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P2 SPRG Other Classes > Health Systems > Flashcards

Health Systems Flashcards

1
Q

T or F: the United States has evolved much differently than other OECD countries

A

True

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2
Q

Within the United States healthcare system, physicians operate as what within the system?

A

separate entities

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3
Q

It is important to note the __ insurance provision which consists of employer sponsored, private insurance, managed care, and federal government payers

A

fragmented

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4
Q

US policy operates through what?

A

incrementalism
small patches to sole fundamental problems

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5
Q

What has been the primary driver of reforms?

A

cost reduction

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6
Q

How has the pharmacists’ role transitioned over time within the US healthcare system?

A

from apothecary/compounding to dispensing to clinician

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7
Q

The US healthcare system was shaped mostly by physicians desire to maintain what? (2)

A

economic control and career
autonomy

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8
Q

The American Medical Association strengthened education, and began to control and standardize what? (3)

A

practitioners
licensure
education

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9
Q

John Morgan was both a physician and a pharmacist, considered the 2nd pharmacist at Philidaphia’s hospital, advocated for Rx writing, and called for the separation of what three entities/professionals?

A

physicians
surgeons
pharmacists

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10
Q

List the 4 societal forces that were important to note as we entered into the 20th century.

A

urbanization
population communication and mobility
science and technology
corporations ad hospitals/asylums

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11
Q

This was a commission report by the Carnegie Foundation with funding and support from the AMA, ad it was found to be the final nail in the coffin for many for-profit colleges competing with endowment and state-funded schools; considered the start of high medical education following this report

A

Flexner Report (1910)

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12
Q

The beginning of ___ in 1929, which became the major health insurance provider

A

Blue Cross/Blue Shield

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13
Q

Along with Blue Cross/Blue Shield, there was a rise in HMOs which included the first HMO __, and the most well known HMO __

A

Ross-Loos Clinic (1929)
Kaiser Permanente

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14
Q

Blue Cross plans demonstrated that __ allowed for underwriting of medical costs; which is a transition from strictly accident coverage to preventative measures

A

prepayment plans

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15
Q

The inclusion of health insurance in __ with unions starting in the 1940s made employers the largest providers of health insurance for the next decades to come (and even so today)

A

collective bargaining agreements

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16
Q

In 1944, Social Security board called for what as part of the Social Security System?

A

compulsory national health insurance

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17
Q

Who strongly campaigned against national health insurance?

A

AMA and southern democrats

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18
Q

There was a time where we had multiple attempts for comprehensive healthcare coverage from multiple politicians in what political parties?

A

both political parties

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19
Q

In 1951, the Joint Commission in the Accreditation of Hospitals formed, and the goal of the Joint Commission was what?

A

to improve quality of hospital care through voluntary accreditation

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20
Q

In 1951, this Amendment defined the kinds of drugs which require medical supervision and restricted their sale to prescription by a licensed practitioner

A

Durham-Humphrey Amendment

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21
Q

In 1965, President Johnson signed into law what important piece of legislation?

A

Medicare and Medicaid (Amendments to Social Security Act of 1935)

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22
Q

The original parts of Medicare were which parts?

A

Part A and Part B

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23
Q

This was covered long-term care of poor and health insurance to elect impoverished and disability groups

A

Medicaid

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24
Q

List 3 factors linked to passing Medicare and Medicaid

A

Social
Legislative
Lobbying support

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25
Q

In 1962, this was passed and required drug manufactures to prove effectiveness of products before marketing them

A

Kefauver-Harris Drug Amendment

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26
Q

In 1972, the Social Security act was amended again and expanded to which individuals?

A

<65 years old with long-term disability and ESRD

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27
Q

Medicare and Medicaid ultimately led to a HUGE increase in healthcare costs and therefore this started the __ era by government

A

health regulation

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28
Q

__ insurance schemes were developed as a form of cost control

A

private

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29
Q

Who become the primary driver of reimbursement policy and insurance schemes through its policy and implementation efforts?

A

CMS

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30
Q

During what presidential era was the Vaccines and Children Program established as a way to provide federally purchased vaccines to states?

A

Clinton Era (1993-2000)

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31
Q

In 2003, during the Bush era, the Medicare Drug Improvement and Modernization Act coined what term?

