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Healthcare Policy 780 > Ch 5,6,8 > Flashcards

Ch 5,6,8 Flashcards

1
Q

HRSA

HC

A

Health resources and services administration

health center

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2
Q

This is a government agency within the US dept of health and human services that supports easy access to care for US residents though community-based, patient directed (51% of the governing board members must be patients of the health center), federally funded centers

A

HRSA

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3
Q

There are criteria that must be met to be designated as a HC:

A
  1. Be located in or provide services to high need communities-those designated by the govt as medically underserved
  2. Provide primary care and promote access to care that exceeds access previously offered through supportive services
  3. Provide services with fees charged on the basis of ability to pay
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4
Q

What is the scope of health center services?

A

Primary care
Dental care
Mental health
Substance abuse service

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5
Q

What percentage of HC patients are of a racial or ethnic background?

A

36% and 40% are uninsured

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6
Q

How is health care spending often described?

A

National health expenditure

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7
Q

What percentage of our GDP was health care spending in 1960?

A

5.2%

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8
Q

These are estimates of annual spending on health services, healthcare supplies, and research and construction activities related to health

A

National health expenditures or nation health spending

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9
Q

What factors have led to increased costs of healthcare spending?

A
  1. Curing versus maintaining wellness
  2. Technology
  3. Inefficiency of third party payer system
  4. Increase in elderly
  5. Waste and abuse within the system
  6. Inflation
  7. Recent recession and recovery
  8. Defensive medicine
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10
Q

Two general types of insurance:

A

Private and public

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11
Q

These are organizations that seek to apply the components of managed care to a population in the hope of providing high quality care at a lower cost than that incurred by the provision of fee for service care:

A

Managed care organizations (MCOs)

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12
Q

This is a care model that is characterized by a designated provider network, standardized review and quality improvement measures, an emphasis on preventative rather than acute care and financial incentives for doctors and patients to reduce unnecessary medical care use

A

Managed care

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13
Q

This is the amount an enrollee must pay to join the managed care plan. It serves as a membership fee and is typically adjusted annually

A

Premium

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14
Q

33% of funding sources for medical expenditures comes from?

A

Managed care organizations

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15
Q

These account of 52% of the funding sources for medical expenditures?

A

Public health insurance plans

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16
Q

This is the amount an insured patient must pay out of pocket for his medical care per year before the insurance plan covers the costs?

A

Deductible

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17
Q

Medicare part a covers what?

A

Hospitals, nursing homes, hospice care and some home health services

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18
Q

Medicare part b covers?

A

Supplemental portion that covers physician services and outpatient care not covered by part A

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19
Q

What services are not covered by medicare a or b?

A

Vision care, glasses, dentures, and hearing aides

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20
Q

How is the federal funding determined for medicaid?

A

On the basis of the state’s per capita income

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21
Q

A calculation reflecting a set of federal government guidelines related to income that is based on the cost of living

A

Federal poverty level

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22
Q

This is a fixed fee for each patient

A

Capitation

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23
Q

A fee agreed on between an insurance plan and physicians to provide medical services at a lower cost than is common for the area in exchange for access to the insurance plan’s pool of patient’s

A

Discounted fee for service

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24
Q

These are primary care providers in managed care who manage routine services and referrals for higher level care or speciality services

A

Gatekeepers

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25
Q

These are services that enhance access to medical care (transportation, interpretation, education, community outreach)

A

Enabling services

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26
Q

This is the least popular source of funding for LTC because of the high cost of premiums and its limited coverage

A

Private insurance

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27
Q

These are defined by the institute of medicine, “providers that by mandate or mission organize and deliver a significant level of health care and other health related services to the uninsured, medicaid, and other vulnerable patients

A

Safety net providers

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28
Q

6 basic activities of ADL’s:

A 
Eating
Bathing
Dressing
Toileting
Transferring 
Maintaining bladder and bowel control
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29
Q

This measures an individuals ability to perform activities that are necessary to live independently in non institutional settings: such as driving a car, shopping, preparing meals and performing light housework

A

Instrumental activities of daily living

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30
Q

This is achieved through control of supply, price, and utilization

A

Regulation based cost containment

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31
Q

____ and colleagues in 2010 conducted a survey on leadership representatives of key stakeholder groups about workforce policies to examine perceptions on nurse workforce issues. The discovered that stakeholders should focus on the current lack of effective policy advocacy and leadership to advance nurse workforce issues on the national health agenda and in the medica

A

Donelan

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32
Q

These are health and safety standards defined by CMS as the minimum requirements that hospitals and medical centers must meet to be eligible to serve publicly insured patients

A

Conditions of participation

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33
Q

These are drug patent settlements where a drug company that has a brand name drug on the market pays a competitor intending to sell a generic version of the drug to delay bringing the lower cost drug to the market

A

Pay for delay

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34
Q

What are the top 3 speciality physician shortages?

