Health Care Trends

Question 1

Scientific Management : Early 1900’s

Answer 1

Grew out of industrial revolution 
Time & Motion Studies 
Worker Efficiency (productivity) 
Monetary motivation 
Process efficiency (cost of therapist vs therapy aids)

Question 2

Human Relations Movement

Answer 2

Studies of work environment
-increase productivity -> lighting & physical condition changes? vs. social relationship?
Maslow’s hierarchy of needs
Lack of empirical research that work productivity and job satisfaction were strongly correlated

Question 3

Behavioral Science Movement (1950’s)

Answer 3

Worked to understand work performance and to study human behavior in organizations

• redesign routine jobs to allow a broarder range of roles
• be aware of informal groups and culture of an organization

Question 4

Groupthink

Answer 4

Difficulty w/ autonomus decision making

Question 5

Pareto Principle

Answer 5

20% of what happens in clinic produces 80% of the work.

i.e. nurture long standing relationships w/ physicians who refer to you, you can expand on that realtionship

Question 6

Peter Principle

Answer 6

Next in line gets the job even if they may not be the most qualified

Question 7

Systems Approach

Answer 7

looking at whole and parts : internal & external

Question 8

Contingency Approach

Answer 8

Applying best available info to current situation

Question 9

Learning Organization

Answer 9

Democracy style
Focuses on evolution of an orginization and values transparency, communication, and less hierarchal activity
Works best when everyone is a professional

Question 10

Medical Model

Answer 10

Short term

Includes history, and physical, Dx, and tx to alliviate or cure an underlying medical condition

Question 11

Educational Model

Answer 11

Services are aimed at adaptation and performance w/in the educational setting

Question 12

Public Health Model

Answer 12

Achieve health or populations through

• prevention of disease: eating nutritious foods to prevent obesity and other related diseases
• slow progress of disease: to prevent disability and complications (secondary prevention)
• tertiary prevention used in advance levels of disease to limit disability and other complications

Question 13

Social Model

Answer 13

Longer term maintenance and episodic restorative services (health promotion and prevention of further decline)

• clients w/ stable health conditions at risk from social isolation, reduced family support
• focus is on social barriers to prevention

Question 14

OT Practice Settings Medical Model

Answer 14

Acute hospital (medical or psych) 
Acute rehab 
Subacute rehab
Home health 
Nursing home 
Free standing out pt. or out pt. at a hospital
Private physician office

Question 15

OT practice Settings Public Health Model

Answer 15

Community Education 
-health insurance company
-Public health agency (CDC, APHA) 
-Private industry 
Research 
-National institute for health

Question 16

OT Practice Settings Educational Model

Answer 16

School system 
Pre school 
Day Care 
EI home health 
EI out pt. clinic

Question 17

OT Practice Setting Community Model

Answer 17

Senior center 
Group home , I living center 
Retirement center 
Sheltered workshop
Prevocational programs 
Community mental health center

Question 18

United States Health Care Now

Answer 18

1st in health care spending

37th in overall health care performance

Question 19

Challenges in US health care

Answer 19

Rising costs
Emphasis on outcome and accountability
Lack of services to meet specific needs
Imbalance in services available to different populations
Frequent advances in medical terminology
Increase government and public scrutiny of industry practices

Question 20

FDR “Right to Health”

Answer 20

Ethical responsibility of an industrialized nation

Question 21

FDR 1930’s

Answer 21

Creation of the first insurance company

-Blue cross & blue shield

Question 22

FDR 1944 : Roosevelt’s Economic Bill

Answer 22

Set forth fundamental social and political rights part of which was the right to health
Health insurance became an employee benefit

Question 23

Hill Burton Act (1946)

Answer 23

Promotes building of hospitals and later free-standing health facilities and later control over-growth and duplication of services (in 70’s & 80’s)

Question 24

1950’s Funds For

Answer 24

Encouraging more schools and training of medical personnel

Question 25

1965 National Insurance Established

Answer 25

``` Medicare (elderly) Medicaid (poor) Based on FFS initially -Fee for service -80/20 w/ no limit to costs ```

Question 26

1972: Amendment to the Social Security ACT

Answer 26

Drove focus toward professional standards review to monitor and control costs and quality

Question 27

!966 Allied Health Professional & Personnel Training ACT

Answer 27

Grant funding to establish schools

Question 28

1970's & 80's Laws Changed d/t spiraling costs of FFS

Answer 28

Established Managed Care - integrated delivery system between payor (insurance company) & care provider (physician or hospital) - Intention to reduce spiraling costs ``` HMO = health maintenance organization PPO = preferred provider orginization POS = Point of service ```

Question 29

1983 Amendment to Social Security Act

Answer 29

Focused on change to in pt. hospital care costs Due to rising costs w/ new technology (ordered things like MRI's that people didnt need to drive up the cost) Many community hospitals closed

Question 30

1986 PPS

Answer 30

Prospective Payment System Medicare began to look at controlling costs Predetermined rate is set for tx of specific illnesses in the hospital setting

Question 31

Hospitals now paid for care based on DRG's

Answer 31

Diagnostic Related Groups -Also known as the product being provided -467 categories initally Closely linked to the patients ICD = international Statistical Classification of Diseasses -in pt. psych issues

Question 32

80's Prospective Payment System

Answer 32

Pushed for less emphasis on hospitalization... incentive to move pt.'s out of hospitals fast as possible encourage expansion of community services

Question 33

1986 Legislation

Answer 33

Expanded coverage of out pt. and rehab based OT services by expanding funding for medicare part B -Medicare part A : in pt -Part B : Supplementaty medical insurances Includes OT services furnished in a SNF, rehab agency, public health agency, or by an I practicing therapist

Question 34

1993 Clinton health care plan

Answer 34

Failed to Pass Universal Health care through a national plan -blocked by lobbyists representing AMA and private health insurance companies

Question 35

1997 State Childrens Health Insurance

Answer 35

Program based on H Clinton | Program to cover uninsured children in families w/ too high income to qualify for medicare

Question 36

1996 HIPPA

Answer 36

Health Insurance Portability and Accountability Act - Assures insurance coverage during time of employment change - Gives small businesses insurance options - Protects patients privacy rights regarding their medical record

Question 37

1997 IDEA

Answer 37

Mandates service delivery in the school system Part B mandates services to 3-5 year preschool Part C mandates services for 0-3 years

Question 38

2003 Bush Ea\ra

Answer 38

Medicare prescription drug act (Part D) | HSA - Health savings account

Question 39

2006 Massachusetts

Answer 39

1st state to require all adult residence purchase health insurance or face legal consequences

Question 40

2008 HIPPA

Answer 40

Passed in 1996 but not really enacted until 2008 amendment - gave more specific language to assure follow through - added Mental Health Parity and Addiction Equity Act (MHPA)

Question 41

2010 ACA -> Obamacare

Answer 41

Patient protection and affordable care act - signed into lay March 2010 - goal of full enactment by 2017 - Requires most US citizens and legal immigrants to have healthcare coverage

Question 42

Primary Practice Settings

Answer 42

``` 61% Medical 27% Schools & EI 5% Academia 3% Mental Health 4% Other ```

Question 43

OT's in Practice Areas : Increase

Answer 43

General hospital neonate intensive care EI centers Psychiatric units of general hospitals Rehab units in hospitals and nursing homes

Question 44

OT's in Practice Areas : Decrease

Answer 44

Community mental health & psych hospitals Voc & pre-vocational programs Rehab hospitals