Other Providers and Regulators

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En provenance du cours de University of Pennsylvania

The Economics of Health Care Delivery

9 notes

University of Pennsylvania

The Economics of Health Care Delivery

9 notes

Cours 2 sur 4 dans Specialization The Business of Health Care

In this course, you’ll learn about the key components of health care, and the economics behind their principles and pricing strategies. Professors Ezekiel Emanuel of Penn Medicine and Guy David of the Wharton School have designed this course to help you understand the complex structure of the health care system and health insurance. Through study and analysis of providers and insurance through an economic lens, you’ll learn how basic economic principles apply to both principles and payment methods. By the end of this course, you’ll be able to identify different types of health care providers and understand the dynamic between the providers and patient so you can employ best practices and maximize profit for your health care organization.

À partir de la leçon

Module 3

In this module, you’ll examine the role of the physicians and hospitals in the health care ecosystem. You’ll explore the different types and payment methods for both physicians and hospitals, and how hospitals utilize these methods to maximize profit. Through analyzing the Health Care Value Chain and Principal-Agent Problem from Economics, you’ll be able to establish the unique importance of physicians in the health care markets as a perfect agent, and the different approaches and implications of this relationship. You’ll also gain a general overview of the characteristics that define hospitals, the effects of different trends on the decline in number of beds in hospitals, and two common hospital practices to address this issue: cost shifting and cross subsidization. By the end of this module, you’ll be able to better understand the role of physicians and hospitals in health care markets and employ best practices and maximize profit for your health care organization.

The Role of Hospitals6:39

Physicians and Nurses6:27

Other Providers and Regulators3:31

Rencontrer les enseignants

Ezekiel J. Emanuel, MD, PhD
Diane v.S. Levy and Robert M. Levy University Professor
Department of Medical Ethics and Health Policy
Guy David, PhD
Gilbert and Shelley Harrison Associate Professor of Health Care Management
Department of Health Care Management

In addition to hospitals, doctors and nurses,

there are a slew of other providers of care.

For example, home health care agencies.

There are about 12,000 in the country and they provide services at home.

If you keep a patient at home and want to give them antibiotics or

want to measure how they're doing, for example, on their weight or whether

they're taking their medications, send a home health care provider to the house.

In addition, there are end-stage renal dialysis facilities so

patients who have kidney failure go and get dialyzed.

There are nearly 6,000 of those in the country.

There are ambulatory surgical care centers where you get simple surgical

procedures outside of a hospital.

There are free-standing imaging facilities,

where you can get an MRI or a CT scan and not get it in the hospital.

In addition,

there are hospices in this country providing end-of-life care to patients.

It's again, an incredibly complicated system of getting care to patients.

In addition to that,

there are what are called manufacturers, pharmaceutical companies.

We have to develop drugs.

These big drug companies, Pfizer, Merck, GSK, Gilead, Novartis, Sanofi.

They develop drugs in the laboratory, then they test them in animals, then they move

on to human testing and apply to the FDA for approval to market their drugs.

They manufacture all the drugs we have in the country.

Typically, they have very high profit margins.

The average is somewhere between 14 and 15% profit per year, but

the best performing ones actually make around 33% profit.

A large portion of their profit, almost half, comes from the United States

even though the United States has only 310 million people and

the rest of the world has billions of people.

In addition to drug companies, there are device manufacturers.

There are over 7,000 manufacturers in the country and

they consume about 4.5% of total health care expenditures.

Some of them are big integrated companies like GE and Siemens.

Some of them are very specific device manufacturers such as Medtronic that make

heart pacemakers and other heart equipment like stents or like valves.

Again, like the drug manufacturers,

they typically have very high profit margins on medical procedures.

In addition to all of that,

there are private regulators of the medical profession.

There are the boards who test doctors,

such as the American Board of Internal Medicine.

There is the Joint Commission, which accredits hospitals.

There is the National Committee on Quality Assurance,

NCQA, which evaluates physician practices.

The system is very, very complicated.

But that's the kind of complication we need if we're going to get

care to a patient who we suspect has a heart attack to evaluate them.

To make sure that the hospitals and

doctors treating them are treating them well.

To make sure they have the drugs and the devices to treat them,

to make sure we can care for them at home if they need to be seen at home.

The American health care system is incredibly complicated and

to understand how to reform it, we really need to understand that complication and

the complication of how each part is paid.

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