A

General practitioners
General internal medicine
Psychiatric physicians

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35
Q

What are the 4 most commonly needed allied health professionals:

A

Nurses
PT
Pharmacists
OT

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36
Q

Macdowel and colleagues conducted survey on shortages in the healthcare system and identified four recruitment and retention factors significantly correlated with the reported primary care physician shortage:

A
  1. Healthcare major part of local economy
  2. Community is a good place for family
  3. Doctors are well respected and supported
  4. People in the community are friendly and supportive of each other
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37
Q

What is the primary goal of health policy?

A

Access to care to serve the most needy and underserved populations

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38
Q

What are the aims of informed consent?

A
  1. Respect and promote the autonomy of patients and research participants
  2. Protect patients and research participants from potential harm
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39
Q

The ability to fulfill the goals of informed consent depends on the presence of three basic components:

A
  1. Prerequisites including competence and voluntariness
  2. Clear and truthful information
  3. Free and voluntary enrollment, including the opportunity to withdraw consent without any impact on the quality of treatment received by the patient
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40
Q

When was emtala passed?

A

1986

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41
Q

What challenges do HC’s face?

A 
Economic slowdown
Demographic trends
Shifting disease burden
Increased complexity of healthcare system
Workforce shortages
Rapid rate of technology innovation
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42
Q

This is the convergence of health risks:

A

Vulnerability

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43
Q

Health risks consist of three characteristics at the individual and ecological levels:

A

Predisposing
Enabling
Need

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44
Q

These charactieristics describe the propensity of individuals to use services: demographics, social structures, and health beliefs live here

A

Predisposing characteristics

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45
Q

These are characteristics available to individuals and families for the use of services, the attributes of the surrounding community or region that affect the availability of healthcare services

A

Enabling characteristics

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46
Q

These are specific illnesses or health needs that drive the receipt of healthcare

A

Need factors

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47
Q

How much of the population is made up of racial or ethnic minorities?

A

34%

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48
Q

RSC is a usual place where or a usual provider from whom an individual received healthcare services

A

Regular source of care

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49
Q

These are efforts by healthcare organizations and providers to increase understanding and produce effective interventions for patients by taking into account patients cultural and linguistic characteristics

A

Culturally appropriate services

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50
Q

What are the factors contributing to the lack of RSC: (hispanic adults least likely to have one followed by America indians)

A
  1. Absence of health insurance coverage
  2. Low family income
  3. Language other than english spoken in the house
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51
Q

Who has the highest smoking prevalence among populations?

A

Blacks and american indians

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52
Q

OMH

A

Office of minority health

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53
Q

IHS

A

Indian health services

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54
Q

What percentage of the population is covered by federal programs like medicare and medicaid and chip

A

40%

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55
Q

This has been credited with improving the health status of undocumented children and reducing preventable hospitalizations

A

CHIs (children’s health initiatives in california)

56
Q

This has been shown to have a greater impact on access to healthcare than race and ethnicity

A

Socioeconomic status

57
Q

This is the only federal program that has a focus on investing in increasing the education level of individuals an often overlooked contributor to SES disparities in healthcare

A

Head start

58
Q

This is a program in south carolina that is a public-private nonprofit partnership that offers free or low cost primary care, free prescription services, and free pediatric dental care to low income people without health insurance

A

Welvista program

59
Q

This local initiative targeting those without insurance is in kansas city

A

Telekids

60
Q

This was funded by robert wood johnson foundation and is one example of privately funded programs addressing SES disparities, through which undergraduate students volunteer in community clinics and connect patients with local health resources.

A

Project health design

61
Q

For the elderly the concerns about primary care and health policy broadly revolve around the following:

A

Cost containment
Reforming health system to better serve a new, large generation of the elderly
Increasing quality of life as far as possible into old age

62
Q

High disease burden means?