A

Medication Therapy Management

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32
Q

In 2010, during the Obama era, which important act was passed that created an insurance marketplace?

A

Affordable Care Act

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33
Q

This branch of government is primarily responsible for enacting laws, creating and funding health programs, and balancing health policy with other policy domains

A

Legislative Branch

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34
Q

This branch of government is primarily responsible for implementation of laws, proposing legislation, approving or vetoing legislation, promulgating rules and regulations

A

Executive Branch

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35
Q

This branch of government is primarily responsible for the interpretation of Constitutional and statutory law, developing body of case law, preserving rights, and resolving disputes

A

Judicial Branch

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36
Q

T or F: the political policy cycle is a convoluted and fast-moving process that demonstrates incrementalism

A

False - slow moving process

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37
Q

What are the 3 processes that take place to create a policy?

A

policy formulation
policy implementation
policy modification

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38
Q

It is important to note, that we should not overlook what type of health policy?

A

state

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39
Q

Public policies that pertain to health are called what?

A

Health policies

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40
Q

Most laws direct an __ to create regulations and rules

A

executive branch agency

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41
Q

The rule making process is made up of 3 parts:

A

posting regulations
public comment
final rule

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42
Q

These are policies that distributor redistribute finite resources and often provide net benefits to one group at the expense of others to meet policy objective

A

allocative health policies

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43
Q

These are directives that influence the actions, behaviors, or decisions of others and examples include: licensing of practitioners, certificates of need, FDA safety/efficacy regulations, antitrust regulations, workplace safety

A

regulatory health policies

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44
Q

this phase of the policy cycle is responsible for agenda setting which involves problems, possible solutions, and political circumstances (and when these align, it is the window of opportunity)

A

policy formulation

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45
Q

List characteristics of problems that get on the agenda (4)

A

important and urgent
issues/trends that reach an unacceptable level
widespread applicability
closely linked to other problems

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46
Q

T or F: a single solution is preferred/best

A

true
fewer solutions expedite the process

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47
Q

The selection of a solution or solutions often have what 3 dimensions?

A

scientific
political
economic

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48
Q

Political circumstances either open or close the window of opportunity and __ deems it necessary, depending on the competing issues on the agenda already, often a numbers game

A

political will

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49
Q

List the steps of Legislative Development in order

A
  1. originate and draft legislative proposal
  2. introduce proposal to entire house or senate
  3. refer proposed legislation to standing committee
  4. committee conferences and then votes on proposed legislation
  5. House or Senate then votes on proposed legislation already approved by committee
  6. the other House or Senate votes or amends
  7. President action on proposed legislation
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50
Q

Hearings provide a forum where facts and opinions can be presented from witnesses with varied backgrounds, and those backgrounds may include the following:

A

government officials
spokesperson for interest groups
researchers and other academics
interested citizens

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51
Q

List 4 ways that interest groups influence policy making

A

lobbying
electioneering
litigation
shaping public opinion

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52
Q

This is the second phase of the policy cycle which includes both rulemaking and policy operations

A

policy implementation

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53
Q

Policy implementation is a management exercise typically carried out by which type of agency?

A

executive branch agency

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54
Q

this is establishing formal rules necessary to effectively carry out the intent of a new legislation/law

A

rulemaking

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55
Q

these are activities of implementing an agency to carry out the law

A

operation

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56
Q

What is the primary role of the executive branch agencies?

A

implementation of laws formulated by legislative branch

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57
Q

What is the primary role of legislative branch oversight?

A

utilizing standing committees for direct oversight of executive branch agency
also appropriation committee for funding purposes

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58
Q

What is the primary role of the judicial branch in policy implementation?

A

review administrative agency decisions
review administration procedures act

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59
Q

How are the policy formulation phase and the policy implementation phase bridged/connected?

A

through formal enactment of legislation

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60
Q

This is the phase of the policy cycle where the majority of health policies are focused around

A

policy modification

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61
Q

Continual modification of US health policy making processes is best described as what?

A

incrementalism

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62
Q

T or F: most policy modification goes through a different process as initial/original policy

A

False
same process

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63
Q

Which level of government utilizes police power to regular behavior and enforce order within their territory for the betterment of the general welfare, morals, health, and safety of their inhabitants?

A

State

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64
Q

What are considered the largest healthcare entities, having more specialized personnel, services, and technology, being the most expensive, and bearing a large burden of uncompensated care?

A

hospitals

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65
Q

Because hospitals are the most expensive and bear a large burden of uncompensated care, this is a large target for what?

A

cost reduction

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66
Q

What type of care is growing, as there are expanding opportunities for ambulatory care and community pharmacy within these settings?

A

outpatient care

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67
Q

Health care services include what 4 domains?

A

prevention
acute care
chronic and rehabilitation
palliative

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68
Q

This is preventing initial development of disease

A

primary prevention

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69
Q

this is early detection of existing disease in order to cure or control the effects of an illness

A

secondary prevention

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70
Q

These are actions to prevent damage, slow progress, or prevent additional complications from a disease in individuals who have symptoms

A

tertiary prevention

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71
Q

Short-term, intensive medical care providing diagnosis and treatment for diseases, illness, or injury and includes the following settings:
- prehospital care
- urgent care
- emergency care and/or short-term stabilization
- surgery or other procedure
- ICU
- hospitalization, general medicine unit

A

acute care

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72
Q

the first and most general source of care for routine treatment of illness and disease

A

primary care

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73
Q

care provided by specialists or sub specialists in the medical field

A

secondary care

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74
Q

care at the site of emergency, before ED, typically involves stabilization before transport to ED

A

Medic and/or ambulance care

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75
Q

care for illness, injury, or condition that is serious enough for a reasonable person to seek care right away, but not serious enough for an ED

A

urgent care

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76
Q

urgent care clinics and EDs are a common source of care for what types of patients?

A

uninsured or underinsured

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77
Q

This setting provides immediate care for sudden, serious illness or injury and consists of triage levels to prioritize who is seen first

A

ED

78
Q

Care that involves continuous close monitoring of patients for 24-96 hours and involves highly specialized health-professionals

A

critical care (ICU)

79
Q

Specialty care that requires highly-specialized equipment, expertise, and involves more complex therapeutic interventions, most likely delivered in a large hospital setting; includes the following:
- complicated surgery
- intensive treatment
- advanced diagnostic testing
- same-say surgery

A

tertiary care

80
Q

Care that is an extension of tertiary care, even more highly specialized services for rare or unusual cases, typically not offered in most types of hospitals or medical centers, most likely offered in academic medical centers

A

quaternary care

81
Q

inpatient care by patient for non-acute care, immediately after or instead of hospitalization for an acute illness, injury, or exacerbation of a disease
ex: waiting in hospital for transfer to another facility
ex: a SNF skilled nursing facility or nursing home

A

sub-acute care

82
Q

the types of care that encompasses a range of services and support to assist for personal care needs, most care in this setting is not medical in nature

A

long term care

83
Q

the focus of this care is to restore an individual to his/her original state of health; to keep, retain, or improve skills of functioning for ADLs that have been lost or impaired due to illness or injury

A

rehabilitation

84
Q

care provided in the final days of an individuals life

A

end-of-life care

85
Q

a type of end-of-life care which is treatment for discomfort, symptoms, and stress of serious illness

A

palliative care

86
Q

a type of end-of-life care use when a patient is expected to live 6 months or less and the setting is typically a home or facility

A

hospice

87
Q

T or F: hospital is not synonymous withinpatient

A

true

88
Q

list the 3 main categories for classification of hospitals

A

type of service
number of beds
ownership

89
Q

Three sources of managerial authority and power exist within hospital administration and they include:

A

board of trustees/directors
hospital administrators
medical staff

90
Q

Determines and monitors the mission and goals of a hospital, creates policies

A

Board of trustees/directors

91
Q

In charge of daily operations and implements policies developed by the board

A

hospital administrators

92
Q

Admits and treats patients, responsible for quality services provided to patients, directs patient care services, responsible for ancillary services

A

medical staff

93
Q

This entity accredits healthcare institutions including hospitals, behavioral health facilities, long-term care facilities, and assisted living facilities, and hospitals must receive accreditation in or to be reimbursed by the government for their services

A

the joint commission

94
Q

T or F: there is an increasing trend in institutions and hospital beds

A

false
decreasing trend

95
Q

list the top 3 issues troubling hospitals CEOs

A

finances
government mandates
patient safety and quality

96
Q

this is a list of medications supplied by a healthcare entity

A

formulary

97
Q

Skilled Nursing Facilities provide 24 hour nursing care and assistance with ADLs (activities of daily living) and most are ________ owned and _____________ funded

A

privately
publicly

98
Q

What is the duration billable to Medicare for SNFs, thus dictating the duration of stay for most patients in these facilities?

A

3-30 days

99
Q

What is the goal for inpatient rehab facilities?

A

return to functioning before injury

100
Q

List long-term care pharmacy services

A
  • Medication packaging and dispensing
  • Medication effectiveness and safety reviews (DURs)
  • Pharmacy consultation (checking for DDI, duplications, therapy alternatives)
  • Infusion therapy (IV solution prep, delivery, administration)
101
Q

Complementary (used in conjunction with conventional medicine) and Alternative (used in place of conventional medicine) medicine practices come from which type of practitioner?

A

naturopaths

102
Q

What is one reason for the shortfall of 91,000 physicians?

A

bottleneck of physicians at residency training

103
Q

Which healthcare professional is responsible for being the largest sector of health care workers?

A

nurses

104
Q

There are desired trends for US healthcare system and improving __ can improve safety, improve satisfaction, and reduce costs

A

quality

105
Q

List 3 organizations with a focus on quality, which lead the improvement movement of the US healthcare system

A

institute of medicine
institute of healthcare improvement
national committee for quality assurance

106
Q

List 3 important and recent ambulatory care models for improving quality of patient care

A

integrated delivery networks
accountable care organizations
patient centered medical homes

107
Q

Which ambulatory care model is increasing, and positive trends in quality have been demonstrated for reshaping technology use, working together, and removing barriers?

A

accountable care organizations

108
Q

Care that is respectful of and responsive to an individual patient’s preferences, needs, and values and ensures that the patient guides clinical decisions

A

patient-centeredness

109
Q

List the 6 dimensions of patient-centerdness

A
  1. Respect for patient’s values, preferences, and expressed needs
  2. Coordination and integration of care
  3. Information, Communication, and education
  4. Physical comfort
  5. Emotional support
  6. Involvement of family and friends (social support)
110
Q

Which organization with a focus on quality released To Err is Human: Building a Safer Health System in 1999, which mandated for improvement in US health system safety by heightening awareness of medical errors in US and focused mainly on hospitals

A

Institute of medicine now called national academy of medicine

111
Q

National Institute of Medicine (NAM) / (IOM) released Crossing the Quality Chasm (2001) that issued a mandate for improvement in US health system ___________________

A

performance

112
Q

this is an independent non-for-profit organization that is leading innovator, convener, partner, and driver of results in health care improvement “worldwide”

A

institute for healthcare improvement

113
Q

List the domains of the IHI quintuple aim

A
  1. Improved patient experience
  2. better outcomes / improved population health
  3. lower costs
  4. clinician well-being
  5. health equity
114
Q

this is an independent non-profit organization in the US that works to improve healthcare quality through administration of evidence-based standards, measures, programs, and accreditation, also responsible for star ratings

A

national committee for quality assurance

115
Q

How can pharmacy services improve performance measures to aid in star ratings?

A

automated refill reminders
prescription pick-up reminders
online refill request

116
Q

these are a formal system of providers and sites of care, including both a health insurance plan and healthcare services, located within a defined geographic area

A

integrated delivery networks

117
Q

Benefits of IDNs include which of the following:
A. Increased Patient satisfaction
B. Increased Communication
C. Improved Patient Outcomes
D. Cost-Reduction

A

A. Increased Patient satisfaction
B. Increased Communication
C. Improved Patient Outcomes
D. Cost-Reduction

118
Q

Physician - Hospital Reimbursement is shifting from the traditional model fee for service to the newer _______________, which has a focus on quality and efficiency

A

pay for performance

119
Q

this is an organization in which a set of healthcare providers work together collaboratively and therefore accept collective responsibility for the quality and cost of care delivered to a specific population of patients

A

accountable care organization

120
Q

this is a form of ACO and a way of organizing primary care that “emphasizes care coordination and communication to transform primary care into what patients want it to be”, leads to higher quality, lower costs, while improving patients’ and providers’ experiences of care

A

patient centered medical home

121
Q

PCMH’s encompass what 5 key functions?

