Health Care Systems
Matthew M. Murawski, R.Ph., Ph.D.
Last Updated- 4-26-18 2:00AM
Topic 1 - Intro to Class ( kind just a practice download to test the system)OVERHEADS HERE
Topic 2 - Goverment Involvement in Health CareOVERHEADS HERE
Topic 2 REQUIRED READINGS!:
Health Care Constitutional RightsOne
A Brave new WorldTwo
Topic 2 Graduate Readings (not required, here for those interested in deeper implications)
Topic 3 - Health Care ModelsOVERHEADS HERE
Topic 3 REQUIRED READINGS!:
What is a health system?One
Key components of a well functioning health systemTwo
Comparing Health SystemsFive
(They are short)
Topic 4 - Evolution of The Health Care SystemOVERHEADS HERE
Topic 4 required Readings:
DEEP READINGS Topic 4(Not Required- but I've learned some of you want to understand at a deeper level)
Topic 5- Organization of Health Care DeliveryHERE
Topic 5 Required reading:One
Topic 5 Required reading:Two
Topic 6- Determinants of Health Care DeliveryHERE
Topic 6 Required Reading:One
Topic 6 Required Reading:Two
Topic 6 Required Reading:Three
Topic 6 Required Reading:Four
Topic 6 DEEP READINGS
Topic 6 DEEP READINGS:OneDR
Topic 6 DEEP READINGS:TwoDR
Topic 7 Overheads (Current HCS)HERE
Topic 7 Required Reading:One
Topic 7 Required Reading:two
Topic 7 Required Reading:three
Topic 7 DEEP READINGS
Topic 7 DEEP READINGS:OneDR
Topic 7 DEEP READINGS:OneDR
I seem to recall the Midterm Topic Break Line as being right here, with Current Health Care System on the Mid-Term
and Illness, Health & Disease and from there on forward targeted for the final exam.
Correct me if I am wrong, but that's the assumption I am moving forward with for right now.
So, from here (Health, Disease & Illness)to the end for the final.
Topic 8 Overheads (IllnessHealthDisease)HERE
Topic 8 Required Reading:One
Topic 8 Required Reading:two
Topic 9 Overheads (International Helath Comparisons)HERE
Topic 9 Required Reading:One
Topic 9 Required Reading:two
Topic 9 Required Reading:three
Topic 9 Required Reading:four
WHAT SHALL BE THE FATE OF PHARMACY?
These readings are dated, but every bit as important as the day they were printed.
What I wish to do is have a socractic discussion with you. It will or will not work.
The determinant will be, will you read these and try and understand them?
If yes, we may really go somewhere. If not, I'll shut it down and go on to the next topic.
Your gain, or your loss. I can't beat this kind of thinking into you. I can only show you the path.
Topic 10- where's pharmacy going?
Not anything we used this year during Socratic Discussions, but a slide deck I created in the past for that purpose. It MIGHT be of value as a study guide-
OK. Dr. Mason is sceduled to lecture on March 29th (Manpower in Pharmacy)and April 5th (Career Paths and Providers Part I)/HealthCare Providers(Part II).
Here are his slides for both dates:
Topic 11 Overheads (Manpower in Pharmacy)HERE
Topic 12 Overheads (Career Paths and Providers Part I)HERE
Other HealthCare Providers(Part II)HERE
No Required Readings for either topic. I won't be present for these lectures, Dean Mason knows how to handle himself.
Today I'll be having it out with my CPA trying to figure out my colonoscop.....I mean, my taxes.
As I already said, I'll hold Accountable Care organizations for now, and we will continue to hammer away at the
Socratic approach to "Where goes Pharmacy?" We will focus primarily on two readings-....
First- "Pharmacy as a Clinical Profession"- which, arguably, if we had all read the piece, we would have gotten to the concept
of seriousness-> (Page 1299, Larsen's list of professional services:
1-Closely linked to major human values
2- Require a degree of knowledge, skill & understanding beyond those of ordinary people
3-They are inherently personal or individualized in nature,
meaning that they could could NOT be readily standardized or mass-produced.
This is important. If we can standardize what it is we do (e.g., fill prescriptions) we are not engaging in what scholars
would consider professional activities- (What do you think? Are we standardizing the work flow in a pharmacy?)
And then, paper RM3658, "The impact of pharmacy specialties on the profession and the public". We will look at the other three in depth if
we get the time; you certainly will be asked questions on the final from these articles, that ask the very germane question
as to whether or not we HAVE moved towards providing something like pharmaceutical care?
Dr. Snyder and I had a conversation yesterday about her lecture on MTM scheduled for the 12th; it seems someone else in some other class
thought Dr. Snyder should cover MTM in THAT class (whichever class that might be) and that there is therefore a certain degree of duplicative material.
Dr. Snyder was working ina work-around, but graciously offered up her time on April 12th for me to do as I might with it for this
year. So we shall have another day, April 12th, to continue the class discussion. I hope you start to get into the
spirit of things to the extent that I have to blow a whistle and send you to neutral corners.
This is an important debate about matters that, depending on how you each, individually, decide how to meet and deal with
will, without question, seriously impact your collective careers and the extent to which each of you actually makes a difference in the world.
