured? Where do we do better
System outcomes can be measured using the Peterson-Kaiser Health
System Tracker and how much we are spending, what is driving growth,
and what we are getting for what we spend.
U.S. compared to OECD nations: spending, outcomes
Cpmpared to OECD nations, the U.S. spends approximately 42% or more
however we have higher mortality rates and lower life expectancy
U.S. System trends; advantages and disadvantages over international comparisons
Different measures/indicators of health system performance;
What do we need to take into consideratuon when comparing infant
mortality rates (and other measures) across nations?
Mortality amenable to health care: definition, how used, how U.S.
compares to other countries; U.S. trend over time; what if we improved
preventable deaths up to rate of top performing nations--how many
Factors outside of the health system that contribute to health status
and affect access
Three common types of health care systems often found in other
countries (be sure to be able to identify examples of countries for
each of the types)
Medicare: history, effects of provider accomodation, changes in type
of Medicare reimbursement over time over time (hospital (1980s)) and
physician payment reform (1990s)--why and components of system
see slides on medicare history
Medicare Modernization act of 2003, what is the donut hole?e
Medicare advantage plan enrollment trends--is enrollment decreasing
or projected to increase
Macra: impact on sustainable growth rate, effect on physician
payment, effect on part B premiums; Who is affected by the quality
payment program? What are the two tracks of the quality payment program?
Structure: What do parts A, B, C, D cover? sources of revenue for
parts A,B, C, D
Spending (both program and beneficiary), beneficiary spending
compared to non-medicare households; factors that affect medicare
Benefits and gaps, Medigap coverage
Be able to distinguish among blended payments, Medicare ACOs, and,
Hospital Readmission Reduction program: What is it? What are the
ongoing policy issues?
factors that affect spending now and in the future; future financing
challenges; Five major challenges that will define future debates over
medicare policy factors that affect solvency of the part A trust fund
What is a defined benefit vs a defined contribution program?
Dual eligible: Who are they? characteristics, health status, and
health care spending compared to other beneficiaries