Study suggestions

PADM 5791

Spring, 2010

Dr. Neubauer

Be prepared to answer questions along these lines. The final examination is April 28 for those not graduating this semester. It is April 21 for any who may be planning to graduate this semester.

1) What is the fundamental problem (regarding costs) with the old fee-for-service with insurance reimbursement that managed care addresses?

2) What is the role of employers in the health care delivery system in the United States today?

3) How (to what degree) do employees have choice of insurers in today's health care delivery system?

4) Does managed care tend to work better for insured persons with modest medical needs or for persons with major medical needs? Why?

5) Why did the legislation recently passed and signed into law not challenge the interests of the pharmaceutical companies, the insurance companies or the hospitals?

6) Given that most of the provisions of the new law will not take effect for several years and the Republicans are likely to gain majorities in both chambers of the U.S. Congress in 2010 or 2012, what is the likely hood that the law as it now stands will continue to be the law?

7) What is the dilemma faced by managed care providers regarding the marketing and servicing of their policies? Do you consider this dilemma to be moral or only legal in nature?

8) Is rationing of medical care services necessary in the United States? Explain or discuss.

9) Summarize Dr. Regina Herzlinger's consumer-driven health care system proposal. How does it square with the former George W. Bush administration's notion of, "the ownership society?" What does it have in common with the bill recently passed which was pushed by the Obama administration?

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10) Congress and some state governments have passed laws regarding minimum number of days of hospitalization associated with "uncomplicated" births. The intent is to prevent managed care providers from discharging new mothers and their infants too quickly. Is this model of medical care decision making/policy sound? Should it be extended to other medical conditions involving hospitalization? Explain or discuss.

http://ajph.aphapublications.org/cgi/reprint/89/6/922.pdf

11) How does federalism factor into health care politics and policy in the United States? I am thinking specifically about the fact that the insurance industry is regulated by the state governments.

12) Reflect on the following statement. Do you agree or disagree, and why?

Health care reform in the United States is deeply divisive and feeds into extreme political polarization because it hits the sensitive nerve of individualism vs. the believe that, "we are all in this together." In other words, it pits self interest against common interests for most Americans. We argue policy in the abstract but sometimes face the cruel reality of pain, suffering and death in specific instances. This is similar to the situation in which a person encounters a person begging on the street. There is on the one hand the wish to help this one person and on the other hand the realization that a small gift may only reinforce the dependency of the person begging and will not address the underlying economic and social problems. We as a people are fundamentally torn between the virtues of the ownership society and the welfare state. What we experience as a moral tug of war in the specific (to give or not to give to the person begging) has the potential to tear our union apart at the level of national politics and pluralism.

13) Reflect on the following statement. Do you agree or disagree, and why?

Our political system as designed by the Founders is presently deeply troubled because the powers of "the powers that be" make rational policy making very difficult or impossible. We are caught in a situation in which only incremental changes are possible and the big changes that need to be made cannot be made for political reasons.

14) What is the effect of new technologies (especially "half-way technologies") have on the aggregate cost of medical care in the United States? What is a half-way technology? Identify and discuss one potential use of new technology to REDUCE aggregate medical care costs in the United States.

15) How important are medical errors in terms of the quality and cost of medical care services in the United States? Has peer-review among physicians and other medical specialists served to effectively reduce the number of medical errors. Why or why not?