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HOSA: Human G&D > Government Influence on Health > Flashcards

Government Influence on Health Flashcards

(63 cards)

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1
Q

Early health insurance was first really seen when?

A

early 19th century

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2
Q

what sparked changes in early health insurance?

A

WWI & Great Depression

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3
Q

What health insurance companies were initially created primarily for elderly protection?

A

Blue Cross & Blue Shield, Social Security (Medicare & Medicaid)

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4
Q

define Health Maintenance Organizations (HMO)

A

provider takes some financial risk; patient uses PCPs & pay monthly fee regardless of service used & must go to HMO provider for coverage, if not must pay out of pocket

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5
Q

define Preferred Provider Organizations (PPO)

A

contract of network of providers to private sector for discounted fee & patient must pay extra fee if using physician outside of network; PPO must approve specialist visit/hospitalizaitions; generally have deductibles & copays

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6
Q

define point-of-service (POS)

A

providers are paid a pre-set payment based on membership/risk & people choose PCPs @ own risk

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7
Q

define Consolidated Omnibus Budget Reconciliation Act (COBRA)

A

health insurance protection for those leaving jobs

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8
Q

Health Insurance Portability & Accountability Act of 1996 (HIPAA) covers what

A

protect PHI, prevents fraud & abuse, administrative supplication & liability reform, application & enforcement of health plan requirements, revenue offsets, & tax-related provisions

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9
Q

define Children’s Health Insurance Program (CHIP)

A

coverage for low-income families not qualifying for Medicaid & in some states pregnant women; federally & state funded

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10
Q

define Affordable Care Act (ACA)

A

health insurance for uninsured & improve coverage of insured to focus on illness prevention, wellness, & equal access to healthcare; makes easy to understand insurance benefits & coverage; expanded Medicaid, & shit more

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11
Q

The affordable care act is also called what

A

Patient Protection & Affordable Care Act (PPACA)

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12
Q

The ACA expanded Medicaid by doing what

A

making certain preventative health measures free, insurance can’t refuse patient bc of pre-existing condition, children covered by parent until 26, companies must provide insurance if at least 50 workers, & creation of state health care

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13
Q

define the World Health Organization (WHO)

A

part of the UN w/the goal of worldwide health promotion & improve health access (thru disease prevention, early detection, & treatment)

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14
Q

what functions does WHO does?

A

coordinate global efforts against health treats & monitors re-emergence of infectious diseases

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15
Q

describe the Centers for Disease Control & Prevention (CDC)

A

under US Dept. of Health & Human Services w/the goal of improving public health by setting guidelines, disease & disability prevention, infection control, & general safety; performs research & disseminates info to public

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16
Q

define the National Institues of Health (NIH)

A

under US Dept of Health & Human Services; conducts public health & medical research

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17
Q

define Medicare

A

covers all people at least 65 yrs, disabled w/SS benefits of at least 2 yrs, & ppl w/end-stage renal disease; composed of 4 parts (A, B, C, D)

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18
Q

define Medicare part A

A

health insurance contributions from employer & employee

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19
Q

define Medicare part B

A

pays for doctor fees & other services (preventative or medically necessary) as long as provider accepts; may need to pay premium & deductible?

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20
Q

define Medicare Part C

A

covers health plans such as HMOs & PPOs

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21
Q

define Medicaire part D

A

covers prescription drug program to lower cost

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22
Q

Medigap

A

health insurance help pays expense not covered by Medicare through private companies; patient pays premium & chooses coverage

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23
Q

Medicaid

A

under social security funded by federal & states where services & qualifications vary by state ; generally for low income, kids who need public assistance, physically disabled & blind

