Download Chapter 19: Making Decisions about Health Care

Chapter 19
Making Decisions About Health Care
Learning Objectives
1. Describe what you need to know to be an intelligent health care consumer.
2. Discuss the roles of several kinds of health care providers.
3. Compare the four main kinds of private health insurance available in the United States.
4. Discuss several reasons why health care costs have risen so dramatically in the United States
in recent years.
5. Explain which populations are served by Medicare and Medicaid.
6. Compare health care and health insurance in Canada and the United States.
7. Discuss some of the problems with the quality of U.S. health care and frequency of medical
errors.
8. Discuss the disparities of medical care based on patient sex, race, and ethnicity.
9. Compare the pros and cons of organ transplants for donors and recipients.
10. List five common kinds of cosmetic surgeries.
Key Terms
Cosmetic surgery (428)
Diagnosis (422)
Health maintenance organization (HMO) (423)
Magnetic resonance imaging (MRI) (425)
Managed care (423)
Preferred provider organization (PPO) (424)
Chapter Summary
Medical care is vital to health; everyone is going to require medical assistance at some time.
Even though medical care in the United States is generally regarded as the best in the world,
many people are dissatisfied with the care they receive. People complain about being charged
high fees, being treated without sensitivity, and not being fully informed about their condition
and the recommended treatments.
Many people are overmedicated with drugs, especially when symptoms and complaints are
minor. Thousands of operations are performed annually for conditions that could be treated more
conservatively by other, less drastic techniques. People have to assume more responsibility for
their health, especially when dealing with hospitals and health care professionals. They should
insist on all possible information pertaining to the illness and the reasons for the recommended
treatment. Having complete trust and confidence in one’s physician is of utmost importance.
Positive statements and healing suggestions can be a powerful aid in the cure. Conversely,
negative, discouraging statements can interfere with recovery.
Most medical office visits involve minor symptoms and illnesses. Indicate to your physician that
you would prefer to deal with the symptoms without drugs or surgery if possible. Begin to try
relaxation, positive mental imagery, a better diet, and exercise to improve your health. Always
remember that your health and what is done to your body are your responsibility. Medical
technology and physicians are your allies when you become ill, but try to live so that you do not
need them.
Lecture Outline
Being a Wise Health Care Consumer
•
Be well-informed and know how to make healthy decisions.
•
Seek reliable sources of information.
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Be skeptical about health information appearing in the news media or in advertising.
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Be wary of unlicensed practitioners.
•
Select practitioners with great care and ask questions about fees, diagnoses, treatments,
and alternative treatments.
•
Report health care fraud to the appropriate authorities.
•
Following are three principles of being a wise consumer:
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Partner with your health care provider.
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Physicians are required to discuss benefits, risks, and costs of appropriate
treatments and alternatives.
•
Manage minor health problems, observe, and record symptoms to share
with your doctor.
–
Share in health care decision making.
•
Participate actively in every medical decision.
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Let your doctor know what you want.
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Do your own research.
–
•
Ask why a test or treatment is recommended.
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Ask for alternatives.
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Consider watchful waiting.
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State your health care preferences.
•
Accept responsibility.
Become skilled at obtaining health care.
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Exercise self-care and self-responsibility.
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Seek health care from a primary care physician.
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Reduce unnecessary medical tests.
•
Reduce drug use.
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Use specialists, hospitals, and emergency services only when necessary.
Choosing a Health Care Provider
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First, decide what kind of health care provider you need for your particular problem.
•
It is important to know if your health care provider relies on Western medical or
traditional medical background.
•
–
Western—based on scientific principles
–
Traditional—based on observation and theories, alternative medicine
Health Care Providers
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Physicians: Are the primary source of medical advice
–
Other health care providers:
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Physicians assistants (PAs)
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Nurses
–
•
Emergency medical technicians (EMTs)
•
Physical and occupational therapists (PTs and OTs)
•
Sports medicine
Physicians assistants (PAs)
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Trained in many aspects of patient care
•
Work under the supervision of a physician
•
Can usually spend more time with a patient and explain most of a patient’s
questions regarding medications or procedures
•
Nurses
•
RN = registered nurse
•
Trained to promote health, advise patients on how to prevent disease, and
assist in the care of patients
•
Nurse practitioner—an RN with additional training and skills that enable
them to proved many patient care services
–
Physical and Occupational Therapists (PTs and OTs)
•
PT—trained to restore function, improve mobility, and relieve pain of
patients suffering from an injury or disease
–
•
OT—help people in the home or workplace perform their daily tasks
•
These two often work closely together to restore normal daily function.
Sports Medicine
•
Sports injuries derive from physiological, psychological, and
environmental causes.
•
If you experience one of the following, you need to seek medical
attention:
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Comparative weakness
•
Muscle cramps
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Numbness
•
Reduced range of motion
•
Sprains
Seeing the Doctor
–
–
Majority of people who go to the doctor have minor complaints:
•
Think they are sick and are
•
Think they are well and are actually sick
•
Those who are well but need reassurance that they are not sick
Patient satisfaction with health care usually depends on what occurs in the
physician’s office.
–
Diagnosis means establishing the cause of the problem, the symptoms, or the
complaint.
Hospitals
•
Upon admission to a hospital, you are required to sign an informed consent form.
