Ch 13-17 Flashcards
1
Q
Ethics
A
Character/customers- a field of study that helps “define what is good for the individual and for society and established the nature of duties that people owe themselves and one another.”
2
Q
Medical ethics
A
Most informative when collaborative, drawing from Sociology, History, Anthropology, Theology, Philosophy and the clinical studies
An example of applied ethics
3
Q
Truth-telling
A
As far back as the Hippocrates oath, but once again at the forefront of medical ethics; has long been a complex decision for doctors
4
Q
Proponents of truth-telling
A
Demonstrates respect for the patient and lying would undermine trust and rapport
5
Q
Opponents of truth-telling
A
Argue that patients really “don’t want to know,” especially about serious illness; thus they are against it because they believe its the patients’ interest.
6
Q
Lying to/deceive patients is justified on the grounds of
A
Discretion - doctors shouldn’t be forced to “just report the facts.”
Lying- may benefit the patient
Patients can’t always fully understand the truth.
7
Q
Truth supports argue that…
A
Patients know themselves better than their doctors, and truth helps in planning —> law suites could occur when truth isn’t told
Truth-telling enhances the doctor-patient relationship (trust/legitimacy)
8
Q
What mandates truth-telling
A
Patient bill of rights & AMA
9
Q
Landmark California Case: The Tarasoff Case
A
Rules that doctors have a duty to break confidentiality in order to protect innocent third parties
10
Q
Confidentiality is a ____ issue, especially with __________ and _____
A
Critical; electronic records; hacking
11
Q
Patients count on their _______ to not share their _____/_____ information with others
A
Physicians; personal/private
12
Q
Confidentiality dates back to ______
A
Hippocrates
13
Q
Protecting Confidentiality is beneficial bc
A
1) people needing treatment will seek it
2) people will provide maximum information
3) trust with physician in enhanced
14
Q
Physicians have a ____ to care for people, even if they have ______ _______.
A
Duty; contagious diseases
15
Q
Recently, there has been a push by some to _____ __ _____ on the basis of: ________, ___________, ________________
A
Refuse to treat; excessive risk (for doc); questionable benefits; obligations to other patients/self/family
16
Q
Proponents of Treating Regardless of Risks argue that…
A
- is inherent part of being a doctor— their profession
- its part of the social contract between society — medical institution
- patients are dependent on their doctors
17
Q
____ policy has changed over time; now it expresses
both ________ and ________
A
AMA; duty to treat; easy exemptions
18
Q
Patients want _______ info from physicians
A
Full/accurate
19
Q
Physicians use ____ based on communication
A
Discretion
20
Q
Cultural differences in communication about diseases
A
Some cultures say disease name while others avoid it (better for psychosomatic health)
21
Q
In terms of _____&______, US health care is _______________
A
Access; outcomes; less than effective
22
Q
The US health care system is ________ ($)
A
Profit-based
23
Q
The US spends _____ than any other country on health care
A
More
24
Q
Before ACA/Obama care, there were >_______ people without health insurance; after _____ don’t have health insurance
A
47 million; 26 million
25
Social medicine
Government pays for health care
US is not socialized medicine (individuals or employers pay for insurance)
26
Healthcare costs are covered by
- employers
-individuals/families (pay what insurance doesn’t cover)
- government (medicare/Medicaid)
27
The __________ is the #1 payer for health care because of ____ & ______
Federal government; medicare/Medicaid
28
Medicare
A federal insurance program that helps pay for medical care for people ≥ 65 years old, permanently disabled workers, their dependents, and people with end-stage renal disease
- recipients must qualify according to income
- no deductibles/co-pays
- lower expenditures in the last 20+ years
29
Part D added to Medicare
G.W. Bush (2003) Bush/Congress passed the Prescription Drug Coverage for Medicare
30
Medicaid
A jointly-funded federal-state-local program designed to make health care available to the poor
- eligibility reqs and program benefits vary from state-to-state
- majority of funds provide service for the elderly, blind, and disabled
- 2/3 of Medicaid recipients are members of an AFDC (aid to families with dependent children)/ welfare family
31
______ health care costs ________ for decades (accounting for _____)
Increased; escalating; inflation
32
Why are health care costs increasing
- new medical technologies
- people living longer & needing more care for chronic & acute illnesses (older population growing)
- medical wastes
- enormous corporate profits
- exorbitant salaries & compensation packages (CEOs, CFOs, advertisement $)
- high administrative costs
- medical fruad
33
Even as a % of _____: the US has much ____ costs than ANY OTHER country
GDP/gross domestic product; higher
34
The US is #__ in health care spending
1
35
__________ accounts for most increases in Health Care costs
Hospital care
36
Past 3 decades: Health care in US has gone from ___________ to __________ & __________ "out of pocket" expenditures
Reliance on private sources; increased dependence on public sources; declining
37
Some companies ______ public health care (________)
Want; to reduce production costs
38
Private business - health care expenditures
1) primarily spent on health insurance
2) increasingly accompanied by higher employee contributions
39
______ of Americans without insurance is in families with __________
Majority; an employed worker
40
The uninsured (before ACA) in the US ~
40-60 million people
41
In any 2-year period before ACA, ________ Americans were without insurance for at least part of the year.
