Aspen N502 2022 March Discussions Latest (Full)

N502 Health Care Systems

Module 1 Discussion

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?

 

N502 Health Care Systems

Module 2 Discussion

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?

 

N502 Health Care Systems

Module 3 Discussion

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?

 

N502 Health Care Systems

Module 4 Discussion

Discussion Question:

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, and others?

 

 

N502 Health Care Systems

Module 5 Discussion

Discussion Question:

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?

 

N502 Health Care Systems

Module 6 Discussion

It is unfortunate that it requires a threat, epidemic, or pandemic 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?

 

N502 Health Care Systems

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?

 

 

 

N502 Health Care Systems

Module 8 Discussion

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 minority 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?

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