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24
Q

Older Americans Act

A

protect institutionalized elderly thru ombudsman programs

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25
Ombudsman programs
programs w/representative or spokesperson generally for elderly
26
Patient self-determination Act
covers living wills & health care proxies & gives directives to any facility getting any federal aid
27
according to the patient self-determination act, any facility getting any federal aid must do what things
- inform patient of rights orally & in writing - provide info & assistance in prep advance directions - document any advance directives - provide written statements to implement rights in decision process - affirm no discrimination/effect on care bc of directives - educate staff on directives
28
define manipulative experiments
changing 1 variable
29
define longitudinal studies
some individual observed over period of time
30
define cross-sectional studies
compare groups of various ages
31
naturalistic experiments
observe only
32
individuals w/disabilities education act (IDEA)
federal law governing how states provide early intervention, SPED, & services for kids w/disabilities
33
Individualized Education Plans (IEPs)
required by IDEA for kids w/specific learning disability; includes specific goals, placement agreement, development team, & classroom inclusion
34
What learning disabilities qualify for IEPs?
disabilities that impair use/understanding of language (listening, speaking, reading, writing, spelling, or calculating)
35
What disabilities/problems do not qualify for IEPs?
issues from physical/cognitive disabilities, emotional illness, or emotional/cultural disadvantages
36
Head start
government pre-K for disadvantages
37
list efforts or methods for cost containment in healthcare
diagnostic-related groups, value-based compensation/bundled payments, combination of services, outpatient services, mass/bulk purchasing, early intervention & prevention, environmental protection, energy conservation
38
what are diagnostic related groups (DRGs)
people w/certain diagnoses put as 1 payment & put limit on cost of care
39
what is value-based compensation/bundled payments
providers paid amount for each diagnosis instead of fee for every service or test
40
what is combination of services
utilizing large labs/joining of multiple agencies (ex: 5 clinics use Sonora quest)
41
Agency for Healthcare Research & Quality (AHRQ)
agency to make healthcare safer, more accessible, equitable, affordable, better quality, avoid waste, & keep cost down
42
Omnibus Budget Reconciliation Act of 1987 (OBRA)
regulations for long-term care & home health care, require training & evaluation for nursing & geriatric assistants, cover certain rights
43
what rights are covered by OBRA of 1987? (10)
free choice of physician, treatment care, & research participation; freedom from abuse & restraint; privacy & confidentiality; accomodations of needs & choice; voice grievances w/o fear; organize & participate in group activities; information; manage personal funds & possessions; unlimited access to familes; remain in facilities w/exceptions
44
US Dept. of Health & human services (USDHHS)
goal to protect health of all Americans & gives most grant money
45
Office of National Coordinator for Health Information Technology (ONC)
monitors private & secure health info exchange w/goal of quickly exchanging PHI among providers
46
public health
provides services directed by USDHHS, recommend mandates, provides wide range of services
47
Veteran's Adminstration (VA)
healthcare for veterans & families; largest US integrated health care system
48
Joint Commission
nonprofit ensuring healthcare quality
49
What does the Joint Commission stand for
The Joint Commission on Accreditation of Healthcare Organizations
50
Worker's Comp
health insurance for treatment of injured workers from state paid by state & employer, reimbursing wages lost due to injury
51
TRICARE
insurance for all active military & families, military personnel survivors, & retired
52
What are the 8 rights onPatient's Bill of Rights
information, choice of provider, access to emergency services, autonomy, complaint & appeal, privacy, justice, & patient responsibilities
53
Supplemental nutritional assistance program (SNAP)
food stamps, supervised by social security
54
WIC
special supplemental food program for pregnant & lactating women, infants, & kids through 4 yrs
55
Commodity Supplemental Food Program (CSFP)
run by US Food & Nutrition Services for pregnant & postpartum women, infants, kids through 6 yrs, & adults +60 yrs
56
Senior Farmers' Market Nutrition Program (FMNP)
food program associated w/WIC giving coupons & food from farmer's markets & roadside stands
57
WICFMNP demographic
for infants, kids thru 4 yrs, pregnant & lactating women
58
SFMNP demographic
for adults +60 yrs
59
Child Protective Services (CPS)
run by each state in charge of children's safety & health
60
Children's defense fund
nonprofit focusing on minorities, low income, & special needs for health, education, safety, & financial standard of living
61
Early intervention
state program for kids under 3 yrs w/disability/developmental delay to help kids progress in development
62
Save the Children
global organizations focusing on health, education, & safety that help communities rebuild after disaster by providing food, medical care, & education
63
United Nations Children Fund (UNICEF)
focus on education, health, & safety; globally provides education, immunizations, clean water & sanitation, nutrition, & emergency relief

HOSA: Human G&D (15 decks)

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