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HCM > HCM II > Flashcards

HCM II Flashcards

1
Q

What are the three ways health care system success is judged?

A

Quality (structure, process, and outcomes), equity, and efficiency

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2
Q

What is the difference between secondary and tertiary care?

A

Secondary care - services in physician’s office and hospitals (treatment specialists - radiologists, cardiologists), whereas tertiary is highly specialized therapeutic and rehab services that require staff and equipment beyond the average hospital (open heart surgery, chemotherapy)

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3
Q

What are the 4 categories of in-patient care facilities?

A

General, special, rehab/chronic disease, psych

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4
Q

Most physician-patient contact occurs in which type of health care facility?

A

Outpatient

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5
Q

How much of US health spending did hospitals account for in 2008?

A

31%

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6
Q

Most of the US health spending goes to community hospitals, how many were not-for-profit, and how many were state/local govt. owned? How many were privately, for profit-owned?

A

58% were not-for-profit, and 22% were state/local government owned. 20% (lowest amount) were investor/for-profit owned.

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7
Q

What is the purpose of the joint conference committee?

A

Serve as a liason between medical staff and hospital’s governing board.

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8
Q

What is the purpose of the QA/QI committee?

A

Monitor and correct any deficiency, in the quality of care by the medical staff.

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9
Q

What is the structure of non-profit and for-profit hospital structures?

A

They have a board of trustees, usually the people who give lots of money to the hospital, and you can have a Pres, or a paid CEO (if same person called the Executive VP/director)

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10
Q

What percentage of nursing homes are for profit, non-profit, and government owned?

A

66% for profit, 26% not for profit, and 8% government owned

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11
Q

Where do more than 1/2 of nursing home financial funds come from?

A

Medicaid/medicare (public funds)

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12
Q

What kind of things do Managed Care Organizations refer to?

A

HMO’s and PPO’s (reduce cost, and improve quality of care)

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13
Q

What are the 3 categories present to emergency departments?

A

Non-urgent, urgent (requires medical attention in a few hours), and emergent (immediate medical attention required)

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14
Q

What do public health departments operate clinics based on?

A

Functions primary physicians have not wanted to focus on. Including: TB control, child health, prenatal care, STD control, and mental health problems

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15
Q

What kind of doctors does the term “primary care” cover?

A

Family medicine, Peds, Geriatric, OB/GYN, Internal medicine

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16
Q

This type of nurse is licensed after passing an exam, and has an AA or a BS in nursing.

A

RN

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17
Q

This type of nurse undergoes a 12-18 month program, after earning a HS diploma. The work requires a lower skill/knowledge level compared to an RN.

A

LPN

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18
Q

This kind of nurse does not require a HS diploma, and undergo a formal education program or learned on the job.

A

Nurse’s Aide

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19
Q

What kind of things can a PA do?

A

Conduct physical exams, diagnose/treat illnesses, order/interpret tests, counsel on preventative health care, assist in surgery, and write scripts.

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20
Q

Where does the federal government derive its powers regarding health care, and what powers are they?

A

US constitution, those population not profitable to care for/difficult, and has the power to tax and spend to provide for the general welfare, and regulate interstate and foreign commerce.

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21
Q

What kind of powers do states have, that lets them regulate health care?

A

“Police” powers, to provide for health, safety, and welfare of the people. States delegate to local governments (county health departments, and programs)

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22
Q

What is the difference between the roles of the legislative branch, executive branch, and judiciary branch?

A

Legislative branch enacts laws. Executive branch writes the regulations for administering legislation. The judiciary branch then determines if the legislation is constitutional.

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23
Q

What is the role of the U.S. department of health and human services?

A

operates >300 programs, promote health, social, and economic well-being of every American, in particular those that cannot help themselves, and helping them develop and lead healthy lives.

24
Q

What is the role of the Dept of Defense/Veterans Affairs?

A

Provide services to veterans and their families. There are 152 VA hospitals, 1 at least in each state, Puerto Rico, and DC.

25
Q

What is the name, of military health insurance?

A

Tricare

26
Q

What act does the Department of Labor administer?

