Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Healthcare Delivery > Block 1 > Flashcards

Block 1 Flashcards

1
Q

What three things are considered in an acceptable health care system?

A

Access
Cost
Quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define healthcare Access

A

All citizens are enabled to obtain needed services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Cost in the Healthcare System

A

Healthcare services are Cost Effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define Healthcare Quality

A

Services must meet established standards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Banyan Tree Analogy for US Healthcare “System”

A

Loosely capitalistic / market oriented in terms of morals and ethics and governmental oversight

Fragmented system with multiple payers, sets of rules, lots of money made by different stakeholders

Broadly described: financing insurance, delivery, payment mechanisms are somewhat coordinated by public and private actors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Unique attributes of US Healthcare System

A

Highly fragmented: in regulation, financing, and delivery

High rates of uninsured and underinsured

Major inequality in quality of care

No comprehensive payment systems for services

For-profit

Expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T or F: The US has the highest expenditure per capita in the world for healthcare

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T or F: The US spends the highest % of GDP in the world on healthcare

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cultural Beliefs and Values Influencing American Healthcare System

A

Self-reliance, Independence, Individualism

“Welfare” only for most needy

Decentralized government (state> fed) and resistance to increased taxes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Social Changes Influencing American Healthcare System

A

Demographic Shifts, Immigration, Urbanization

Decreasing % of White only demographics & Increasing % of Non-White and 2+ race demographics

Increasing Urbanization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Technological Advancements Influencing American Healthcare System

A

New treatments are expensive

Progressively increased training of health professionals creates more expensive system

Tech, Facilities, & Equipments advancing = increased cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Economic Constraints Influencing American Healthcare System

A

Health care costs
Health Insurance Cost
Family Incomes disproportionately increasing alongside service costs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Political Opportunism Influencing American Healthcare System

A

President’s agenda
Domestic and Foreign priorities
Party politics
Power of interest groups (APTA)
Laws, regulations, policies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Three Eras of US Healthcare System

A

Pre-Industrial
Post-Industrial
Corporate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pre-Industrial Era

A

Minimally educated physicians, some nurses
Inexpensive: cash payment or trading
Medical Institutions: Poorhouses (Almshouses) run by government, Hospitals were few w/ poor conditions, Asylums for housing people w/ chronic untreatable illnesses (esp. mental illness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Post- Industrial Era

A

Development of medical and nursing professions: increased education, urbanization begins office-based practice rather than house calls, science and technology begins to drive medicine

Development and growth of hospitals: centralized and institutional approach from medical science advancement for facilities and equipment & nursing especially becomes a profession

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Post - Industrial Era Insurance

A

Health insurance emerges: care advancement = cost increase, so people invested in insurance for unpredicted care needs, largely provided by hospitals early on due to Great Depression

Provider inspired insurance followed including: American Hospital Association’s Blue Cross & State Medical/Physician Societies Blue Shields

Creations of public health insurance like Medicaid (poor) and Medicare (elderly)

Post Great Depression: economy booms and employers utilize health insurance as a benefit to attract employees instead of raising wages

18
Q

What post-industrial insurance policy emerged in 1954?

A

Congress made employer based health insurance non-taxable

equivalent of getting more salary with out having to pay taxes

19
Q

4 Main Features of the Corporate Era

A

Corporatization

Growth of Non-Physician Workforce

Information Revolution

Globalization

20
Q

Corporatization : Corporate Era

A

Medical care is dominated by large corporations with little attention from federal government (no anti-trusts enforced) resulting in:

Managed care insurance companies
Large pharmaceutical and device manufacturers
Large hospital systems
Large physician practices ( can be owned by hospital systems)

21
Q

How has the Information Revolution impacted the Corporate Era?

A

COST!!!
Telehealth, Electronic Health Records, massive amounts of information and resources at everyone’s disposal creates larger health service costs

22
Q

Globalization in Corporate Era

A

Cross-border exchange of goods and services
Migration of health professionals: majority of PCPs in America have immigrated from other countries to fulfill residencies

23
Q

Historical Reasons for Failure of US Health Care Reform

A

Anti-German feelings and criticism of social insurance during WW I
Lots of rhetoric has been historically created that equates national health insurance to socialized medicine
Opposition from the AMA (literally fuck the AMA so bad)
🦅🦅Traditional American Beliefs and Values 🦅🦅: capitalism, self-determination, distrust of big government, tax aversion

24
Q

Affordable Care Act

A

2010
Access > Quality > Cost
Political Battlefied

25
Q

Why do people have insurance?

A

To reduce their risk of financial strain in the event of the need of medical services

26
Q

Guaranteed Issue

A

the government passes a law stating that if an individual applies for insurance that the insurance company has to sell a policy that applies

27
Q

Individual Mandate

A

Insurance mandate
the government has determined that everyone living in the country is required to obtain insurance

28
Q

Employer Mandate

A

Insurance Mandate
all employers are required to provide insurance to their employees

29
Q

Underwriter in Health Insurance

A

A person employed by an insurance company who decides whether or not the company should sell a policy to an individual who has applied

low risk, high risk, etc

30
Q

Risk Pool

A

A certain group of people who have bought an insurance policy from a company

Characteristics: Large vs Small and Healthy vs Sick

ex: Large, healthy pool or small, sick pool changes how premiums work

31
Q

Favorable Selection

A

Higher number of healthy people in the risk pool

32
Q

Adverse Selection

A

Higher number of sick people in the risk pool

Bad for insurance companies b/c increased claims and decrease $

33
Q

What Risk Pool will pose the highest risk for insurance companies and how does this affect?

A

a Large, Sick pool because adverse selection

The insurance company will likely increase premiums to stabilize the risk pool or refuse to operate in a region

34
Q

Individual Rating

A

Rating individuals by select factors

Preferred by insurance companies
They would be able to charge people more/not sell at all if they are old, of child bearing age, have pre-existing conditions, risk factors, etc

35
Q

Community Rating

A

The policy being sold by the insurance company has to be the same for all individuals who apply

36
Q

Modified Community Rating

A

ACA

An Insurance company cannot use individual rating; however to allow more Healthy people into the Risk Pool, they can give lower premium rates if :

younger, in a region where it is inexpensive for insurance company to do business (urban), and does not use tobacco

37
Q

T or F: The Affordable Care Act allows price variation based only on age, geography, and tobacco use

A

True!
This is a part of the Modified Community Rating concept

38
Q

T or F: The ACA only allows a limited amount of price variation

A

True

39
Q

Rescission

A

Existed before ACA

An insurance industry practice in which an insurer takes action retroactively to cancel a policy holder’s coverage by citing omissions or errors in the customer’s application even if the policy holder has diligently kept their policy current

Usualy occured when someone would suddenly get a bad diagnosis

40
Q

Common Insurance Practices Prior to ACA

A

Denying
Excluding
Charging based on gender, pre-existing, or certain occupations
Limiting benefits associated with mental health, substanc use, maternity, prescription drugs, pre-existing
Imposing lifetime or annual benefit caps

41
Q

Changes to Insurance Following ACA

A

Elimination of: Recission, Underwriting, Individual vs Community

Healthcare Delivery (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions