Stakeholders

Consumers
Providers
Pharma
Insurers
Employers
Government
Healthcare triangle
Cost
Accessiblity
Quality
(if one optimised, the others must give up)
Healthcare spending drivers
The top income percentages uses the most
Distribution of the type of spending
Hospital care
Physician services
Other care
Prescription
Nursing and continuing care do not add up to too much
Trends in US health
Current cost drivers
Outpatient
Inpt admission
Presciption
Professional
Healthcare is outpacng inflation
Comparison of health spending
Average spending is increasing
Ratio of GDP also increasing
Quality
Clinical quality vs consumer satisfication
Structure, process or outcome measures
Access: an individual ability to obtain medical services in a timely and financi
al acceptable basis
Influences
Avaliablty of facilities and operation
Hours of operation
Ability to pay
Medicare: Old and disabled
Mediaid : poor
Drivers of expenditure
Supply vs Demand side
Supply
Imperfection informatin
Tech change
Demand side
Insureance
Preference of technology
Aging
Health behaviours

Efforts to control costs

Limits to hosp input
Utilisation management
Rate setting
Propsective payment of inpatient stays
Managed care
Key issues
Techology
Population and demographics
Behaviour
Production of health (Factors which affect health)Some factors are luck of the d
raw,medical care is not,demographics is when the person is born into a better fa
mily
Demographics
Lifestyle
Genetics
Medical care
Once you reach abv 75
Thought questions
How are demographic shifts going to affect t market of physician and physician s
ervices
hospital services
long term care
How do demogrphic shifts affect younger generations
What other changes are going to affect the care markets
Effects of health behaviours
Health bad
Externalities: affects other people , unintended consequences
Market failure( we need to find ways to fund it): subsidies for positive externa
litis flu shots
Taxes for negative externalitis ( to get money back to take care of problemss)
Health bads( Smoking)
Obesity: htn high cholesterol, coronary heart disease, T2DM responsible for 400K
deaths
Negative externalities
Alcohol lost productivity crime , neglenct of family
Monopoly
Legal barrier to entry
Public francise
Natural barrier
They can set prices
Price discrimination
Physicians
Software can be set for everyone
Single price for whole monopoly
Price discimination
Helps to capture all consumer surplus for itself
Price discrimination
Amongst units of good
Among individuals
Between groups
Perfect price discrimiation
Charge everyone their willingness to pay
Auctions can have this effect
Two offices in different places
Resisting the
Company
Consumer club
Skills
William and Charles Mayo
Point of origin in group practices
Sites of practice
Short term
Long term
Shifts from inpatient to long term
Physician visits increases
Hospital stays decreasing
It depends on the location of visits
Decomposition of ER care
only a third is urgency
Laparascopic surgery
New issues in 21st centure
Patient saefty
Changing models of insurance
Demographics

Tinker
Invent new techologies
Work with patient to customise solutions
Create new medical professionals
Create new science
Create new organisation
Broker
Certifies medical providers
Gatekeeper to academic med
Referrals
Trade information with other doctors
Set prices
Financiers
Entrepreneur
Build specialitis
Incubator
Bench science for profit and glory
Spy
Consumerism
Depression
Pte hosp under utilised
Medicare and mediaid
1970s spiraling of costs
Medicare prospective payment system
Payer driven competition
rather than patient driven
Move from inpatient
Academic health centre
Other teaching hospitals
And other hospitals
Hospital scale or scope
General vs speciality
Regions vs Children
Short vs Long term
Federal vs Non federal
Length of stay has decreased
Hospital issues today
Quality and patient safety
Capacity issues, inpatient
Financing
Competition
Consumer driven plans
Beds to population retio
Occupancy
Influential factors
Capacity M nA
Regulatory environment
Occupancy
Technologu
Reimbursement
Beds
Too few beds
Units vs hospital level
Hospital location
Demographics
Variation by time of the day
Labor shortage
Needs based
Or economics based
Labor market equilibrium
It can be a dynamic shortage or
Static shortage
Supply of nures
New nurses or re entrants
Retirees and exit
Policies
Nursing education subsidies
Ratios
Quality
Clinical quality structure, process and outcomes
Customer satisfication
Patient safety
Preventing adverse outcomes
stemming from the process of healthcare.
Production of hospital services
Complex and labor
Errors
IOM
Safe
Effective
Patient centered
Timely
Efficient
Equitable
Leapfrog grp
Contracting decisions
Leapfrog quality index used to rate for safety measures
Private payers, Medicare and medi
How do hospitals compete now
Competition with other hospitals
Speciality hospitals
Hospital and policy maker response
Ambulatory surgical centres
CMS innovation centre: created to test and expand models
Many

Opportunities
Hospice for children
Accountable care organisation
E med
Evidence of improved care outcomes
Is the future tourism
Great differences in prices
US vs India
Insurance vs Cash