The Powerpoint Flashcards

(131 cards)

1
Q

What is the purpose of the country’s healthcare system?

A

A country’s health care system is organized to provide the diagnosis and treatment of individuals health problems

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2
Q

What is health?

A

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

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3
Q

How do DO’s embrace “health” more consistently than other healthcare professionals?

A

whole person approach, they help pt’s develop attitudes and lifestyles that don’t just fight illness but also prevent disease.

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4
Q

How can the environment influence health?

A

Can provide exposure to toxins and unsafe

conditions, including due to employment

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5
Q

How can the social environment influence health?

A

Those with a lower socioeconomic status have

more health risks

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6
Q

What is the #1 cause of death in 2007?

A

Cardiovascular disease

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7
Q

What is the goal of healthcare?

A

restore
health or prevent exacerbation of health
problems

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8
Q

What is primary prevention?

A

Eliminate risk factors for a disease

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9
Q

What are some examples of primary prevention?

A
– use automobile seat belts
– use condoms
– protect from ultraviolet light
– tobacco cessation programs
– dietary modifications
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10
Q

What is secondary prevention?

A

Early detection of disease so treatment is more

effective

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11
Q

What is tertiary prevention?

A

Focuses on treatment of identified disease to

reduce the incidence of later complications

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12
Q

Which 2 prevention systems does healthcare focus on?

A

Secondary and tertiary

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13
Q

What is system management?

A

Each component of a health care system must

be managed

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14
Q

What are some elements in management?

A

– Administration
– Planning
– Regulation
– Evaluation

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15
Q

In what ways can healthcare systems be judged as successful?

A

– the quality of the health care provided
– the equity achieved in the provision of health care
– the efficiency with which health care is provided

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16
Q

Has the # of healthcare workers in the US increased or decreased?

A

Increased from 15.5 million in 2009 from 12.2 million in 2000

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17
Q

What type of care do most people need most of the time for health and illness?

A

Primary care

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18
Q

What types of components does primary care involve?

A

immunization, prenatal care, periodic health
examination for early disease prevention, treatment for
illness

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19
Q

What is secondary care?

A

– services are available in physicians’ offices and
hospitals
– Includes most surgical procedures, diagnostic, and
treatment interventions of specialists

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20
Q

What are some examples of secondary care physicians?

A

radiologists, cardiologists,

ophthalmologists

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21
Q

What is tertiary care?

A

highly specialized diagnostic, therapeutic and
rehabilitative services that require staff and
equipment beyond what an average community
hospital has available

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22
Q

What are some examples of tertiary care services?

A

open heart surgery, organ
transplantation, complex chemo-therapy and radiotherapy
for cancer, preservation of very low birthweight
premature infants

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23
Q

What are the most numerous inpatient care facilities?

A

Acute care community hospitals

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24
Q

Has the # of hospitals increased or decreased from 2000-2008?

