EXAM 1 Flashcards
A state of complete physical, mental, and social well-being, not merely the absence of disease (WHO, 1948)
- Considers that a person’s environment influences the degree to which they are able to function effectively in everyday life
Health
Three models of health care
- Biomedical
- Biopsychosocial
- Sociocultural
_ model of health care
- premise that ill health is a physical phenomenon that can be explained, identified, and treated through physical means
biomedical
_ model of health care
- An approach that takes into account people’s physical conditions (biology), their thoughts and beliefs (psychology), and their social expectations
biopsychosocial
_ model of health care
- The view that health reflects a complex array of factors involving personal choice, social variables, and culture
sociocultural
(sociocultural model)
- childhood experiences
- housing
- education
- social support
- family income
- employment
- community
- access to health care
social determinants of health
Effective health communication techniques
- collaboration
- multiple levels of meaning
- context and culture
_ effective health communications technique
- meaning does not lie in discrete units of information or in any one person, emerges with experiences that participants collaboratively create
- patient-provider collaboration
- NOT provider does all the talking and patient sits there silently
collaboration
_ effective health communications technique
- meaning is interpreted at both content and a relational level
multiple levels of meaning
_ effective health communications technique
- We are influenced by larger environments and contexts such as past experiences, neighborhoods we live in, cultures we identify as
- Each of these is likely to influence what we consider acceptable and how we interpret what happens around us
Context and Culture
- communication is crucial to the success of health care encounters
- wise use of mass media and social media can help people learn about health and minimize the influence of unhealthy and unrealistic media portrays
- communication is an important source of personal confidence and copying ability
- effective communication saves time and money
- communication helps health care organizations operate effectively
- Health communications may be important to you because of career opportunities
Communications influence on health
_ level of multiple levels of meaning
- meaning considered to be mostly denoted - subject to literal interpretation
content
_ level of multiple levels of meaning
- participants consider the implications of communication in terms of their relative status and feelings about each other
relational
Communications influence on health _
- without it, caregivers cannot hear patient’s concerns, make diagnoses, share their recommendations, or follow up on treatment
- Patients who take an active role in medical encounters are more likely than others to be satisfied with their care
communication is crucial to the success of healthcare encounters
Communications influence on health _
- media consumers are likely to be well informed about health issues and to take an active role in maintaining their own health
- Be aware of fake news
Wise use of mass media and social media can help people learn about health and minimize the influence of unhealthy and unrealistic media portrays
Communications influence on health _
- Health professionals are less likely to experience burnout and less likely to leave the profession if they are satisfied
Communications is an important source of personal confidence and copying ability
Communications influence on health _
- Caregivers who listen attentively and communicate a sense of caring and warmth are less likely to be sued for malpractice
Communication helps health care organizations operate effectively
Communications influence on health _
- Communication skills are central to jobs in clinical care, public relations, marketing, health care administration, Human Resources, education, community outreach, crisis management and more
Health communications may be important to you because of career opportunities
- Early and preventative care
- Access and health disparities
- Navigating a complex system
Current issues in health care
Current issue in health care:
- It is healthier and ultimately less costly, to prevent illness and injuries than to treat then once they become serious
Early and preventative care
Current issue in health care:
- Experts can predict roughly how long a person will live based on where the person lives and how much money they make
- 14.7% of Americans 18-64 are uninsured (approx. 30 million)
- 25.8% of poor persons
- 26.8% of near poor persons
- 9% of not poor persons
Access and health disparities
Current issue in health care:
- Most common frustrations involve communication: unclear instructions, contradictory information from different providers, hard-to-understand insurance policies, and a sense that health professionals don’t communicate with each other
- results include added stress, communication gaps, adverse patient outcomes, and additional emergency department visits and hospitalizations
Navigating a complex system
- Overall US ranked 11/11(worst)
- Access with cost-related problems ranked 11/11
- Efficiency ranked 11/11
- Equality ranked 11/11
- Healthy lives ranked 11/11
- Most health expenditures/capita in 2011 was $8,508
US health care system in comparison to 10 other OECD countries
- The Commonwealth Fund Study (2014)
- increasing older population creates increasing demand for health care providers
- increasing % of racial/ethnic minorities creates increasing % of underprivileged population and increasing demand for health care providers who are aware/sensitive of intercultural differences
Impact of the changing population in the US on its health care system
Practice of paying a care provider for specific care provided
- Doctors, hospitals, physical therapists and so on, only make money if people use their services
fee-for-service
Three parties involved, the provider, the patient, and the payer (insurance companies)
- a benefits provider (usually an insurance company) that is separate from the patient and the care provider
Third-party payer
Flat rate reimbursement amounts for specified inpatient hospital procedures
Ex: A certain amount paid for an appendectomy, established in advance rather than based on actual costs incurred by the health provider
Diagnosis-related groups (DRGs)
A membership fee paid by subscribers in a conventional insurance or managed plan care
- often deducted from paychecks
Premium
The portion of a health care bill the patient is required to pay when services are rendered
- a cost per visit
Copay
An upper limit on the amount of out-of-pocket expense an insurance subscriber is required to pay each year beyond that limit insurance pays 100%
Catastrophic cap
The amount of out-of-pocket expense an insured individual is required to pay before receiving financial assistance from insurer
Ex: you might pay first $500 of your emergency room bill, and insurance will pay 80% of the remaining cost
Deductible
- HMO
- PPO
- HDHPs
Different types of managed health care
A managed health care organization that offers enrollees a variety of health services for a set monthly fee and copays
- Provider networks
- Cannot see specialist unless such care is recommended by a provider
- Not third-party or fee-for-service
Health Maintenance Organization (HMO)
A managed health care organization that pays independent caregivers a discounted fee for each service they provide to their members
- Patients may visit providers not on the preferred list, but they pay higher fees to do so
- operate on a fee-for-service basis
Preferred Provider Organization (PPO)
A managed health care plan with lower than normal premiums but higher than normal deductibles and out-of-pocket spending caps
- most qualify members to establish tax-exempt health saving accounts
- appealing to people on limited budgets
High-deductible health plans (HDHPs)
The provision that all citizens ( and in some countries, temporary residents and visitors) are assured health care
Ex: Italy
Universal coverage
A system of universal coverage in which one source (a government or a privately run national health insurance plan) pays
- usually funded by tax dollars
single-payer system
A system in which health insurance is provided by a variety of sources, usually including both private companies and government programs
- may or may not include universal coverage
- typically funded by a mixture of individual contributions and tax dollars
multi-payer system
A rule requiring everyone to have health insurance
- option for universal coverage in a multi-payer system
indvidual mandate
Goal: universal coverage
Funding: increasing tax revenue and lowering costs (long-term) by covering more people
Affordable Care Act (ACA)
- multi-payer system
- health benefit exchange
- coverage of the “essential 10”
- parental coverage until 26 years old
- free prevention and wellness exams
- individual mandate
- employer mandate
- Insurance policy reforms
- health care resources
- federal-state partnership
provision of the Affordable Care Act (ACA)
