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U.S. Healthcare System > Ch. 1-History Of The U.S. Healthcare System > Flashcards

Ch. 1-History Of The U.S. Healthcare System Flashcards

0
Q

Gross domestic product (GDP)

A

Total finished products or services produced in a country within a year

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1
Q

How much did the U.S. spend on healthcare expenditures in 2010?

A

$2.6 trillion, or 17.6% of GDP

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2
Q

What is healthcare spending estimated to be in 2020?

A

$4.6 trillion, almost 20% of GDP

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3
Q

How many uninsured in 2011?

A

48.6 million, decreased from 50 in 2010

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4
Q

Institute of Medicine’s 1999 report found:

A

Nearly 100,000 citizens die every year as result of medical error

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5
Q

How many employers offer health insurance?

A

67.5% in 2010, dropped from 72% in 2002

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6
Q

Most developed countries have what?

A

Universal healthcare program

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7
Q

Universal healthcare program

A

Access to all citizens,run by government and finances by taxation. Single payer-government

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8
Q

Patient Protection and Affordable Care Act (ACA)

A
  • 2010
  • attempts to increase access to affordable care for those that do not qualify for government assistance
  • mandates state run marketplaces to search for care, and mandates that insurance has to be purchased in order to decrease the price for everyone
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9
Q

3 major concepts of healthcare delivery

A

Primary, secondary, and tertiary prevention

-vital to understanding system

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10
Q

Primary prevention

A

Avoids development of disease

-health education, vaccines, smoking cessation programs

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11
Q

Secondary prevention

A

Focused on early disease detection and preventing progression
-screening programs, colonoscopies, mammograms

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12
Q

Tertiary prevention

A

Reduces impact of disease by minimizing complications

  • traditional medicine focuses on this
  • rehab and monitoring diseased individuals
  • ex) person taking blood pressure meds
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13
Q

4 major sectors of healthcare system

A
  1. History of practicing medicine and the development of medical education
  2. Development of hospital system
  3. History of public health
  4. History of health insurance
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14
Q

During early medicine, who could be doctors?

A

Anyone could be a doctor without major studying and exams. Barbers and clergy were often surgeons

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15
Q

Early physicians relied mostly on what to make diagnoses?

A

Common sense

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16
Q

American Medical Association (AMA)

A

Formed in 1847

  • professional membership organization for physicians
  • driving force for concept of private practice
  • standardized medical education
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17
Q

In early history, medical schools required what?

A

4+ physicians, a classroom, discussion rooms, and legal authority to grant degrees. Operated from tuitions

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18
Q

How did the Doctor of Medicine become the standard?

A

No entry restrictions caused more and more students to enroll in medical school, which in turn dissolved the internship with physicians

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19
Q

What caused medical schools to develop curriculums and admission testing?

A

1910 Flexner Report that evaluated schools in US and Canada was responsible for this which still goes on today (MCAT testing)

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20
Q

In 2008, what race represented the largest ethnic group of medical school graduates?

A

Asian

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21
Q

Average annual cost for public and private medical schools in 2012-2013?

A

Public-$30,000

Private-$50,000

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22
Q

When and where the first medical school was established and what did it help change?

A

1765, University of Pennsylvania

It was common to be an apprentice under one physician until mid 1700s

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23
Q

How much was the GDP in the 1900s-1930s?

A

Less than 4%

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24
Q

When did the AMA finally establish standards for medical education?

A

1904 when they created the Council on Medical Education

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25
Q

When and why did the relationships between patient and doctor change?

A

1940s when group health insurance was offered

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26
Q

What percentage of medical students were female in 2012-2013?

A

47%

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27
Q

What were almshouses or poorhouses and when were they built?

A

Provided shelter while treating illness, but mainly to serve the poorer community. Built in the 1820s (early 19th cent.)

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28
Q

What were pesthouses?

A

Government operated “hospitals” in the 19th century that were specifically for contagious illnesses

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29
Q

Why were early hospitals only occupied by poor?

A

The conditions were bad, caretakers were often not very skilled, and the physicians that practices often owned the place.

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30
Q

When did ownership of hospitals change from physicians to churches, government, and profit organizations?

A

1930s-1940s after the AMA standardized education and improved the reputation of physicians

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31
Q

When was the first patient bill of rights passed and what did it do?