A

Increased from 4915 to 5010

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25
Has the # of beds in hospitals increased or decreased from 2000-2008?
Decreased from 823,560 to 809,069 (typically cuz better care has been administered)
26
What are the 4 ways of categorizing hospitals?
– by control – size – function – average length of patient stay
27
What are 4 functional categories of hospitals (by like what they do)?
* general * special * rehabilitation and chronic disease * psychiatric
28
What are 4 categories of hospitals by control of ownership?
– government federal – private, not-for-profit – private, for-profit – government nonfederal
29
What are community hospitals?
Community hospitals are all nonfederal, shortterm general, and special hospitals whose facilities and services are available to the public
30
What are some examples of special hospitals?
obstetrics and gynecology; eye, ear, nose and throat; rehabilitation; orthopedic
31
What defines short vs long term stay hospitals?
Whether is it > or < 30 days
32
How is average stay length calculated?****
Dividing the # of inpatient days by the # of admissions
33
What accounts for the largest portion of healthcare spending in 2008?
Hospitals (38%)
34
Which agency counts and classifies hospitals?
American Hospital Association (AHA)
35
Are most hospitals federal or nonfederal?
Nonfederal (96%)
36
Are most nonfederal hospitals community or specialty?
Community (86%)
37
Are most community hospitals for profit or not for profit?
Not for profit (80%)
38
Why are the # of hospital beds shrinking?
– higher fixed costs in staff, facilities, and equipment that adversely affect smaller hospitals – the increasing difficulty in hiring and retaining appropriate staff in rural hospitals – the increasing economies of scale for larger and larger hospitals as the availability of expensive technology increases – when a hospital performs a procedure more frequently, the quality of each one goes up
39
What are the main fxns of hospital administration?
``` – Finance – Personnel – Provision of services (maintenance, housekeeping, laundry, and dietary) – Community/public relations – Development (fundraising) ```
40
What is the hospital medical division?
The physicians (which have their own respective specialties)
41
What is the fxn of the executive committee?
provides overall coordination and sets | general policy
42
What is the fxn of the Joint conference committee?
serves as liaison between the | medical staff and the hospital’s governing board
43
What is the fxn of the credentials committee?
reviews applications to join the | medical staff and controls the periodic reappointment process
44
What is the fxn of the Infections control committee?
is responsible to prevent infections and monitors and corrects any outbreaks that do occur
45
What is the fxn of the Pharmacy and therapeutics committee?
reviews pharmaceutical agents for inclusion in the list of drugs approved for use in the hospital
46
What is happening to complementary and alternative medicine trends in hospitals?
It's growing
47
What are some examples of complementary and alternative therapies?
acupuncture, massage therapy, guided imagery for stress reduction, pet therapy, and music/art therapy
48
What are some examples of for-profit enterprises?
Pharmaceutical companies, commercial health insurance companies, nursing homes, some hospitals
49
What is the administration like in not-for-profit hospitals?
• has a board of trustees, usually prominent persons who give or raise a substantial amount of money for the hospital or represent an important community institution • The person with the title President of the hospital can either be the leader of the board of trustees or the paid chief executive officer (CEO) • If the CEO has the title of President, then the top operations person is usually called the executive director or executive vice-president
50
How can a hospital remain as a not-for-profit status?
Excess profit is distributed back to investors or to community health. Not for its own profit. lol
51
What % of nursing homes are for-profit?
66%
52
Where does more than 1/2 of the nursing home financial support come from?
Public funds (medicaid, medicare, etc.)
53
Why do some patients end up getting medicaid when they are in the nursing home when they didn't have it before coming in?
Institutional care is very expensive.
54
How can we bypass nursing homes because they are so expensive?
improved home care services and improved health promotion, disease prevention, and self-care programs for the growing U.S. elderly population
55
What is a managed care organization (MCO)?
• Traditionally, the patient contracted directly with the provider of care and a third-party provided payment • With managed care, the patient contracts with the MCO for the provision of care, and the MCO is paid for the provision of that care, often by the patient’s employer • The MCO determines what care the patient is entitled to and under what circumstances
56
What is outpatient/ambulatory care?
care given to a person who is not a bed patient in a health care institution (most physician-pt contacts)
57
How many ambulatory visits were there in 2008?
1.2 billion, which is up from 1 billion in 2000
58
Where do most ambulatory medical care visits take place?
Doctors offices (48%)
59
How many ambulatory care visits per person was made in 2008?
Americans averaged 4.05 physician visits per person
60
Who made the most primary care visits, men or women?
Women made up 58.2% of all physician office visits
61
What is the main reason why men seeked ambulatory care?
Injury
62
What are the main forms of payment for ambulatory care visits?
``` – Private insurance (59%) – Medicare (21%) – State Children’s Health Insurance Program (SCHIP) or Medicaid (15%) – Self-pay and other sources (6%) ```
63
What are the fxns of the Emergency Department?
