US Healthcare Exam 1

Question 1

Aims for 21st Century HCS

Answer 1

• Safe
• Effective
• Patient-Centered
• Timely
• Efficient
• Equitable

Question 2

What are the 3 things the report looked at?

Answer 2

• Low average age before death (60 years old)
• Infant mortality
• Mortality due to medical care

Question 3

What drove healthcare during the Agricultural Era

Answer 3

Farming

Question 4

Who provided healthcare during colonial times?

Answer 4

Family, firends, clergy

Question 5

During colonial times was there a clear distinction between medicine and pharmacy?

Answer 5

No

Question 6

During what era did more products become available for treamtment?

Answer 6

Industrial

Question 7

During what era was there an explosion in delvery of healthcare and what is available

Answer 7

Information Era

Question 8

What happened in 1956?

Answer 8

Clerical and managerial jobs overcame blue collar jobs.

Question 9

What are the 3 major economic eras in the US?

Answer 9

• Agricultural (Late 18th - Early 19th)
• Industrial (Late 19th - Early 20th)
• Information (1956 - Present)

Question 10

How was reimbursement handled during the Agricultural Era?

Answer 10

Fee for service: cash or “in kind”

Question 11

What year was the first medical school?

Answer 11

1765

Question 12

What year was the first US Pharmacopeia?

Answer 12

1820

Question 13

What year was the first college of pharmacy?

Answer 13

1821

Philadelphia College of Apothecaries

Question 14

When did the Germ Theory of Disease start to become accepted?

Answer 14

Agricultural Era (Late 1800’s)

Shift toward scientific based medicine (not leeches)

Question 15

When did hospitals start transforming from charitable institutions to showcases of modern technology?

Answer 15

Agricultural Era (Late 1800’s)

Question 16

When was there a large scale manufacture of patent medicines?

Answer 16

Industrial Era

Question 17

What is Pharmacopeia?

Answer 17

Pharmacopeia is a deliniation for the preparation of medicines.

Question 18

What were patent medicines?

Answer 18

marketed as cures. Primary ingredient was alcohol. Also had narcotics: cocaine, morphine, etc)

Question 19

Why was regulation of patent medicines needed?

Answer 19

The ingredients caused addiction and death. So by 1920’s regulation was needed.

Question 20

When did we start seeing the government become involved as a regulator?

Answer 20

In the 1920’s we started seeing the government become involved as a regulator.

Question 21

What was the Pure Food and Drug Act of 1906?

Answer 21

Government involvement started with the Pure Food and Drug Act of 1906. It addressed misbranding. What was on the label, it had to label the active ingredients accurately. It did not address whether the product was safe or effective.

Question 22

Why was the Food, Drug and Cosmetic Act (1938) significant?

Answer 22

It created the FDA. Put under govt control the safety of drugs in the market. Required drugs to be pre-approved by the govt before going to market in the US. It still had no distinction between prescription and non prescription drugs so anyone could prescribe.

Question 23

Name the other goverment involvement agencies of the 1900’s - 1940’s

Answer 23

• Public Health Service (1912)
• Children’s Bureau (1912)
• Sheppard-Towner Maternity & Infancy Act (1921)
• National Institute of Health was for medical research (1930)

Question 24

When did the first insurance plans come out?

Answer 24

1929, Baylor University - plan for public school teachers, then Blue Cross

Question 25

What is the significance of health care plans?

Answer 25

if you have health insurance you have greater access to healthcare.

Question 26

What are the 2 major health reports of the early 1900’s?

Answer 26

Flexner Report (1910)

Charters Report (1927)

They defined professionalism of the medical and pharmacy professions

Question 27

What was the Flexner Report?

Answer 27

Revealed deficiencies in medical training and called for reform in the way of medical education being placed with Universities, accreditation under the AMA, closing of weaker schools, eliminated apprentice programs.

It was the start of the Golden Age of medicine

Question 28

What was the Charters Report?

Answer 28

It studied the needs of profession/curriculum, defined pharmacy as a profession, adopted a 4 year BS degree(1928)

Question 29

When was the Era of Expansion?

Answer 29

1940’s-1960’s

Question 30

When was the Era of Cost Containment

Answer 30

1970’s-1980’s

Question 31

When was the Era of Assessment & Accountability?

Answer 31

1990’s - Present

Question 32

What was the Era of Expansion known for?

Answer 32

Significant growth in # of facilities, insurance, utilization of services (due to available funding)

Question 33

What were the 2 major legislations of the Era of Expansion?

Answer 33

• Hospital Service and Construction Act (Hill-Burton, 1946) - construction of hospitals in underserved area (Jackson Hospital in Miami)
• 1935 Social Security Act - Established Medicare/Medicaid (1965) that provided service to underserved.

Question 34

Most legislation during the Era of Expansion (1940’s - 1960’s) were amendments to what?

Answer 34

FDC Act of 1938

Question 35

What was the Durham-Humphrey Amendment (1951)?

Answer 35

Creation of legend drugs (required physiscian authorization to dispense)

Question 36

What was the Drug Amendment (Kefauver-Harris) of 1962?

Answer 36

• Proof of efficacy and safety
• Acurate advertising
• Adverse Drug Reactions (ADR) reported to FDA
• Can no longer market generics as a new costly drug under a different brand name
• Human studies required informed consent

Question 37

What did the 1965 Drug Abuse Control Amendments

Provide?

Answer 37

controlled substances and eventually creation of Drug Enforcement Agency

Question 38

In what era did we In this era we see streamlining in manufacturing and marketing?

Answer 38

Era of Expansion (1940-1970)

Question 39

What happened to HC expenditures in the 1970’s (Cost Containment Era)?

Answer 39

Exponential increase in expenditures due to new expensive medications and technology and specialization of professions.

Question 40

What did health insurace coverage encourage during the 1970’s (Cost Containment Era)?

Answer 40

Overuse of HC services (due to cost per fee structure)

Question 41

What were some measures to control costs?

Answer 41

• Voluntary hospital planning
• Wage and price freezing
• Development of cost effective HC delivery systems (HMO Act 1973)
• Changes in reimbursement for services and implementation of Medicare DRGs (1983) (payment amounts for different treatments)
• Utilization review

Question 42

When cost control methods of the 1970’s did not work, what did they look at?

Answer 42

They started looking at outcome data to determine the value of medical care interventions for people.

Question 43

What were the major outcomes of the Era of Assessment & Accountability (1990-Present)

Answer 43

Health care outcome data essential to determine value of medical care

Development of:

• Standardization of care
• Comparative effectiveness research
• Evaluation of medical errors
• Evaluation of population outcomes & disparities
• Reimbursement based on outcomes

Question 44

In the Colonial Era up to the early 20th Century what were Americans mainly affected by?

Answer 44

Acute Illness

Malnutrition

Infectious diseases (malaria, dysentery, respiratory infections)

Injuries