A

1973, it protected patients in hospitals from misrepresentation etc

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32
Q

When was the Certificate of Need law passed?

A

1974, it mandated that the state had to approve expenditures related to construction and expansion and made sure the construction was actually needed. Repealed in 1987,but 36 states still have it

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33
Q

Emergency Medical Treatment and Active Labor Act (EMTALA)

A

Enacted in 1985

Ensured consumers wouldn’t be refused treatment for an emergency for any reason

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34
Q

Balanced Budget Act of 1997

A

Authorized Medicare reimbursement to support outpatient and ambulatory surgery

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35
Q

Hospitalists

A

Created in 1996
Providers that focus on the care of patients when they are hospitalized
Recognized need of providing quality care

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36
Q

What did the Joint Commission issue in 2002?

A

Standards to require hospitals to tell patients if their results are not normal

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37
Q

How many hospitals did the AHA say had outpatient surgery in 1987?

A

87%

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38
Q

Bundled Payments for Care Improvement initiative

A

by Center of Medicare and Medicaid in 2013

providers enter into payment arrangements, including financial and performance accountability for each patient

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39
Q

When was the concept of public health born, and who pioneered it?

A

1800s, Edwin Chadwick of Great Britain

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40
Q

General Report on the Sanitary Condition of the Labouring Population of Great Britain

A

by Edwin Chadwick in 1842

considered one of most important documents of public health, stimulated development of state public health laws

41
Q

John Snow

A

found the contaminated water in London to be the cause of the cholera epidemic in 1854
-established link between environment and disease

42
Q

Lemuel Shattuck

A

developed state public health law in 1850 based on Chadwick’s report and Snow’s findings
-this was the foundation for public health

43
Q

Charles Winslow

A

defined public health as a focus of preventing disease, prolonging life, and promoting physical health and efficiencyin 1920

44
Q

public health functions

A

services provided, such as child vaccine programs, health screening in schools, community health services, substance abuse programs, and STD control

45
Q

When was the vaccine for diphtheria and whooping cough developed?

A

1923

46
Q

Who discovered penicillin and when?

A

Alexander Fleming, 1928

47
Q

When was the polio vaccine developed, and by who?

A

1952 by Jonas Salk

48
Q

National Mental Health Act (NMHA)

A

1946

provided funding for research, prevention, and treatment of mental illness

49
Q

When was cigarette smoke finally identified as a cause of lung cancer?

A

1950

50
Q

Poison Prevention Packaging Act of 1970

A

prevent children from accidentally ingesting substances; childproof caps were also developed

51
Q

When was smallpox eradicated?

A

1980

52
Q

When did Oregon approve physician-assisted suicide?

A

1997

53
Q

When was the first Healthy People Report published, and what did it say?

A

1987, it recommended a national prevention strategy for public health

54
Q

Public Health Security and Bioterrorism Preparedness and Response Act of 2002

A

enacted in response to 9/11 attacks

provided grants to hospitals and public health organizations to prepare

55
Q

When was the ACA passed and what was its goal?

A

2010, improve access to health insurance

56
Q

Where was the first public health school?

A

Johns Hopkins University, 1916

57
Q

3 Most Important Public Health Achievements

A
  1. surgeon general’s recognition that tobacco is a health hazard
  2. # of vaccines developed have eradicated some diseases and controlled number of childhood diseases
  3. early detection programs for blood pressure and heart attacks and smoking cessation decreased # of deaths
58
Q

Core Functions of Public Health

A

assessment, policy development, and assurance

59
Q

The Future of Public Health report

A

1988

indicated a reduction of public health activities protecting community

60
Q

assessment

A

focused on systematic continuous data collection of health issues

61
Q

policy development

A

planning at all health levels

62
Q

assurance

A

evaluating any processes put into place to assure programs are being implemented correctly

63
Q

Healthy People 2000 report

A 
started in 1987
created to implement a new national prevention strategy with 3 goals:
1. increase life expectancy
2. reduce health disparities
3. increase access to primary care
64
Q

Healthy People 2010 report

A

released in 2000
health promotion and disease prevention focus to identify preventable threats and set goals to reduce threats
-nearly 500 objectives set in 28 focus areas
-developed infrastructure to ensure services are provided

65
Q

Healthy People 2020

A

released in 2010

-1,200 objectives in 42 focus areas

66
Q

Leading Health Indicators (LHIs)

A

smaller set of Healthy People 2020 objectives

target to communicate high priority health issues

67
Q

When and where was the first place to offer health insurance?

A

1847, Massachusetts Health Insurance Co. of Boston

68
Q

When and where was the blueprint for health insurance established?

A

1929, J. F. Kimball began hospital insurance plan for schoolteachers at Baylor University Hospital in Texas
-foundation of nonprofit Blue Cross plans

69
Q

Social Security Act

A

signed in 1935 by Roosevelt

created “old age insurance” to help those of retirement age

70
Q

When and where was the first college to establish a policy for students?

A

1936, Vassar College in New York

71
Q

Why did the War Labor Board freeze wages in the 1940s?

A

to force employers to provide health insurance to attract employees

72
Q

How much of the population had hospital insurance by 1950?

A

57%

73
Q

When was Medicare and Medicaid signed into law, and who signed it?

A

1965, President Johnson

74
Q

Consolidated Omnibus Budget Reconciliation Act (COBRA)

A

1985

required employers to offer partially subsidized coverage to terminated employees while they are out of a job

75
Q

Family Medical Leave Act (FMLA)

A

1993

allowed employees up to 12 weeks unpaid leave for family illness

76
Q

Health Insurance Portability and Accountability Act (HIPAA)

A

1996

made it easier to carry insurance changing employment, and increased confidentiality of patient info

77
Q

Medicare Prescription Drug, Improvement, and Modernization

Act

A

2003

created Medicare Part D, prescription plans for elderly

78
Q

American Recovery and Reinvestment Act (ARRA)

A

2009, Obama

provided 65% subsidy for COBRA to make premiums more affordable

79
Q

group insurance

A

risk transferred from individual to group, and group shares cost of any covered losses incurred by member

80
Q

Why couldn’t a national health insurance program be implemented in the 30s?

A

World War 2 and the Great Depression left enough impact that there was no funding

81
Q

diagnostic related groups (DRGs)

A

provide guidelines for treatment, attached to insurance reimbursement categories

82
Q

Uniformed Services Employment and Reemployment Rights Act (USERRA)

A

1994

entitles individuals who leave for military service to keep their job

83
Q

Largest public coverage program

A

Medicare-14% population

84
Q

State Children’s Health Insurance Program (SCHIP)

A

ensures children receive healthcare that are not Medicaid eligible

85
Q

Three Governmental Levels participating in healthcare system

A

federal, state, and local

86
Q

What the federal government provides

A

determines national healthcare budget, sets reimbursement rates, and formulates standards for Medicare and Medicaid providers

87
Q

What state government provides

A

regulatory and funding mechanisms and healthcare programs dictated by federal government

88
Q

what the local government provides

A

implementing programs dictated by federal and state

89
Q

Agency for Healthcare Research and Quality (AHRQ)

A

primary federal source for quality delivery of health services

90
Q

Center for Mental Health Services (CMHS)

A

lead national efforts to assess mental health delivery services

91
Q

Sherman Antitrust Act of 1890

A

ensures fair competition in the marketplace for patients by prohibiting monopolies

92
Q

Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996

A

prevents health insurance companies from discharging mother and child too early

93
Q

Women’s Health and Cancer Rights Act (WHCRA) of 1998

A

prevents discrimination of women with cancer

94
Q

Mental Health Parity Act (MHPA) of 1996

A

requires health insurance companies to fairly cover mental health conditions

95
Q

Genetic Information Nondiscrimination Act of 2008

A

Prohibits insurance companies and employers from discriminating based on genetic test results

96
Q

Lilly Ledbetter Fair Pay Act of 2009

A

provides protection for unlawful employment practices related to compensation discrimination

97
Q

cost share

A

out of pocket payments are the individuals share of the healthcare costs

98
Q

How much healthcare financing is through employer plans?

A

57%

99
Q

Iron Triangle of Health Care

A

1994 by Dr. William Kissick
focuses on balance of quality, cost, and accessibility to healthcare
ex) if access is increased, cost could increase. if cost is cut, access and quality will be reduced

U.S. Healthcare System (3 decks)

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