Ch 3 Flashcards
resolution supporting primary health care for all people by 2000
declaration of alma-ata
an integrated system for providing health care services in which consumers must abide by certain rules designed to achieve cost savings
managed care
a commissioned corps of health personnel who provides care in designated underserved areas
National Health Service corps
the providing of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community
primary care
a combination of primary care and public health care made universally accessible to individuals and families in a community, with their full participation, and provided at a cost that the community and country can afford
primary health care (PHC)
a technique for identifying prevention of error strategies and developing a culture of safety
root cause analysis
the federal agency most heavily involved in health and welfare
US dept of health and human services
activities whose goal is to protect people from becoming ill due to actual or potential health threats
disease prevention
racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention
disparities
a trend toward an increased flow of goods, services, money, and disease across national borders
globalization
a part of the National Academy of Sciences and an organization whose purpose is to provide national advice on issues relating to biomedical science, medicine, and health
Institute of Health
people 65 yrs or older
under 65 if disabled
ESRD
Medicare
Fed pays
low-income families with children who meet eligibility requirements
disabled who meet eligibility requirements
poor elderly
medicaid
Fed and State pay
created by the balanced budget act of 1997
builds on medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid
family of four income must be below $42,406
SCHIP
State administered with federal allocations
difference between primary care and primary health care
primary care is the first level of primary health care and is delivered in a variety of community settings, such as physcian’s office, urgent care centers, in-store clinics, community health centers, and community nursing centers.
mandated through laws that are developed at the national, state, or local level. Instituted to protect the health of the community such as a law mandating immunizations for all children entering kindergarten and a law requiring constant monitoring of the water supply
public health
Health Resources and Services Administration (HRSA)
USDHHS agency with primary responsibility for improving health care of special populations, including people who are uninsured, isolated, or medically vulnerable
Bureau of Health Professions
a component of HRSA, provide competencies and and expertise for education legislation for each of the health professions
National Institute of Health (NIH)
world’s premier medical research organization
Agency for Healthcare Research and Quality (AHCRQ)
supports research on healthcare systems, health care quality and cost issues, access to healthcare, and effectiveness of medical treatments; provide EBP
Food and Drug Administration
ensures the safety of foods and cosmetics and the safety and efficacy of pharmaceuticals, biological products, and medical devices. Also tracks foodborne illnesses
Centers for Disease Control (CDC)
main job is protect lives and improve health. Two primary goals are to prepare for terrorist health threats and protect the health and quality of life across the US. Provides a system of health surveillance to monitor and prevent disease outbreaks, implement disease prevention strategies, and maintain national health stats. Also provides for immunization services, workplace safety, and environmental disease prevention
those with insurance; employers prob provide insurance; viewed as being superior
private insurance
depend on public funds; less adequate healthcare
public insurance
the working poor
uninsured; typically young adults ages 25-34 are most likely to lack coverage
food and nutrition service; WIC
dept of agriculture
health services to federal prisoners
dept of justice
provides health information and support the control of urban air quality
Dept of commerce
develop safety and health standards and ensure compliance
Dept of Labor: OSHA and Mine Safety and Health Administration
WHO, declaration of Alma-Ata, movement that came from this meeting and US answered with healthy people 2020; focus is on PREVENTION; encourages self care and self management of health; community participates and helps define problems; workforce is made up of a multidisciplinary team
primary health care
the person that a sick person sees first
primary care physician (falls under primary health care)
increasing quality and years of healthy life
eliminating health disparites
goals of Healthy People 2020
what could cause a disparity?
mistrust, genetics, environment, lifestyle choices, little consensus in medical community regarding causes
you buy the plan that lets you pick your provider (how medicaid is set up) generally costs less; needs referral to specialist
HMO
can go to anyone on list, no need for referrals, can change providers as long as they are on the list
PPO
at the local level, who provides care that is mandated by state and federal regulations?
health dept
protect from bioterroism
Dept of Homeland Security (DHS)
health services to military and their dependents
Dept of Defense
Board of Nursing; population based, administration of programs such as Title V, surveillance and data collection, mental health hospitals and correctional facilities
State Public Health System
provides mandated public health services
vital stats, communicable disease control, maternal and child health, health education, public health laboratories
local public health system
Management of questions regarding West Nile, animal bites, vaccines, flu shots, insurance, manage all active and latent TB infections
local public health system
what do comsumers want?
lower costs and better care
what do employers want
reasonable price on insurance for employees
what do managed care and insurance companies want?
balance in reimbursement
legislators want?
access and quality? incremental changes
what does the future hold?
EBP; the most sustainable individual and system changes come when the people who live in the community actively participate!
no monthly premium, yearly deductible; pays for hospital, skilled nursing, hospice, prescribed home helath and durable medical equipment. Fee for Service
Medicare part A
Monthly premium; pays for outpatient services, physician care, outpatient procedures, surgeries, PT, lab services, preventative service-screenings and immunizations. Fee for Service
Medicare Part B
Medicare Advantage: HMO or PPO, can enroll in Medicare Advantage plan instead of original fee for service
Medicare Part C
Prescrition drug coverage began in Jan 2006
Medicare Part D
What doesn’t Medicare pay for?
skilled nursing home care past 100 days in each benefit period
meds if not administered in hospital or rehab setting (unless you have Part D)
medicare CAN be supplemented with other private insurance