A

comprehensive care
patient centered
coordinated care
accessible services
quality and safety

122
Q

Within the structure of the PCMH, do the PCMH providers accept accountability for the entirety of care?

A

no

123
Q

Insurance is a basic __ to life in the US

A

economic reality

124
Q

What is the cost of health insurance in the US compared to other countries?

A

US health insurance is very expensive

125
Q

What makes up the largest proportion of private coverage in the US?

A

employer sponsored insurance

126
Q

this is one of the basic concepts behind insurance, where the larger the pool, the lower the cost, and the better the coverage of personal protection against costly adverse life events

A

risk pooling

127
Q

this is when one side of a transaction has more information than the other side, and the less information a party has, the harder it is to negotiate / purchase goods and services in a consumer marketplace

A

information asymmetry

128
Q

this is the trend towards more risky behaviors when a person knows they are protected from future consequences, copays coinsurances and deductibles are attempts to prevent this

A

perils of moral hazard

129
Q

this is a fixed payment for health care regardless of the amount or types of services eventually rendered in the care of an individual, and this is a method used by organizations to control healthcare costs

A

capitation

130
Q

this is the pooling of resources by individuals to purchase goods and services at a discount

A

collective buying power

131
Q

any individual member enrolled in a health insurance plan

A

beneficiary

132
Q

the person who purchases the plan

A

payer/subscriber

133
Q

any other individual on the plan

A

dependent

134
Q

a monthly subscriber fee to maintain enrollment in health insurance plan

A

premium

135
Q

the Affordable care act prevents setting premiums based on individual risk (past medical history, pre-existing conditions) and the ACA only allows insurance companies to adjust rates based on the following:

A

age
geographic location
family composition
tobacco use

136
Q

fixed dollar amount the beneficiary must pay entirely out of pocket before insurance begins to pay

A

deductible

137
Q

total amount of money paid towards healthcare before insurance covers 100% of remaining costs

A

out of pocket maximum

138
Q

fixed dollar amount the beneficiary must pay for certain services

A

co-pay

139
Q

a percentage of a bill the beneficiary must pay

A

co-insurance

140
Q

list the 3 main types of insurance plans

A

indemnity
managed care organizations
consumer-driven healthcare plans

141
Q

this is the simplest and most popular plan prior to managed care revolution, but it was extremely limited in its ability to affect provider prices and care provided to beneficiaries

A

indemnity plans

142
Q

list the 4 types of organizations an HMO structure can exist in

A

staff model
group model
open-panel model
network model

143
Q

PPOs negotiate contracts with physicians referred to as what?

A

preferred providers

144
Q

which model is considered the largest and fastest growing model?

A

PPO

145
Q

this is a combination of HMO and PPO

A

point of service POS

146
Q

Consumer Driven Healthcare Plans include the Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs) and they are all considered __________ premium and __________ deductible health plans

A

low premium
high deductible

147
Q

List trends for employer sponsored insurance, which makes up the largest proportion of private coverage in the US

A

plan type
cost
cost sharing
deductibles

148
Q

Health insurance obtained/paid by an individual is __ expensive without employer assistance

A

more

149
Q

which Act was meant to help create a marketplace to lower costs for those who have to purchase individual (self) insurance?

A

affordable care act

150
Q

List the federal public payer of insurance

A

Medicare

151
Q

Who is eligible to receive Medicare?

A

individuals 65+
disabled
ESRD or ALS

152
Q

this part of Medicare was an attempt to wean beneficiaries away from Medicare to more efficient Managed Care plans and to modernize Medicare

A

Medicare Part C

153
Q

T or F: Medicare Part D is included in beneficiaries plans at no additional cost

A

False

154
Q

This is private supplemental insurance, example is AARP

A

Medigap

155
Q

Which level of government controls the scope and structure of Medicaid programs?

A

state

156
Q

which level of government establishes broad guidelines, promotes and monitors program development, and provides financial assistance through matching grants to Medicaid programs?

