Health care policy and economics probably aren’t too high on the list of reasons most medical students decide to pursue lives as physicians. Yet, if you as a medical student know how these two areas work, they can play a significant role in ensuring that your future patients have better health outcomes.

How health systems work

Expand your understanding of how to successfully work within a health system to improve patient care with health systems science.

The COVID-19 pandemic that is reshaping American life and medicine on a daily basis offers even greater incentive for medical students to master the basics of these complicated topics. Understanding health care policy and reform efforts in the United States—efforts that include Medicare, Medicaid, the Health Insurance Portability and Accountability Act (HIPAA), the Children’s Health Insurance Program (CHIP) and the Patient Protection and Affordable Care Act (ACA)—will help you provide high-quality, affordable care.

An education module offered via the AMA Ed Hub helps medical students—and residents and physicians who may not have received such training—better understand health care policy and economics. The module defines the core principles of how health care policy in America was formed and implemented and explains the economic aspects of the U.S. health care system. It also helps learners understand how health care professionals, health plans and patients affect health care spending, as well as identify central themes of health care reform over the past century and how they relate to the main components of the ACA.

The free online education module “Introducing Health Care Policy and Economics” is one of 13 modules released as part of the Health Systems Science Learning Series.

The AMA Ed Hubis an online platform that consolidates all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

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Find out more about how these modules offer medical students insight on health systems science.

The module outlines the steps that you as a physician will be able to take to help patients navigate the health system so they can receive the best care at the most affordable price.

Inform and empower your patients. Understanding the type of insurance plan your patient has, the plan’s benefits and the out-of-pocket costs for services you provide and recommend will help you provide the patient more comprehensive care.

Discuss no-cost preventive services. Talk about preventive services your patient can access for free.

Ask questions, address concerns. Be sure patients don’t have unaddressed concerns about the services and care provided. If they need a test like an MRI, discuss location options because each will have cost implications.

Discuss prescription-drug options and costs. Talk about options such as prescribing a generic or brand-name drug and how each may affect your patient’s out of pocket costs.

Use quality measurement tools. Use patient surveys and other quality measurement tools to help assess your level of service and identify inefficiencies.

Adapt to new payment structures. As the ACA shifts payment for medical services away from fee-for-service toward other methodologies, adapt to new payment structures.

Work with other care professionals. The ACA is using incentives to shift clinical decision-making toward a team approach where you are encouraged to work with other care professionals to provide patient care. If making a referral, you can work with the patient to refer them to an in-network physician.

By understanding the economics and policy of health care and following the advice above, you can:

  • Ensure a diabetic patient will fill a prescription and take it as prescribed.
  • Prevent a patient from incurring thousands of dollars in medical bills for an elective surgery because anesthesia was out of network for the patient even though the hospital was in-network.
  • Safeguard critical pre-natal care by reviewing upcoming prenatal tests and discussing insurance to make sure any updates or plan renewals are made before the necessary tests.

The AMA also has released the second edition of the Health Systems Science textbook, published by Elsevier, which is a framework for this third pillar of medical education.

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Health systems science is defined as the understanding of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. Health Systems Science Review was published last year. Both books are available for purchase from the AMA Store.

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