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Nursing semester 1 > Intro Chapter 2 > Flashcards

Intro Chapter 2 Flashcards

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1
Q

How do you describe the US healthcare delivery system

A

Multi tiered

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2
Q

What does the DHHS oversee

A

All health related concerns of the general public international

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3
Q

What subdivisions are included in the DHHS

A 
WHO
CDC
HUD
OSHA
EPA 
FDA
USDA 
Disaster response
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4
Q

What is the DHHS emphasis

A

Monitoring, policy development, and ensuring healthcare accessibility

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5
Q

What is Medicare and the parts of Medicare

A

Medicare is an insurance program funded by the US government for those over 65 who paid into Social Security

Includes
Part A
Part B 
part C 
part D
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6
Q

Describe Medicare part A

A

Free to everyone Eligible, covers essential hospital costs but has a limited number of days

Also covers disabled and end stage renal disease patients

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7
Q

Define premium

A

Amount of money paid each month to an insurance company

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8
Q

Define deductible

A

Specified amount of money the patient pays before an insurance company will pay a claim

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9
Q

Describe Medicare part B

A

Covers doctors visits and outpatient services

Requires premium and deductible only covers 80% of expenses

Frequently Used with private insurances

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10
Q

Describe Medicare part C

A

A combination of A, B, and D only has one premium

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11
Q

Describe Medicare part D

A

Covers prescribed drugs on formulary (restrictions)

has premium and deductible

many elder people drugs are not covered

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12
Q

What is Medicaid

A

We aid everyone

Health insurance for the poor pregnant and very young (under five)

Only has a premium if dental and vision added
WIC

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13
Q

At would level is Medicaid dispersed

A

STATE

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14
Q

What is CHIP and who is it available for

A

CHIP Was created for children to have a fordable means to access healthcare
If above poverty line

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15
Q

What is Texas Health steps

A

An early and periodic screening, diagnosis, and treatment program specifically for children under Medicaid

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16
Q

Private health insurance

A

Private or employer sponsored

“BCBS”

Premiums requires

May have Deductibles or co pays

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17
Q

Subcategories of private health insurance

A

HMO

PPO

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18
Q

HMO information dump

A

Coordinated through primary doctor

few plans out there

Specified amount of money for each patient

no reimbursement (prospective payment)

primary controls health care (i.e. referrals diagnostic test and health services)

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19
Q

PPO information dump

A

Patient selects from a list of approved doctors and specialists

in the majority

yes reimbursements for preestablished fees (retrospective reimbursement)

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20
Q

Affordable care act a.k.a. Obamacare

Intentions

A

Meant to improve quality of healthcare, improve access, and lower costs

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21
Q

Where are the three major shifts to the success of the law

Study These Flashcards
A

Employers offering healthcare insurance

Increase participation in CHIP

Expended Medicaid coverage by state

22
Q

What items on the affordable care act were revoked

Study These Flashcards
A
  1. The mandated coverage in which people were being fined after not having insurance coverage
  2. Tax credits which reduce the cost burden to some individuals
23
Q

Key provisions Of the affordable care act

Study These Flashcards
A

Guaranteed coverage regardless of pre-existing condition

insurance companies must justify premium increases of more than 10% per year

preventative services at little to no cost yearly wellness exams screenings

24
Q

How is healthcare delivery described

Study These Flashcards
A

By the place it is being delivered

25
Primary care
In doctors offices least expensive Addresses problem before it gets worse
26
Secondary care
In hospitals most expensive
27
Tertiary care
Skilled nursing facilities/ rehab second most expensive
28
How would you describe disease prevention
Strategies for certain populations of people
29
Primary prevention
Target: healthy people Done by: health promotion and disease prevention (I.E: health education, of lifestyle vaccines, washing hands) AVOID IT
30
Secondary prevention
Target: population at risk for disease Done by: screenings (not diagnostic) early disease detection examples: pap smears pelvic exams colonoscopies REDUCE RISK
31
Tertiary prevention
Target: those who have the disease Done by: health management and prevent complications Examples: Education, strategies for compensation ALREADY HAVE IT BUT MANAGE IT
32
Can primary prevention happened in tertiary care
Yes the setting and strategies do not have to match
33
Define screening
Assesses the need for further evaluation
34
What is the best screenings have
Strong reliability and validity
35
Define reliability
Repeatability with the same results every time
36
Define validity
Accuracy High sensitivity and specificity
37
Sensitivity
True positive those who truly need a follow up
38
Specificity
Decrease in false positive show true negative
39
What is true in regards to disease
It is least expensive to prevent disease than to treat it
40
What are the major concerns of healthcare delivery
Cost access quality
41
What are things that drive healthcare costs up
Diagnostic tests pharmaceuticals specialists increasing population of elder people (living longer with more disease
42
Why are diagnostic related groups a problem to health delivery
They interfere with quality healthcare by providing standardized non-individualized healthcare dictating how much an insurance company will pay for hospitalizations and outpatient services they stereotype diseases saying they all cost same and they all require the same tests don’t cover extra
43
Do nursing shortage is increased cost
Yes
44
Factors in Cost containment
Managed care: determine when and where insured can receive service (I.Einsurance companies) •increases costs Care management: advocacy for the ill moving through healthcare delivery system •decreases costs •hospice Nurse case managers: assure continuity and quality of care move patient through healthcare delivery system •decrease cost
45
Access to healthcare challenges
Time: hours of operation are limited Transportation: long distance with no car • there are volunteer groups that pick up and take patients to appointments Insurance: many people don’t have insurance and do not have the money to go get seen
46
Quality of healthcare
Facility must be accredited by the joint commission (TJC) and the Center for Medicare Medicaid services (CMS) who provide funding; increase quality of care
47
Self-determination act
Patient has a right to: Advanced directives : documents saying what can and can’t be done to patient if a person cannot speak for themselves (A WILL) informed consent : Full explanation of procedure (outcomes, complications) understanding of the procedure, treatments and what would happen if the patient didn’t receive treatment • must be free from coercion • must be able to understand refusal to treatment
48
HIPPA
``` patient confidentiality, on a need to know basis Verbal written online leaving items out with information ```
49
Americans with disability act
Equal Access to opportunities to those with disabilities
50
Equal opportunity act
Provide services to those who do not have the same opportunities because of location or economic status i.e. headstart

Nursing semester 1 (19 decks)

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