• provide care to critically ill and injured patients (true emergencies) • serve as a secondary, well-equipped private physician’s office with more sophisticated resources • a source of patient admissions to the hospital • provide care to persons who are not injured or critically ill but cannot reach their private physician, regular clinic, or HMO, are geographically out-of-region, or have no insurance coverage and nowhere else to go when sick
64
What are the 3 categories of patients that present to ED's?
nonurgent (shouldnt be at a ED), urgent (needs care within a few hrs), and emergent (yup, be at an ED).
65
Did insured or noninsured patients visit ED's more?
Noninsured (41.6/100 people rather than 19.9/100 insured people)
66
What are some examples of public health agency clinics?
``` – tuberculosis control – child health (immunizations and examinations) – prenatal care – sexually transmitted disease control – mental health problems ```
67
What % of the US workforce in 2009 was in healthcare?
11.1%
68
What is the physician/population ratio?
27.7/10,000
69
What are the functions of a primary care physician?
Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health needs, developing a sustained partnership with patients, and practicing in the context of family and community.
70
What are some primary care physician specialties?
Physicians that practice family medicine, internal medicine, pediatric medicine, geriatric medicine, and obstetrics/gynecology are generally considered primary care physicians.
71
Why are PCP's called the "gatekeeper's?"
They are the ones who are usually seen first for illness and are the ones who make referrals for specialized care.
72
What are physician assistants (PA's)?
PAs conduct physician exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and can write prescriptions
73
Though the government is less involved with healthcare than any other industrialized country in the world, what populations does it serve?
The government provides health care to populations not profitable to care for or are otherwise difficult: sick poor, mentally ill, Native Americans living on reservations, short and long term care for the elderly, and infectious disease control
74
Where does the federal government's authority concerning healthcare services come from?
– the powers to tax and spend to provide for the general welfare – the ability to regulate interstate and foreign commerce
75
How does the legislative branch of the government influence healthcare?
legislative branch, Congress (Senate & House of Representatives), enacts laws to protect people’s health (e.g. laws about clean water or workers health) and to effect the framework for the delivery of health care
76
How does the executive branch of the government influence healthcare?
The executive branch writes regulations for | administering legislation
77
How does the judiciary branch of the government influence healthcare?
The judicial branch (courts) determines if legislation is constitutional and if regulations exceed the original statutes
78
What is the goal of the U.S. Department of Health and Human Services (DHHS, part of the executive branch of the government)?
The mission of the DHHS is to protect and promote the health, social and economic well-being of all Americans and in particular those least able to help themselves - children, the elderly, persons with disabilities, and the disadvantaged - by helping them and their families develop and maintain healthy, productive, and independent lives.
79
What is the goal of the FDA?
The Food and Drug Administration (FDA) protects the public against food, drug, and medical device and product hazards and ensures drug potency and effectiveness
80
What are the goals of the CDC?
– preventing and controlling disease and personal injury – directing foreign and interstate quarantine operations – developing programs for health education and health promotion – improving the performance of clinical laboratories – developing the standards necessary to ensure safe and healthful working conditions for all working people
81
The Indian Health Service (IHS) provides care for native americans and alaska natives who are where?
Who live ON or NEAR indian reservations
82
Who is eligible for VA services?
A veteran is anyone who has served 90 days or more in an armed service and who received an honorable or general discharge. There are complex rules for eligibility for many classes of veterans
83
Who is eligible for services from DOD hospitals and clinics?
members of the armed forces, their dependents, surviving dependents of service people killed while on duty, and military retirees and their dependents in DOD facilities and by civilian providers
84
What is the main insurance for the military?
Tricare
85
What 2 things are types of therapeutics?
equipment and pharmaceuticals
86
What % of the total national health expenditures was on therapeutics?
12.8%
87
What are National Health Expenditures (NHE)?
– health consumption expenditures – investment in health care structures and equipment – noncommercial health care research to procure future health care expenditures
88
In 2009, how much $ was spent on healthcare? How much of this is part of the GDP?
In 2009, $2,486 trillion was spent on health care – This was 17.6% of the gross domestic product
89
In 2009, the US rate of health expenditures was 46% higher than which next highest country?
Netherlands
90
What accounts for the majority of NHE's?
The increase in expenditures is due in part to the increasing use of expensive technology-based diagnostic and procedural interventions, particularly at the beginning and end of life
91
What are the sources of the NHE?
– 12% of the NHE were paid out-of-pocket – 32.2% by private insurance – 38.9% by public insurance – 7.5% by other programs and third-party payers – 3.1% were public health activities – 6.3% investment in research, structures, and equipment
92
What are out-of-pocket expenditures?
– direct payments to providers for noninsured services – extra payments to providers of insurance-covered or managed-care-covered services that bill at an amount higher than the insurance/managed care company pays for the service – deductibles – coinsurance
93