80 million
42
Managed care programs
Have attempted to cut costs while securing “lower provider reimbursements” (lower insurance payments) and “regulating patient care.” (Decrease MD autonomy)
43
Health Maintenance Orgs (HMOs)
Type of managed care
Prepaid health care plans offering a range of services for a fixed fee
44
Preferred provider orgs (PPOs)
Type of managed care
Network of physicians & hospitals that agree to give price discounts to groups who enroll in their program, use their services, and agree to follow specified regulations
45
MD-owned facilities ________ more procedures with ________
Tend toward; higher feed
46
MDs refer to places where they have ______
Money interests
47
1997 Children’s Health insurance program (CHIP)
Aimed to decrease the number of children without health insurance
48
Medical reform has not addressed ______
Malpractice
49
5 important components of the US health care delivery system
1) hospitals
2) freestanding ambulatory sites
3) surgical care sites
4) nursing homes
5) hospice care facilities
50
1700s-1800s
Most general hospitals were charitable care for people without family/money, staffed by volunteers. Much of this care was “hospice-like”
51
~1900, hospitals…
Began to admit mostly sick people (but curable), w/other care for elderly and the homeless
- religious funding for hospitals/health care centers
52
!! By 1920
Hospitals became primary centers for acute care treatment, including surgery, skilled nursing, etc
53
With ____ hospital size, ______ administrators to coordinate complex bureaucracies
Increased; increased
54
_____ lead to BILLIONS of government money for _____________ after WWII
Keynesianism; community hospitals
55
Hospitals = _____ source of US health care
Primary
56
~_____ hospitals with > _______ workers, BUT _____ in # of hospital beds for several decades because _____________.
5,700; 6 million, decrease; insurance doesn't want to pay
57
In the US, in 2014, ~_____ of hospitals are _______, and they have been replacing public hospitals
18% OR 21%; for profit
58
_____ hospitals are also consolidating through _______
For-profit; mega-mergers
59
For-profit hospitals are accused of/criticized for:
- profit maximizing
- catering to rich clients/patients
- providing little/no care for those who cannot afford to pay
60
Uncompensated hospital care ($)
In the US is annually $25-30 billion
61
Increased Ambulatory care
Care provided to an individual who is not an impatient in a health care facility. [Save $, not health; e/g/ increased outpatient surgeries].
62
Urgent care, med express, retail store clinics (e.g. Walgreens), ambulatory surgical centers, and public health centers etc are…
Alternatives to doctor’s offices, family doctors, used by poorer people and for acute events
63
_____ of US physicians practice in offices/groups
Majority
64
Patient dumping
Hospitals kick patients out (illegal); it increases homelessness
65
Increased home health services —>
Decreased costs; serving increasingly elderly population, the disabled and veterans
66
Hospices
Given when patients had <6 months to live
Provide services, care, comfort and palliative care for terminally ill patients. Relief to patients and family at life’s end. Increased concern for profit is increasingly playing a role
67
Hospice team
Social worker, religion, nurses, doctors, etc
68
Nursing homes
Long-term residential facilities that provide nursing and other therapeutic and rehabilitation services. They mainly serve incapacitated elderly residents, but also some younger adults with significant physical and/or mental health problems (chronic care)
69
Nursing homes = ______ of the COVID pandemic. Deadly consequences stemming from _______ _________ in uncertain times. Many ____ _______ are underway in this arena.
Epicenter; political intervention; legal battles
70
Primary concerns about nursing homes include
- neglect
- abuse
- accidents
- the high price of care
- staffing shortages
71
Free “Health Clinics” (1950s/60s)
Young Lords (street gang) + Black Panther Party worked together in the Rainbow Coilition to provide health care to poor. I.e. TB tests with stolen ambulance.
72
Rapid ____ technological innovation with _____ and ______/_______
Increase; equipment; technicians; operators
73
Benefits of advanced health care technology
- more accurate diagnoses
- quicker diagnoses
- increased effective treatments
- increased life expectancies
74
Negatives of advanced health care technolgoy
- increased costs
- tech ≠ access
- technological advances that FAIL
- ethical issues
- dependence of technology; loss of “eye skills”
75
Social consequences of new health care technologies
1) new options for people / more options
2) can alter human relationships (keeping people alive)
3) can affect entire health care system (can replace/displace workers)
4) increased reflection on value questions (is it worth it?)
