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population health > pop health (up to basic medicare/caid) > Flashcards

pop health (up to basic medicare/caid) Flashcards

(45 cards)

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1
Q

what is the largest per capita category in healthcare spending?

A

inpatient + outpatient care

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2
Q

what category has had the highest growth rate in the US for annual healthcare expenditures?

A

retail prescription drug prices

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3
Q

what is the largest relative contribution to total national health expenditure?

A

hospitals

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4
Q

what part of the US has the lowest life expectancy?

A

southern states

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5
Q

what area of US spending that does not have clear benefits?

A

older patients at the end of life

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6
Q

who is the biggest payer for HC in the US?

A

medicaid and medicare (the government)

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7
Q

what is the largest cause of revenue growth in the pharmacy industry in the US?

A

price-driven revenue growth

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8
Q

what percent of dispense products are generic?

A

90%

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9
Q

what part of the country has the longest travel times to the nearest hospital?

A

west north central (northern plains)

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10
Q

what type of firms provide better insurance coverage?

A

larger firms

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11
Q

what is the largest cause of preventable deaths in the US?

A

drug overdoses

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12
Q

how do managed care organizations negatively impact HC?

A

focus on decreasing utilization of HC services and certain medications across the board
often not determined with pt care in mind

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13
Q

what is the largest area of funding gap in american HC?

A

preventative medicine

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14
Q

what are the pharmacist roles over time according to the article?

A

apothecary
dispense
merchandiser
expert advisor
HC provider

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15
Q

what percent of people are underinsured (still have insurance)?

A

23%

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16
Q

what percent of people are uninsured?

A

9%

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17
Q

what type of people are more likely to be underinsured?

A

ages 19-34
white people
below 200% federal poverty line
sicker people
living in souther states

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18
Q

what is the Social Security Act (1936)?

A

WWII employer-sponsored health plans as a benefit dramatically expanded as a direct result of wage controls

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19
Q

what did the Hill Burton Act of 1946 do?

Study These Flashcards
A

provided funds to construct hospitals

20
Q

what did the Revenue Act of 1954 do?

Study These Flashcards
A

tax deduction for employers

21
Q

what did the Affordable Care Act?

Study These Flashcards
A

law passed in 2010 to expand access to insurance especially to self-employed individuals, address cost reduction, and affordability, improve the quality of HC, and introduce the pt’s bill of rights
30 day readmission penalties (75% of readmissions of medicare pts were preventable)

22
Q

what did Lyndon B Johnson do?

Study These Flashcards
A

passed Civil rights act
enacted Medicare and Medicaid as a part of the social Security act in July of 1965

23
Q

what are the characteristics of medicare at creation?

Study These Flashcards
A

began july 1, 1966 (when life expectancy was 70 yo)
health insurance for the elderly, disabled, people of all ages with ESRD or ALS/Lou Gehrig’s
no dental, eye, or outpatient drug benefits

24
Q

what part of medicare has the largest share of spending?

25
what are the characteristics of medicare part B?
everyone enrolled covers hospital costs with no premium costs, skilled nursing facility care (max of 100 days), and some home HC/hospice
26
what are the characteristics of medicare part B?
opt in to enroll premium costs deducted from SS ($185/mo) covers medical supplies and drugs administered in the doctor's office premium increases based on income levels
27
what is medicare part C?
medicare advantage, parts A/B/D covers managed care (private insurance companies manage it) PAs very common United Healthcare most popular insurer
28
what are the characteristics of medicare part d?
drug benefit premium costs deducted from SS (46.50 / mo) maxed out at 2K run by private insurance companies but CMS set minimum standards formularies for each plan are different
29
how would a pt enroll in medicare part a?
3 months before 65 bday to 3 months after (penalties) do not need to be retired do not have to enroll as long as you have a comparable insurance plan starts when you start receiving SS benefits
30
what is not covered by part B?
LTC dental cosmetic surgery eye exams for prescribing glasses routine foot care hearing aids and exams acupuncture
31
what is the Medigap-Medicare supplement?
not administered through CMS, but standardized by federal law picks up deductibles for part A and deductibles/copays for part B 89% of plans also cover part D average premium is $217 / mo purchased through private companies
32
what is the medicare STAR rating system?
used by CMS to measure how well Medicare advantage and part D plans perform
33
what is a CMS?
centers for medicaid and medicare services
34
what were the characteristics of medicaid at its creation?
began january 1, 1966 health insurance for the poor and medically indigent of all ages covers both inpatient and outpatient managed by state governments so wide variation and quality/range of services
35
what was the last state to implement medicaid?
AZ in 1982 because it wasn't required originally
36
what are the specifics to medicaid in Indiana?
65% of adults in IN on medicaid are working government pays 65% of medicaid costs in IN except for ACA expansion (90%) children account for largest share largest payer of LTC
37
how did the ACA affect medicaid?
expanding Medicaid eligibility for states that choose to opt in allows people with income up to 138% of FPL to qualify over 50% of the nation's uninsured live in states that have opted out of the expanded program
38
who has adopted the medicaid expansion?
41 states 9 left out mostly in the south
39
what are the qualifications of medicaid?
under 138% of FPL in IN infants born to medicaid-eligible pregnant women children under 6 yo and pregnant women with incomes under 158% of FPL pregnant women covered 12 months after pregnancy ends certain medicaid beneficiaries
40
what is hoosier healthwise?
managed care org used for children and pregnant women
41
what is hoosier care connect?
care mangement organization for pts over 65 not eligible for medicare, blind, or disabled
42
what is traditional medicaid?
fee for service pt over 65 eligible for medicare, LTC, home or commmunity based waiver services
43
who is the healthy indiana plan (HIP) for?
low-income adults 19-64 with income under 138% of FPL
44
what mandatory services does medicaid provide?
LTC hospital physician home health prenatal care family planning services
45
what are optional medicaid services?
pharmacy dental (few dentists participate) ICF for mentally retarded mental health rehab

population health (7 decks)

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