•
The Patient Bill of Rights is published by the American Hospital Association, and each
hospital should have it posted prominently.
Understanding Health Insurance
•
Large employers supply health insurance for employees and their dependents.
•
The U.S. government supplies health insurance for federal employees, veterans, armed
services, and their dependents.
•
Federal, state, and local governments supply insurance for the elderly and people with
disabilities.
•
Three Types of Health Insurance Plans
–
Private insurance: Fee-for-service, traditional type of health care in the United
States
–
Health maintenance organizations (HMOs): Prepaid health insurance plans that
are an alternative to private insurance
–
•
•
Preferred provider organizations (PPOs)
Fee-for-Service Plans
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Each individual can choose his or her physician or hospital.
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The plan usually pays around 80% of the patient’s medical costs.
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There are restrictions on what it pays for.
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Not covered = routine exams, immunizations, drug treatment
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20% can be a lot if there is a major injury or illness
HMOs
– Four requirements define HMOs:
•
Organized system that accepts responsibility to provide health care
•
Agreed-upon set of comprehensive health maintenance and treatment
services
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Voluntarily enrolled group of people in a specific geographic region
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Reimbursement through a prenegotiated and fixed payment schedule on
behalf of enrollees
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Emphasis is on early detection and disease prevention.
•
HMOs and other health care organizations deliver medical services as
managed care, a system that reduces the cost of health care.
•
PPOs
– Combination of the traditional fee-for-service health care plan and an HMO
– Employers or insurance companies negotiate low fee-for-service rates with
hospitals and health care providers in a specific geographic region.
– Participants must use one of the “preferred” providers for the majority of bills to
be paid; if a patient uses a nonpreferred provider, that person must pay a
substantial fee.
•
Point-of-Service Plans
– A primary care physician who is a part of the HMO can refer a patient to a
specialist who is not a part of the HMO, but the patient’s treatment is still
covered.
– If the patient goes to the same specialist without a primary care referral, then all
treatments would come out of pocket.
How the Federal Government Supports Health Care
•
Medicare
– Federal insurance program for:
•
Americans over age 65
•
Certain disabled Americans under age 65
•
People of any age with permanent kidney failure
– In 2000, there were 40 million enrollees
– Insures 1 in 7 Americans
– Medicare Part D
– Helps offset the cost of prescription drugs for those on Medicare and Medicaid
– Medicaid
– Provides health insurance for certain low-income people in the United States. To
be eligible, a person must meet one of the following requirements:
•
Be on welfare
•
Have dependent children
•
Be an elderly person or a person who is blind or has a disability who
receives supplementary security income (SSI)
Health Care Costs
•
Why Health Care Costs Continue to Rise
– Two issues surface when analyzing health care costs: malpractice insurance and
health insurance
– Americans are living longer
– Unhealthy lifestyle behaviors
– Overdeveloped medical capabilities and expensive technologies
– Overtrained, overspecialized physicians
– Administrative overhead
•
Medical Tourism
– Because of how expensive it is in the United States, many people seek treatment
in other counties.
– Estimates are as high as 150,000 people yearly.
– Some overseas hospitals are accredited by U.S. standards.
– Health Care Costs in Other Countries
– Other industrial nations spend half as much on health care as the United States,
and manage to provide insurance for all citizens.
– Although it is said that the United States has the best health care, it has lower life
expectancy and higher infant mortality rates than Canada and other nations.
•
Quality of Medical Care
– Health care access depends on socioeconomic status, education level, amount of
income, type of job, race, lifestyle, and behaviors.
– People should not rely solely on hospitals and professional health care.
– Prevention and risk-avoidance behaviors should become priorities.
•
Inequities in Health Care
– Socioeconomic status and race play crucial roles in health and health care, as well
as education, amount of income, and type of job.
– People who earn less than $9,000/year die at a 3–7 times greater rate than those
who earn more than $25,000/year.
– A central priority of Healthy People 2010 was to reduce racial differences in the
delivery of health care.
•
Organ Transplants
– Most major organs can be transplanted, such as the kidney, liver, lung, or
pancreas.
– Organs can be transplanted from cadavers or living donors.
– More than 71,000 people in the United States have donated an organ to another
person.
– No federal guidelines or laws regulate who can donate and who can receive an
organ; each hospital or organ transplant center makes its own rules.
•
Medicalization of Human Behaviors and Traits
– Medical consideration of conditions, behaviors, or traits that generally were not
regarded as illnesses or medical problems
– For example, homosexuality until the 1970s
– Smoking and drinking problems
– Sexual impotence and baldness
– Hyperactive children
– Obesity
Cosmetic Surgery
•
Cosmetic surgery is solely to enhance appearance or to correct visible effects of aging.
Making Decisions About Health Care
•
What are ways that you think we as a nation can decrease health care costs?
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Do you know how to get insurance if you don’t have a job that provides it? Do you know
what your insurance covers right now?
•
What do you think about medicalization for things like obesity and hyperactivity? Is it
appropriate?
Study Guide and Self-Assessment Workbook
19.1 My Medical History
19.2 Am I an Intelligent Health Consumer?
19.3 Using the Internet for Health Research
19.4 Web Field Trips
Additional Resources
Consumer Information Center
Room G-142 (XC)
1800 F Street NW
Washington, DC 20405
(202) 501-1794
www.pueblo.gsa.gov