5) increased social policy questions (vaccine mandate, abortion rights, etc. )
76
Top medical technology advances
- cardiac technologies (pacemakers, defibrillators)
- critical care medicine (ICU)
- medical imaging (MRI, CT, CAT)
- genomic medicine (genetic mutations, JAK, mRNA vaccines)
- telemedicine (online med info; more common in dev. Countries)
77
Value issues w/ med tech advancements
Increased “distance: between Physicians and patients
78
The Karen Ann Quinlan Case
Karen fell into a Pervasive Vegetative State (PVS) & family wanted doctors to pull the plug, doctors refused:
do/should patients have the right to refuse technology? Yes
When is a patient able to make the decision (competent/incompetent)/who makes the decision for the patient when they are incompetent?
79
1991 patient self-determination act
Requires all health care providers to INFORM patients about their RIGHTS under the LAW to prepare an advance directive (“living will”)
80
Defining “death”
Developed by Harvard Medical School in 1968
81
The cerebrum
“Upper brain” w/cortex/outer shell; primary center of consciousness, thoughts, memory, feeling
82
The brainstem
“Lower brain,” respiration, swallowing, yawning, sleep & wake (primitive functions)
83
The cerebellum
Coordination/ muscular movement
84
“Death”
A permanently non-functioning whole brain (cerebrum & brainstem), including no reflexes, no spontaneous breathing, no cerebral functioning, and no awareness of externally applied stimuli
85
Robert Veach proposes
An irreversible cessation of the capacity for awareness. This would make the vegetative state (PVS) declared dead (even if heart is still beating)
86
Terry shiavo
The politicized PVS case with republican / tea party interference
87
Doctor assisted suicide supporters
1) its consistent with patient self-determination
2) already most deaths in hospitals involve preliminary discussion and agreement NOT to do everything to prolong life
3) majorities of US public favors it
88
Dr. Kevorkian did many ____________, eventually convicted of __________ with an ALS patient
Assisted suicides, 2nd degree murder
89
Opponents of doctor-assisted suicide
1) patients considering it might be too sick to think straight
2) its inconsistent w/ doctors’ traditional responsibility to sustain life and relieve suffering
90
The most important objective in Organ donation in the US
Protecting the voluntary nature of donation (prevents kidnapping/stealing/selling)
91
United Network of Organs Sharing
US
System for potential donors and people needing a transplant
92
Health care providers are ______ to notify patients/families about ____ ______ options
Required; organ donation
93
The “_____ _______ ______” in contrast to the more capitalist (organ donation)
Weak required request
94
“Strong market approach”
Where individuals (for living or related donors) OR their next-of-kin (for deceased persons) should be able to AUCTION organs to the highest bidder
95
US government and private corporations are saying… (about price of medical procedures)
That they can’t afford to spend on every potentially helpful medical procedure for every person
- it takes away from money spent on education, environment, government, etc
96
Issues with Preventative vs. Curative Care Spending
- end of life spending (lowering stress/regular check-ups)
- newborns w/ lifetime care needs
97
Healthcare is based on _____ and _____ for life expectancy
Income; wealth
98
US (comparative)
- most expensive
- ranked #37 in World by WHO (2010)
- Ranked #11 by citizens.org in 2021
- ranked #18 and 30 in 2022 b World Population review
99
“Categories of Performance” (hospital rankings)
1) Preventative health care
2) health care use and services
3) availability of top health technologies (to what %) —> depends on highest tech avaliable
4) mortality (rate & causes of death)
5) health systems responsiveness
6) stability of per capital health spending relative to National Income
100
Major influences on health care systems
- physical, historical, and situational events (politics)
- cultural norms and values (sociology)
- structural factors
101
In US, we have “______ ________” cultural tendencies: We consider ourselves, “__________,” aggressive, and of course ______ (vs. ___________)
Rugged individualistic; can-do’ers; individualistic; collectivist
102
Four general categories of health care systems
1) Private insurance w/ private, entrepreneurial services (for profit). E.g. US
2) National Health Insurance w/ private, regulated services. E.g. Canada/Germany
3) National Health Insurance w/ public, regulated services. E.g. Great Britain, Norway
4) National Health Insurance: sate-run/socialized system. E.g. Cuba, former USSR, China (similar but changing)
103
China health care system
WAS cooperative system with community health workers, NOW moving toward private, capitalist for profit system
Profit system NOT AS EFFECTIVE, especially for rural areas in a country of >1 billion people. Big concern and outrage.
104
Cuba health care system
High standards, with high health outcomes. Socialized medicine.
- make money on global scale (medical tourism, exporting doctors)
105
Canada health care system
- free system with Universal Coverage
- shifted financial/administrative control to the provinces
- Canadian health care workers are NOT public employees
- high outcomes, with high satisfaction
- now facing cuts
106
Great Britain National Health Service (NHS)
- FREE, publicly-regulated services
- publicly-owned, paid for by taxes
- popular system. You select doctors off of a roster. Cost increasing of late, as of everywhere.
107
Russia (USSR) health care systems
- free system (no longer USSR). Long history of High End Preventative Care
- transitioning to private, free market, profit system
- health indicators falling as they do that, marked by shortages of medical supplies
- increasing concern for disgruntled citizens (access wanes)
- ~70% of doctors are women
