Ch. 1-History Of The U.S. Healthcare System Flashcards
Gross domestic product (GDP)
Total finished products or services produced in a country within a year
How much did the U.S. spend on healthcare expenditures in 2010?
$2.6 trillion, or 17.6% of GDP
What is healthcare spending estimated to be in 2020?
$4.6 trillion, almost 20% of GDP
How many uninsured in 2011?
48.6 million, decreased from 50 in 2010
Institute of Medicine’s 1999 report found:
Nearly 100,000 citizens die every year as result of medical error
How many employers offer health insurance?
67.5% in 2010, dropped from 72% in 2002
Most developed countries have what?
Universal healthcare program
Universal healthcare program
Access to all citizens,run by government and finances by taxation. Single payer-government
Patient Protection and Affordable Care Act (ACA)
- 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
3 major concepts of healthcare delivery
Primary, secondary, and tertiary prevention
-vital to understanding system
Primary prevention
Avoids development of disease
-health education, vaccines, smoking cessation programs
Secondary prevention
Focused on early disease detection and preventing progression
-screening programs, colonoscopies, mammograms
Tertiary prevention
Reduces impact of disease by minimizing complications
- traditional medicine focuses on this
- rehab and monitoring diseased individuals
- ex) person taking blood pressure meds
4 major sectors of healthcare system
- History of practicing medicine and the development of medical education
- Development of hospital system
- History of public health
- History of health insurance
During early medicine, who could be doctors?
Anyone could be a doctor without major studying and exams. Barbers and clergy were often surgeons
Early physicians relied mostly on what to make diagnoses?
Common sense
American Medical Association (AMA)
Formed in 1847
- professional membership organization for physicians
- driving force for concept of private practice
- standardized medical education
In early history, medical schools required what?
4+ physicians, a classroom, discussion rooms, and legal authority to grant degrees. Operated from tuitions
How did the Doctor of Medicine become the standard?
No entry restrictions caused more and more students to enroll in medical school, which in turn dissolved the internship with physicians
What caused medical schools to develop curriculums and admission testing?
1910 Flexner Report that evaluated schools in US and Canada was responsible for this which still goes on today (MCAT testing)
In 2008, what race represented the largest ethnic group of medical school graduates?
Asian
Average annual cost for public and private medical schools in 2012-2013?
Public-$30,000
Private-$50,000
When and where the first medical school was established and what did it help change?
1765, University of Pennsylvania
It was common to be an apprentice under one physician until mid 1700s
How much was the GDP in the 1900s-1930s?
Less than 4%
When did the AMA finally establish standards for medical education?
1904 when they created the Council on Medical Education
When and why did the relationships between patient and doctor change?
1940s when group health insurance was offered
What percentage of medical students were female in 2012-2013?
47%
What were almshouses or poorhouses and when were they built?
Provided shelter while treating illness, but mainly to serve the poorer community. Built in the 1820s (early 19th cent.)
What were pesthouses?
Government operated “hospitals” in the 19th century that were specifically for contagious illnesses
Why were early hospitals only occupied by poor?
The conditions were bad, caretakers were often not very skilled, and the physicians that practices often owned the place.
When did ownership of hospitals change from physicians to churches, government, and profit organizations?
1930s-1940s after the AMA standardized education and improved the reputation of physicians
When was the first patient bill of rights passed and what did it do?
1973, it protected patients in hospitals from misrepresentation etc
When was the Certificate of Need law passed?
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
Emergency Medical Treatment and Active Labor Act (EMTALA)
Enacted in 1985
Ensured consumers wouldn’t be refused treatment for an emergency for any reason
Balanced Budget Act of 1997
Authorized Medicare reimbursement to support outpatient and ambulatory surgery
Hospitalists
Created in 1996
Providers that focus on the care of patients when they are hospitalized
Recognized need of providing quality care
What did the Joint Commission issue in 2002?
Standards to require hospitals to tell patients if their results are not normal
How many hospitals did the AHA say had outpatient surgery in 1987?
87%
Bundled Payments for Care Improvement initiative
by Center of Medicare and Medicaid in 2013
providers enter into payment arrangements, including financial and performance accountability for each patient
When was the concept of public health born, and who pioneered it?
1800s, Edwin Chadwick of Great Britain
General Report on the Sanitary Condition of the Labouring Population of Great Britain
by Edwin Chadwick in 1842
considered one of most important documents of public health, stimulated development of state public health laws
John Snow
found the contaminated water in London to be the cause of the cholera epidemic in 1854
-established link between environment and disease
Lemuel Shattuck
developed state public health law in 1850 based on Chadwick’s report and Snow’s findings
-this was the foundation for public health
Charles Winslow
defined public health as a focus of preventing disease, prolonging life, and promoting physical health and efficiencyin 1920
public health functions
services provided, such as child vaccine programs, health screening in schools, community health services, substance abuse programs, and STD control
When was the vaccine for diphtheria and whooping cough developed?