What is a deductible?
a flat amount that an individual or family must pay out-of-pocket before the insurance company will begin paying during some set time period (usually a calendar year)
94
What is coinsurance/co-pay?
a share of each service that the patient is to pay. It may be a percentage, for example it may be 20%
95
What are third-party payers?
All responsible for paying for health care other than the patient and the patient’s family and the health care provider are termed “thirdparty payers”
96
What are some examples of third-party payers?
``` the patient’s or family member’s employer; private insurance or managed-care organization; charity organizations; Workers Compensation; and federal, state, and local governments ```
97
Has the rates of private health insurance from 1990-2011 increased or decreased?
decreased from 73% to 64%
98
When was medicare established by congress?
1965
99
What is medicare part A?
``` hospital insurance (covers limited skilled nursing care also) ```
100
What is medicare part B?
covers physician and some other health professional services, hospital outpatient care, and some other services
101
What is medicare part C?
permits Medicare | beneficiaries to enroll in managed care organizations
102
What is medicare part D?
designed to lower the cost of | prescriptions for Medicare beneficiaries
103
In what ways are each parts of medicare funded?
– Part A is funded primarily from Social Security taxes – two-third of Part B is funded from general revenues with the balance from enrollee premium payments – Part D is funded through premiums
104
What is the RBRVS system of medicare payment for physicians?
payments for services are determined by the resource costs needed to provide them
105
How is the cost of providing services determined?
– physician work – practice expense – professional liability insurance
106
How are hospitals reimbursed from medicare?
Hospitals are reimbursed on an episode-ofcare basis, the amount of payment for each case determined by a formula based on a fiscal construct called the Diagnosis Related Group (DRG), one form of the prospective payment system (PPS)
107
In 2009, 46 million enrollees racked up how much $ in medicare expenditures?
$502 billion
108
What is medicaid?
Medicaid is a needs based program that provides coverage for some health services for some of the poor on a “means-tested” basis (income based)
109
How does a person get medicaid?
A person must apply for Medicaid to receive it and only those persons with incomes and other assets below a certain level specified by law are eligible for coverage
110
How are providers reimbursed for medicaid?
Providers are generally reimbursed on a feefor- service/episode-of-care basis like Medicare. (it's basically the same as medicare, but for poor people)
111
How much of the medicaid expenditures were for the elderly?
25% (remember, those nursing homes are really expensive!)
112
How much of the medicaid expenditures were for the disabled?
42%
113
What is the State Children’s Health Insurance Program (SCHIP)?
SCHIP provides health coverage for uninsured children who are not eligible for Medicaid
114
Who regulates each SCHIP programs?
the state
115
What are some examples of non-governmental organizations (NGOs)?
– American Heart Association – The Red Cross – The Visiting Nurse Association
116
What are some of the services of NGO's?
– perform services not rendered by other health care agencies – pursue research or service objectives – work to advance the interests of a population subgroup – engage in public and political education and advocacy – carry out certain tasks when asked by government agencies
117
What are some examples of professional organizations?
– American Osteopathic Association (AOA) – Pennsylvania Osteopathic Medical Association (POMA)
118
How are healthcare systems generally evaluated?
– quality of health care – equity of heath care – efficiency of health care
119
How are some of the structures to which quality is measure for healthcare system performance?
Structure encompasses the conditions under which the care is provided (facilities, equipment, human resources, non-profit status, academic affiliation, governing structure)
120
How are some of the processes to which quality is measure for healthcare system performance?
``` Process encompasses the activities that constitute health care (includes diagnosis, treatment, rehabilitation, prevention, and patient education) ```
121
How are some of the outcomes to which quality is measure for healthcare system performance?
Outcomes are changes, desirable and not desirable, in individuals and populations that can be attributed to health care
122
Has life expectancy increased or decreased from 1990-2011?
Increased (75.4 to 78.7 for every1)
123
How high is the US ranked for life expectancy in the world?
In 2004, U.S. ranked 10th in life expectancy at birth for | males and 12th in life expectancy at birth for females
124
How high is the US ranked for infant mortality rate in the world?
In 2004, U.S. infant mortality rate was the HIGHEST OMG
125
In 2006, how many people DID NOT have health insurance?
41.6 million
126
What does the Affordable Care Act (PPACA) do about insurers denying coverage?
Prevents health insurers from denying coverage to people for any reason, including health status, charging higher premiums based on health status and gender, and imposing a lifetime limit on insurance coverage
127
How old can a child be covered under the affordable care act?
26
128
When do most individuals required to have health insurance under the PPACA?
2014
129
How does the PPACA expand medicaid coverage?
Expands Medicaid coverage to 138% of the federal poverty level ($15,415 for an individual and $31,809 for a family of four in 2012) for individuals under age 65 to insure more low income people
130
How does the PPACA close the donut hole of medicare part D?
coverage gap when enrollees hit a specified amount of spending and until a larger specified amount is reached
131
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