A

federal

157
Q

this coverage, state-run, extends Medicaid coverage to children with family incomes above the 100% FPL minimum, and each state is free to select benefits within federal guidelines

A

S-CHIP

158
Q

Unfettered markets free of government and monopoly interference would produce the greatest benefit for mankind, and this would be the most efficient form of market that quickly identifies the best price for a good or service; any outside intervention that interferes with the price makes the market ______________

A

inefficient

159
Q

Is healthcare a free market?

A

no

160
Q

US healthcare market is __ (3)

A

institutionalized
bureaucratized
extensively regulated

161
Q

List economic drivers of free market inefficiencies

A

information asymmetry
insurance as insulation
conflicting interest
tax subsidies
failure of competition
regulation

162
Q

resources spent to create product or provide services

A

cost

163
Q

ability to charge a certain amount for a product or service

A

price

164
Q

Note: price manipulations by entities to increase their service revenue inflate prices and do more of it in what type of model?

A

fee for service model

165
Q

Can uninsured patients needing uncompensated care be denied access to healthcare services?

A

no
hippocratic oath and health policy prevents this

166
Q

An economic situation where one entity underpays for a good or service resulting in another entity overpaying

A

cost-sharing

167
Q

the consequence of underpaying and cost-shifting includes both raising __ and reducing __

A

raising premiums
reducing insurance benefits

168
Q

What is the underlying problem in high US healthcare costs?

A

fee-for-service

169
Q

increasing the role of _________ in reimbursement calculations is needed, however it is hard to define and incorrect application may actually lead to reduced quality

A

value

170
Q

this reimbursement model encourages a larger number of services provided and encourages the use of more expensive procedures, however it also does not limit providers in their clinical decision making

A

fee-for-service

171
Q

this reimbursement model has incentives to reduce services provided, less likely to pursue more expensive therapies or diagnostic tests, and it also limits providers in their clinical decision making

A

par per patient

172
Q

this concept for reimbursement has been increasing popularity over the past 10-15 years, and it is a simultaneous method for quality improvement and cost control through its measures of clinical impact (safety, efficacy, and patient satisfaction)

A

pat for performance

173
Q

List key areas of waste that contribute to high healthcare costs

A

medical errors
adverse drug events
patient healthcare transitions
hospital acquired infections
overtreatment
overconsumption
overpriced inputs

174
Q

The application of electronic systems to organize and use health data

A

health information technology

175
Q

goals of health information technology (2)

A

increase efficiency and reduce errors
transform healthcare delivery

176
Q

What is the difference between EMRs and EHRs?

A

Electronic Medical Record (EMR is a single patient chart versus the Electronic Health Records (EHRs) are from multiple providers and locations and are more long term

177
Q

Basic EHR systems organize and store info and include the following types of information:

A
  • patient info and demographics
  • clinicians notes
  • nursing assessments
  • labs and diagnostic test results
  • medications
  • facilitates computerized orders of medications (e-prescribing)
178
Q

This is the ability for systems to communicate with each other

A

interoperability

179
Q

Using telecommunication technologies to exchange medical information between sites of patient care

A

telehealth

180
Q

telehealth includes both

A

telemedicine and telepharmacy

181
Q

telehealth has led to large advances in what type of medicine practice?

A

rural medicine

182
Q

telehealth has been further progressed due to what major life circumstance we lived through?

A

COVID-19 pandemic

183
Q

Articles, instruments, apparatuses, or machines that are used in the prevention, diagnosis, or treatment of illness or disease, or for detecting, measuring, restoring, correcting, or modifying the structure or function of the body for some health purpose

A

medical device defined

184
Q

How does the FDA classify medical devices?

A

Class I
Class II
Class III

185
Q

Medical Devices Class I =

A

low risk, most devices

186
Q

Medical Devices Class II =

A

intermediate risk, 40% of devices

187
Q

Medical Devices Class III =

A

high risk, 10% of devices

188
Q

What types of approval do Class I medical devices need?

A

registration only

189
Q

What types of approval do Class II medical devices need?

A

registration and substantial equivalenvce

190
Q

What types of approval do Class III medical devices need?

A

registration, substantial equivalence, and premarket approval

P2 SPRG Other Classes (2 decks)

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