1923
Who discovered penicillin and when?
Alexander Fleming, 1928
When was the polio vaccine developed, and by who?
1952 by Jonas Salk
National Mental Health Act (NMHA)
1946
provided funding for research, prevention, and treatment of mental illness
When was cigarette smoke finally identified as a cause of lung cancer?
1950
Poison Prevention Packaging Act of 1970
prevent children from accidentally ingesting substances; childproof caps were also developed
When was smallpox eradicated?
1980
When did Oregon approve physician-assisted suicide?
1997
When was the first Healthy People Report published, and what did it say?
1987, it recommended a national prevention strategy for public health
Public Health Security and Bioterrorism Preparedness and Response Act of 2002
enacted in response to 9/11 attacks
provided grants to hospitals and public health organizations to prepare
When was the ACA passed and what was its goal?
2010, improve access to health insurance
Where was the first public health school?
Johns Hopkins University, 1916
3 Most Important Public Health Achievements
- surgeon general’s recognition that tobacco is a health hazard
- # of vaccines developed have eradicated some diseases and controlled number of childhood diseases
- early detection programs for blood pressure and heart attacks and smoking cessation decreased # of deaths
Core Functions of Public Health
assessment, policy development, and assurance
The Future of Public Health report
1988
indicated a reduction of public health activities protecting community
assessment
focused on systematic continuous data collection of health issues
policy development
planning at all health levels
assurance
evaluating any processes put into place to assure programs are being implemented correctly
Healthy People 2000 report
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
Healthy People 2010 report
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
Healthy People 2020
released in 2010
-1,200 objectives in 42 focus areas
Leading Health Indicators (LHIs)
smaller set of Healthy People 2020 objectives
target to communicate high priority health issues
When and where was the first place to offer health insurance?
1847, Massachusetts Health Insurance Co. of Boston
When and where was the blueprint for health insurance established?
1929, J. F. Kimball began hospital insurance plan for schoolteachers at Baylor University Hospital in Texas
-foundation of nonprofit Blue Cross plans
Social Security Act
signed in 1935 by Roosevelt
created “old age insurance” to help those of retirement age
When and where was the first college to establish a policy for students?
1936, Vassar College in New York
Why did the War Labor Board freeze wages in the 1940s?
to force employers to provide health insurance to attract employees
How much of the population had hospital insurance by 1950?
57%
When was Medicare and Medicaid signed into law, and who signed it?
1965, President Johnson
Consolidated Omnibus Budget Reconciliation Act (COBRA)
1985
required employers to offer partially subsidized coverage to terminated employees while they are out of a job
Family Medical Leave Act (FMLA)
1993
allowed employees up to 12 weeks unpaid leave for family illness
Health Insurance Portability and Accountability Act (HIPAA)
1996
made it easier to carry insurance changing employment, and increased confidentiality of patient info
Medicare Prescription Drug, Improvement, and Modernization
Act
2003
created Medicare Part D, prescription plans for elderly
American Recovery and Reinvestment Act (ARRA)
2009, Obama
provided 65% subsidy for COBRA to make premiums more affordable
group insurance
risk transferred from individual to group, and group shares cost of any covered losses incurred by member
Why couldn’t a national health insurance program be implemented in the 30s?
World War 2 and the Great Depression left enough impact that there was no funding
diagnostic related groups (DRGs)
provide guidelines for treatment, attached to insurance reimbursement categories
Uniformed Services Employment and Reemployment Rights Act (USERRA)
1994
entitles individuals who leave for military service to keep their job
Largest public coverage program
Medicare-14% population
State Children’s Health Insurance Program (SCHIP)
ensures children receive healthcare that are not Medicaid eligible
Three Governmental Levels participating in healthcare system
federal, state, and local
What the federal government provides
determines national healthcare budget, sets reimbursement rates, and formulates standards for Medicare and Medicaid providers
What state government provides
regulatory and funding mechanisms and healthcare programs dictated by federal government
what the local government provides
implementing programs dictated by federal and state
Agency for Healthcare Research and Quality (AHRQ)
primary federal source for quality delivery of health services
Center for Mental Health Services (CMHS)
lead national efforts to assess mental health delivery services
Sherman Antitrust Act of 1890
ensures fair competition in the marketplace for patients by prohibiting monopolies
Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996
prevents health insurance companies from discharging mother and child too early
Women’s Health and Cancer Rights Act (WHCRA) of 1998
prevents discrimination of women with cancer
Mental Health Parity Act (MHPA) of 1996
requires health insurance companies to fairly cover mental health conditions
Genetic Information Nondiscrimination Act of 2008
Prohibits insurance companies and employers from discriminating based on genetic test results
Lilly Ledbetter Fair Pay Act of 2009
provides protection for unlawful employment practices related to compensation discrimination
cost share
out of pocket payments are the individuals share of the healthcare costs
How much healthcare financing is through employer plans?
57%
Iron Triangle of Health Care
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