A

Two or more diseases

63
Q

Chronic conditions means:

A

Five or more illnesses

64
Q

Bodenheimer, chen, and bennett note that the most proactive ways to raise the quality of life for the elderly are to:

A
  1. Provide effective and low cost preventive treatments designed to lower risks factors for future adverse health outcomes
  2. Provide such treatments throughout the patients life
65
Q

The burden of chronic illness is borne both by the _____, who experience frustration, high costs, and negative health outcomes, and by the _______ _______ which is often unable to provide appropriate, effective, and efficient care

A

Patient, healthcare system

66
Q

This is a process by which a person or an idea is pushed aside n favor of another. This type of subject typically receives few resources and little attention

A

Marginalization

67
Q

They tend to live longer, report more physically and mentally unhealthy days each month and have higher rates of chronic conditions in old age than men

A

Women

68
Q

DALY: a measure of the loss of healthy life. This measurement is intended to capture the economic, social, and functional realities that a person with a disability will face and the corresponding loss in health status and quality of life

A

Disability adjusted life year

69
Q

This is the m out documented risk for asthma, obesity, and adhd in children.

A

Maternal cigarette smoking

70
Q

Who said that barriers that disabled patients confront represent quality problems and also heighten patients sense of stigmatization, disenfranchisement, and demoralization

A

Kirschner, breslin, and iezzoni

71
Q

Who is one of the most marginalized groups in society?

A

The homeless

72
Q

____ percent of residents will bear at least one occurrence of homelessness in their lives

A

7

73
Q

Homeless and _____ unstable people are subject to much higher resource competition than most of the general population, and health issues that would be considered by others absolutely necessary to resolve may be sidelined by the homeless in favor of basic need,s such as foods and shelter

A

Housing

74
Q

Up to _____% of the homeless population has a chronic mental health disorder or abuses drugs or alcohol

A

75

75
Q

This homeless program is a leading outreach program that works to integrate care across the medical spectrum and housing situations to provide continuous services and preventive care

A

The boston health care for the homeless

76
Q

When were the first AIDS cases identified?

A

1981

77
Q

44% of this population group account for new hiv infections each year, and this population group accounts for 61% of new hiv infections every year.

A

Blacks, gay men

78
Q

The barriers that inhibit hiv positive people from accessing lifesaving medications are significant:

A

The lifetime healthcare costs is one major issue

79
Q

Assuming there is access to care the average length of lifespan post diagnosis with hiv is?

A

24.2 years

80
Q

Obama’s national strategy for the aids strategy is hailed as the most comprehensive federal response to the domestic hiv epidemic to date sets three targeted goals for the country to achieve in the next ten years:

A
  1. Reduce new infections
  2. Improve access to care and outcomes
  3. Reduce health disparities
81
Q

HPR

A

Health policy research

82
Q

This is the process of scientific investigation that applies to various heal related and social science methodologies to formulate and evaluate health policies.

A

Health policy research (HPR)

83
Q

What is the goal of HPR?

A

To improve the health of populations through needs assessment, policy, and program development, implementation, and evaluation

84
Q

How is health policy research different from health policy analysis?

A

HPR tends to be conducted in a rigorous and systemic fashion, whereas policy analysis is time sensitive and relies on existing and current information

85
Q

This is a systematic approach by high to assess problems and guide decision making.

A

Policy analysis

86
Q

What do policy analysts help do?

A

Planning, budgeting, program evaluation, program design, program management, public relations, and other functions

87
Q

Policy analysts follow a five step framework to assess problems:

A
  1. Establish the context and goals for a particular issue
  2. Identifying alternative approaches in addressing the issue
  3. Evaluating alternative and predicting consequences
  4. Valuing the outcomes
  5. Making a choice
88
Q

There are five main attributes that characterize health policy research:

A
  1. Its nature as an applied field
  2. Ethics framework
  3. The multidisciplinary input it enjoys
  4. Its basis in science
  5. Its focus on population
89
Q

Health policy research aims to address problems related to?

A

Specific populations like pregnant women, the elderly, or migrants and to enhance health interventions at the local, national, and international levels

90
Q

Is the objective of researchers and policy makers always complementary?

A

No.

91
Q

When does HPR come into play?

A

Often comes into play as the life of a policy begins, at policy formulation stage… a window of opportunity must exist for a policy to be fully developed

92
Q

When does the window of opportunity open for HPR and policy to occur?

A

When there is favorable confluence of problems, possible solutions, and political circumstances

93
Q

Policy process is a ______ cycle that is constantly informed by policy research

A

Feedback

94
Q

This is a committee that examines the ethical implications of research to protect study subjects from physical or psychological harm

A

Institutional review board (IRB)

95
Q

_____ standards dictate the proper conduct of research, including accommodation of the interests of research subjects.

A

Ethical

96
Q

Throughout the duration of the study, the _____ of subjects should be protected through _____ or _______

A

Privacy, anonymity, confidentiality

97
Q

The ______ sciences include the study of biological determinants, risk factors, and consequences of health processes, as well as methods and techniques to characterize such phenomena to contribute to the understanding o human populations

A

Biological

98
Q

Theories from the ____ sciences and methodologies used in empirical research can provide guidance for HPR and include problem conceptualization, data collection, and analysis and interpretation

A

Social

99
Q

This is the gold standard for scientific research?

