define health
state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
what was the leading cause of death in the US in 2007
diseases of the heart
what is the central focus of health care
restore health or prevent exacerbation of health problems
what is the goal of primary health care
prevention (eliminate risk factors for a disease)
what is the goal of secondary prevention
early detection of disease so treatment is more effective
what is the focus of tertiary prevention
focuses on treatment of identified disease to reduce the incidence of later complications
what are the management elements of healthcare
administration, planning, regulation and evaluation
what criteria can health care systems be judged on
quality of health care provided, equity achieved in the provision of health care, efficiency
what does primary care include
personal treatment and preventive measures
what type of care do most people need most of the time
primary care
what does secondary care include
most surgical procedures, diagnostic and treatment interventions of specialists
what are the 2 main types of health care facilities
inpatient and outpatient
what are the 4 ways to categorize hospitals
by control, size, function and average length of patient stay
what are the 4 functional categories of inpatient care
general, special, rehabilitation and chronic disease, psychiatric
what type of hospitals are all non-federal, short-term general and special hospitals whose facilities and serves are available to the public
community hospitals
what is the average number of people served on an inpatient basis on a single day
average daily census
what accounts for the largest portion of US health care spending
hospitals (31%)
what is the primary agency that counts and classifies hospitals in the US
AHA
what percentage of nonfederal hospitals are community hospitals
86%
what is the role of the executive committee
provides overall coordination and sets general policy
what is the role of the joint conference committee
serves as liaison between the medical staff and the hospital’s governing board
what is the role of the credentials committee
reviews applications to join the medical staff and controls the periodic reappointment process
what percentage of nursing homes are for-profit
66%
what percentage of nursing homes are not-for-profit
26%
where does the majority of nursing home financial support come from
public funds
what type of care is given to a person who is not a bed patient in a health care institution
ambulatory care
what setting do most physician-patient contacts occur
ambulatory care settings
what speciality is visited the most in ambulatory care settings
general and family practice
what is the major source of payment for ambulatory visits
private insurance
what are the 3 categories presenting to EDs
non urgent, urgent, emergent
describe non urgent presentation to ED
condition does not require the resources of an ED (condition is not acute or is minor)
what was the rate of ED visits for the uninsured in 2007
41.6 visits per 100 persons
what was the rate of ED visits for persons with private insurance in 2007
19.9 visits per 100 persons
what was the physician/population ratio in 2008
27.7 per 10,000
what type of physicians have a gatekeeper function
primary care physicians
under the US constitution, where does the federal government’s authority concerning health and health services come from
the powers to tax and spend to provide for the general welfare and the ability to regulate interstate and foreign commerce
what branch of the federal government writes regulations for administering legislation
executive branch
what branch of the government determine if legislation is constitutional and if regulations exceed the original statutes
judicial branch
what branch decides things if contract disputes occur
judiciary
what is the most important federal agency involved in the delivery of healthcare
DHHS
what is the focus of the FDA
efficacy and safety
how long must someone serve for the armed services to be considered a veteran for VA services
90 days
what is the name of the military health insurance program
TRICARE
what does “therapeutics” include
equipment and pharmaceuticals
what does national health expenditures (NHE) include
health consumption expenditures, investment in healthcare structures and equipment, noncommercial health care research to procure future health care expenditures
what is most of the natural health expenditure from
person health care (84%)
what is a deductible
fat amount that an individual or family must pay out-of-pocket before the insurance company will begin paying during some set time period
what does MCO (managed care organization)determine
determines what care the patient is entitled to and under what circumstances
when was medicare established and by what
by congress in 1965, authorized by title XVIII of the social security act
describe part A of medicare
hospital insurance (covers limited skilled nursing care also)
describe part B of medicare
supplementary medical insurance which covers physician and some other health professional services, hospital outpatient care, and some other services
describe part C of medicare
permits medicare beneficiaries to enroll in managed care organizations
describe part D of medicare
medicare prescription drug coverage which was designed to lower the cost of prescriptions for medicare beneficiaries
what is part A of medicare funded primarily from
social security taxes
what is part D of medicare funded from
through premiums
what is the majority (2/3) of part B off medicare funded from
general revenues with the balance form enrollee premium payments
what is medicare operated by
centers for medicare and medicaid services (CMS)
how are payments for services determined in the RBRVS system
by the resource costs needed to provide them
what components are the cost of providing services for medicare payments divided into
physician work, practice expense, professional liability insurance
why were DRGs implemented
to control medicare expenditures
describe medicaid
needs-based program that provides coverage for some health services for some of the poor on a “means tested basis”
how is medicaid supported and administered
supported by federal and state tax funds and is administered by the states
what 3 criteria are health care systems generally evaluated on
quality, equity, and efficiency of health care
what was the average life expectancy for all US residents in 2011
78.7
when was the children’s health insurance program (CHIP) created
1997
when was the sustainable growth rate (SGR) created
1997
when was the medicare prescription drugs benefit (medicare part D) created
2003