A

OSHA, occupational safety and health act

27
Q

What does the Department of Health & Human Safety do?

A

Provide financial support through grants and contracts, and provide federal support for research through the NIH.

28
Q

The Public Health Services operate what?

A

NIH & CDC

29
Q

Radiological equipment is regulated by which administration?

A

FDA

30
Q

What are the resources the Indian Health Services (IHS) provides native americans/Alaska natives that live on/near a reservation?

A

28 hospitals, 58 health centers, 31 health stations, and 5 school health centers.

31
Q

What percentage of national health expenditure are therapeutics?

A

13%, over 170 billion dollars

32
Q

What items are included in the National Health Expenditures?

A

Health consumption expenditures, investment in equipment, and non-commercial research.

33
Q

Why is there an increase in expenditures in healthcare?

A

Expensive technology is more frequently used, especially at the beginning and end of life.

34
Q

What percentage of national health expenditures are for personal health care?

A

84%

35
Q

What do out-of-pocket expenditures include?

A

Payments to providers for non-insured services, extra payments if insurance company doesn’t cover something. (Deductible: flat amount the individual has to pay, before the insurance company will being paying), and co-insurance/co-pay, a share of service that the patient has to pay.

36
Q

Third party payers are responsible for paying for health care that are not the:

A

Patient, patient’s family, or health care provider

37
Q

What percentage of Americans have private insurance?

A

About 64% (decrease from 73% in 1990)

38
Q

What kind of profit is Blue Cross/Blue Shield?

A

Not-for-profit, but affiliated with some for-profit affiliates

39
Q

How do Managed Care Organizations work?

A

Patients contract with the MCO for the duration of care, the MCO is paid for the provision of that care, often by the patient’s employer.

40
Q

When was medicare established by congress, and what title of the Social Security Act was it authorized by?

A

Est. in 1965, authorized by Title XVIII

41
Q

Who is eligible for Medicare?

A

People 65 and older, permanently disabled workers & dependents eligible for disability payments, & lastly people with end-stage renal disease.

42
Q

What are the 4 parts of Medicare?

A

Hospital insurance
Supplementary Insurance (other services)
Medicare + choice (enroll in MCO’s)
Medicare Prescription Drug Coverage

43
Q

Where does funding for Medicare come from?

A

Hospital insurance comes from SS taxes
MCO enrollment (2/3 from general revenues and premium payments)
Prescription Drug Coverage funded through premiums

44
Q

How does medicare pay physicians?

A

Standardized schedule, based on resource-based relative value scale (RBRVS)
(payments determined by resource costs)

45
Q

What 3 components are the costs of physicians providing services divided into?

A

Physician work, practice expense, professional liability insurance x conversion factor

46
Q

How does medicare calculate reimbursement for hospitals?

A

Diagnosis Related Group, provides a formula, that allows payment on an “episode of care” basis

47
Q

What codes does the Diagnosis Related Group utilize?

A

ICD-9 codes

48
Q

What has the total medicare expenditure risen to now?

A

500 billion

49
Q

Medicaid is what type of program?

A

Need-based program, that gives coverage on a “means/income” tested/based manner

50
Q

What funds is medicare supported by?

A

Federal/state tax funds

51
Q

What does the State Children’s Health Insurance Program do?

A

Created in 1997

Provide coverage for uninsured kids not eligible for Medicaid (financed by federal and state governments)

52
Q

What is the role of NGO’s?

A

Perform the services that other health care agencies do not carry out, and pursue research.
Work to advance public interest, and carry out certain tasks when asked by the government.

53
Q

What are the 2 levels that health-care systems may be evaluated at?

A 
Micro level (physicians, hospitals)
Macro level (regions, states, nations)
54
Q

What is the average life expectancy currently?

A

78.7, gap between males/females is getting smaller. US ranked 10th-males, 12th-females, in life expectancy)

55
Q

What are some clinical outcomes measurements?

A

Readmission into hospitals, long term pain, nosocomial infections, 5 year mortality rate for patients treated with cancer, heart disease, etc.

HCM (1 decks)

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