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PUSHES > 1 - US Healthcare System > Flashcards

1 - US Healthcare System Flashcards

1
Q

Primary Care

A

“First-contact Care” - Basic or General Health Care

MOST ACESSIBLE type of care: 80-90% of visits to providers

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2
Q

Who are PRIMARY CARE Physicians?

A

PCP = Primary Care Providers
Pediatricians / Gynecology / Internal Medicine

  • sometimes NP’s / PA’s / Chripractors*
  • *depends on your Health Plan - may require a REFERRAL** to specialist
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3
Q

Secondary Care

A

Physician SPECIALIST

FACILITIES treating problems like

SURGERY / HOSPITALIZATION / REHAB

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4
Q

Tertiary Care

A

MOST COMPLEX DISORDERS

Specialized CONSULTATIVE care –

typically need Referral from PCP

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5
Q

Preventative Care

A

PREVENT disiease or injury

Reduce EXPOSURES to health problems

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6
Q

Chronic Care

A

opposite of acute diseases

CHRONIC diseases that persist over time

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7
Q

Respite Care

A

service for DEPENDENT patients

provides TEMPORARY CARE RELIEF

to their informal caregivers (family)

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8
Q

Long-Term Care (LTC)

A

EXTENDED ASSISTANCE

for the chronically/mentally/disabled ill people

Assists those who have limitations in ADLS or IADLS

activities of daily living (instrumental ADLS)

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9
Q

Acute Care

A

Short-Term / INTENSE care for an illness or injury usually HOSPITILIZATION (inpatient)

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10
Q

Sub-acute care

A

comprehensive INPATIENT services for those who need

MORE intensive skilled nursing –> nursing homes

TOO WELL FOR HOSPITAL, but too frail for nursing homes

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11
Q

Rehabilitative Care

A

Therapies to RESTORE/MAINTAIN levels of FUNCTIONING and to PREVENT further deterioration

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12
Q

Palliative Care

A

Serving to RELIEVE or COMFORT/ALLEVIATE

rather than curing

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13
Q

HOSPICE CARE (end-of-life)

A

Humane / compassionate services for the DYING

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14
Q

Common classifications for HOSPITALS

A

Size = # of beds

Length of Stay: short / long

Location: urban / rural

Type of Service: general / surgical / specialized

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15
Q

Hospital Classifications - OWNERSHIP

A

Public = federal/state/municipal

Private Not-For-Profit

Private PROPRIETARY = for-profit / investor owned

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16
Q

Ambulatory Care

A

OUTPATIENT healthcare services that do NOT require inpatient hospitilzations

wide variety of practitioners for the “WALKING” / non-institutionalized patient

Disease prevention / health promotion / medical care

17
Q

Accountable Care Organization = ACO

A

MODEL OF CARE

From the AFFORDABLE CARE ACT - sought to reduce healthcare cost by encouraging physicians / healthcare providers

to FORM NETWORKS to COORDINATE CARE & receive bonuses for EFFICIENT care delivery ACCOUNTABLE forquality / cost of care delivered

18
Q

ACO

A

Accountable Care Organization

INCENTIVIES hold ACO’s responsible for both COST & QUALITY OF CARE

Houses numerous medical practices within 1 organizing entity, PCP leadership ACCOUNTABILITY ( quality metrics )

SHARED SAVINGS

FREE CHOICE in PROVIDERS for the patients

19
Q

Patient-Centered Medical Home = PCMH

A

Enhanced PRIMARY CARE delivery MODEL

PCMH uses Physician-led, coordinated team based approach to care:

Spectrum of disease state / various life stages while MANAGING COSTS

20
Q

PCMH

A

Patient Centered Medical Home

PRIMARY CARE
Centered around a SINGLE MEDICAL PRACTICE (small/independent office)

Payers give providers a BONUS for imrpoving primary care services for each patient in PCMH

21
Q

Universal goal of the healthcare system?

A

Adequate ACCESS to QUALITY CARE at a REASONABLE COST

22
Q

Triple Aims of the healthecare system:

A

In concert with the universal goal:

Better Individual Care + Experiences

Better Population health

lower _Costs_

23
Q

Major components of ACCESS
to health care

A

ABILITY to PAY (self or insurance coverage)

AVAILABILITY of health care personnel / facilitites

Issues affecting EASE OF USE / BARRIERS to timely participation
(Transportation / Language / Culture / Scheduling)

24
Q

Total U.S Health Care Expenditures in 2016

A

3.3 TRILLION

17.9% of US GDP

25
Q

Major Factors Contributing to the

COSTS of Healthcare

A

Social Factors
Lifestyle Factors & personal behaviors

Chronic Disease + AGING Population
Longer lives -> more CHRONIC conditions / comorbidities

Prescription Drugs + Medical Advancements

Fragmented Healthcare Delivery

Current Payment / Reimbursement Mechanisms

Administrative Costs
for providers & payers

26
Q

Financial Barriers to Healthcare

A

28 million UNINSURED in the US
mainly due to COST BEING TOO HIGH / LOST JOB or emplyer change

41 million UnderInsured in the US

When out-of pocket costs (includes PREMIUMS) add up to
10% or more of houshold income

or
Deductables amount to 5% of income or HIGHER

27
Q

Under-insured Definition

41 million UnderInsured in the US

A

When out-of pocket costs (excluding premiums) amount to:
10% + of household income

or

When deductables amount to
5% + of income or higher

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