Category Archives: History

Healthcare Financing and Reform

Watch the following Khan Academy Videos:

Module 1: Health care system overview 8 minutes

Explains how patients/populations, providers, and payors interact.  Introduces government insurance, direct payment of patient to doctor, HMOs and PPOs.  Explains the rationale for insurance to mitigate risk and discusses the need to manage “moral hazard” as well as over-utilization of services when not directly responsible for payment.

Module 2: Paying doctors 12 minutes

Defines FFS, capitation and salary.  Describes the lack of cost accountability to patients and providers in the third party payor system.  Describes issues with capitation with particular attention on “cherry picking” or patient shifting.

Module 3: Medicare overview 16 minutes

Introduces Medicare and Medicaid.  Defines populations covered for Medicare (Elderly/ALS/ESRD) and Medicaid (low income) as well as funding source (Federal Government for Medicare and combined Federal and State for Medicaid).  Defines Secretary of HHS and CMS (Centers of Medicare and Medicaid Services).  Describes Medicare parts A-D.

Review the Fact Sheet on Healthcare Financing and Reform

The Bell Curve

Many of you are familiar with Atul Gwande and his writings.  We will refer to The Bell Curve, What happens when patients find out how good their doctors really are? by Dr. Gwande many times in EHM.  This article emphasizes many aspects of the course.  Some of the major themes are health systems improvements, social determinants of health, inter professional education, communication, professionalism and ethics.

Click the link to download The Bell Curve highlighted for this reading.

We have highlighted the passages with in the reading that are directly related to this session.

  • What did you find surprising about this article?
  • How did you feel when you read about the initial appointment Honor and Don Page had with the team at Cincinnati Children’s Hospital?
  • What did you think about the appointment Alyssa had with Cori Danes?
  • Compare and contrast that with Janelle’s appointment with Dr. Warwick at Fairview-University Children’s Hospital in Minneapolis.
  • Write down some different strategies employed by both care teams.  Are there other strategies you might have employed when communicating with these two patients?
  • Did this article make you rethink your understanding of ‘non-adherence’?  If so, how?