TOPIC 13 Overheads (Medicare Part D- Alan FarkasHERE
Oh, and by the way- while we may not have all the time we wished we had, I offer you the chance to ask me questions about what we are talking about, and just about anything else
that might occur to you. I will do my best to either answer in class, or on this webpage. In the case of multiple questions in a short period of time,
I will present the questions (without your name) to the class overall, and ask for a vote as to which questions get priority. It is something I wanted to
try using a software program called "hotseat" but it turns out I didn't have the TA support I would need to make it work in real time
(Think of all of you posting questions during lecture, and then the group "liking" those questions most interesting to the class, which are then
the questions I try and address. So we will try and do the same thing, only a little s.l.o.w.e.r.......
But YOU need to play if YOU want it to work. Let's give it a shot, from here on out- Unca Matt.
Topic 14 - Medical Home Model - Dr. Jasmine Gonzalvo HERE
Topic 15ish- MTM and CDTM - Dr. Margie Snyder HERE
Topic 16ish- Advanced Practice ModelsHERE
DEEP READINGS(for the motivated- will NOT appear on exam, even as bonus points)
Topic 17 - Pharmacy Practice Scale and ScopeHERE
DEEP Reading:six-the Avelere report
NOT REQUIRED READINGS! Just things that make me say.... Hmmmmmmmmm
International Variations in Pharmacist Salary- here's the top NINE
Mark Cuban wants to eat you for lunch. See: Here
The current jobMarket
Some good news for your futureHERE
Remember how I talked about how much the bill for identical services might differ across the state?
And I mentioned an article in the local paper actually hit on this subject?
Take a lot look at the articleHERE
There is a growing business model that is a possible vision of the future- from TIME magazine-HERE
One of you shared this idea; I tracked the episode from "Inside Man" down on youtube- a mix of explaining how "weird" US pricing is, and a throrough
examination of the growing phenomena of Medical Tourism
Canadian Health CareHow I got my new hip
OK, So how can I stand there in front of you and suggest you should focus on helping your patients?
I mean, what am I doing to move things forward? Check out my research -just click on "watch the video"HERE
Then, take a look at the data we have collected so far this year from students on Community Pharmacy APPE Rotations. The extent and the degree of the data collected so far is rather amazing-
See it HERE
THINGS NO ONE EVER KNEW BEFORE:
The distribution of the incidence of side effects is negatively normal (an upside-down bell curve)
People tend to either have symptoms only every once in a while (probably just somatic complaints) OR, they have symptoms almost every day ("REAL" side effects)!
We can show that different classes of drugs differ in terms of how high their mean IMACT scores are- probably a function of how instrusive the disease state itself can be, so patients are willing to put up with more.
This is getting really close to pharmacy practice as SCIENCE. Check out the data, let your mouse hover over any data point and more information will be displayed.
We take the integer values for the frequency (1 through 5) and the integer values for each ADR's severity (1 through 6) and calculate the product for each Adverse Drug Reaction (ADR), or "side effect"- we call this "ADR IMPACT".
The maximum possible score is 30 (almost every single day, almost intolerable when it happens). Look at the last graph for a distribution of these impact scores.
To me, any score above 20 is actionable: here's your homework- hover over each bar, and calculate the percentage of our sample with actionable levels of ADR burden- that is, IMPACT scores of 20 or above.
Not too surprizingly, drug classes vary in terms of their mean impact; some drug classes are just dirtier than others.
Look a little closer, and you'll see that disease states with objectionable symptoms seem to be able to tolerate higher levels of ADR burden (Say, in example,Asthma, or Epilepsy, and so on.
Here are the disease states where we can make a difference!
If you find this data interesting, stop by sometime in the fall when you get back, and I will be happy to sit down with you and explain this
work in greater detail. Maybe you'd like to try your hand at research- I've got tons of data that needs organized and analyzed, and I can ALWAYS use some extra hands.
We have limited goals at the Murawski lab, all we are trying to do is change the world by saving Community Pharmacy Practice.
The big stuff we'll get to later.......
;~> Unca Matt
These are all about events around Chicago in 2016-2017. Just Newspaper-type articles. But take a look. Remember how we ended the Socractic? Basically, how can we buck the chain system?
Look at these links and what comes through is something I told you in our first real lecture- SAFETY trumps all other cards......remember that. Unca Matt
Chicago Reading 1HERE
Chicago Reading 2HERE
Chicago Reading 3HERE
Chicago Reading 4HERE
Chicago Reading 5HERE
The Colorado Provider Statue:HERE
This PBM thing is really getting out of hand- Check out this reading, and especially the embedded links in itHERE
A kefffluffal in Arkansas over PBMS-HERE
AND Kentucky zooms on past us....HERE
It looks like a duck, walks like a duck, and smells like a duck. Must be QUACKERY!
Homeopathy and other strange things- just download the MS Word file and click on the links- I can't seem to get it to work on this web-pageHERE
How Quackery Sells HERE
An old lecture I used to give on QUACKERY
International Variations in Pharmacist Salary- here's the top NINE
FINAL EXAM MONDAY APRIL 30th, 3:30-5:50PM in PHYS 112
QUESTIONS? E-Mail Matthew Murawski, R.Ph.,
...... Always Under