A

Randomized controlled trail

100
Q

In this trial the research subjects are randomly assigned to an experimental group or a control group

A

Randomized controlled trial

101
Q

Why is the randomized controlled trial incompatible with HPR?

A

Researchers must consider determinants of health ad environmental factors beyond those captured under strict experimental conditions

102
Q

Because of the ethical standards of HPR researchers typically use ___-____ designs, cohort studies, longitudinal analyses, survey analyses, and multidisciplinary approaches

A

Quasi-experimental

103
Q

HPR focuses on the ____ rather than the individual

A

Population

104
Q

HPR or analysis can be undertaken in a number of ways, the most widely used approach is the _____ model.

A

Rationalist

105
Q

What are two types of execution errors that prevent successful completion of a study?

A

Writing an untestable hypothesis and securing an inadequate sample

106
Q

The process of health policy analysis under rationalist method:

A
  1. Define the problem
  2. Determine evaluation criteria
  3. ID alternative policies
  4. Evaluate alternate policies
  5. Select the preferred policy
  6. Implement the preferred policy
107
Q

Steps in conducting HPR:

A
  1. Conceptualization
  2. Groundwork
  3. Methods
  4. Design
  5. Sampling
  6. Measurement
  7. Data collection
  8. Data processing
  9. Data analysis
  10. Application
108
Q

The conceptualization phase completes the development of a _____ framework, which is a preliminary model of the problem under study that depicts relationships among critical variables of interest and between variables and concepts of interest

A

Conceptual

109
Q

This is a critical step within the conceptualization component, it informs researchers about the current state of the study on the topic as well as the existing limitations in the body of research

A

Conducting a literature review

110
Q

These help facilitate the identification of theories and provide guidance in the formulation of hypotheses to be tested.

A

Literature reviews

111
Q

In the groundwork stage the researcher does the following:

A
  1. Identifies relevant date sources
  2. Explores potential funding
  3. Develops research plan or proposal by which to obtain funding
  4. Makes organizational and administrative preparations to carry out the research
112
Q

Those engaged in policy research used a range of data types:

A

Quantitative
Qualitative
Experimental
Descriptive data

113
Q

What are the three categories of research methods?

A

Exploratory
Descriptive
Explanatory

114
Q

These research methods are used to learn more about a little known topic or to test new research methods and examples are case studies or focus groups

A

Exploratory

115
Q

These research methods are used to investigate study characteristics among subjects an example is the administration and analysis of survey data.

A

Descriptive research

116
Q

Why are descriptive research methods difficult to conduct?

A

They are expensive to conduct and often require large sample sizes

117
Q

This research method includes experimental studies and is considered the gold standard among research study methods, as well as case control studies and longitudinal research. They are the most rigorous in design, so findings have the greatest level of generalizability compared with other methods and it can be expensive and requires large sample sizes and complex statistical analysis

A

Explanatory research method

118
Q

research design addresses the planning of scientific inquiry by:

A

Anticipate the stages of the project and choosing the method
Identify the unit of analysis and variables to be measured
Establishing procedures for data collection
Devising an analysis strategy

119
Q

There are four types of sampling methods, often referred to as probability sampling designs because each subject in a sampling frame has a known probability of being selected for the sample, incorporating varying degrees of random selection:

A

Simple random sampling
Systematic sampling
Cluster sampling
Stratified sampling

120
Q

This is the most basic sampling method in which every subject is the sampling frame has an equal probability of being selected

A

Simple random sampling

121
Q

This sampling method is a bit more complicated in every kth subject from the sampling frame is selected (every 5th subject is selected from the sampling frame). The interval between selected subjects (k) is chosen by the researcher

A

Systematic sampling

122
Q

______ selection are methods by which subjects from a sampling frame are randomly selected to create representative samples

A

Random

123
Q

This involves the distribution of subjects in the sampling frame into herteogeneous clusters, which are then randomly selected to comprise a sample of clusters. These can be cost effective way to conduct research over a broad geographic area

A

Cluster sampling

124
Q

This is similar to cluster sampling in that subjects from the sampling frame are divided into groups, however these groups (known as strata) are homogenous this method is chosen to ensure the sample is a representative of the population about which a researcher hopes to draw inferences in terms of charateristics of interest

A

Stratified sampling

125
Q

Give an example of nonprobability sampling methods: the probability of subject selection in a sample is unknown when these methods are used

A

Convenience sampling, quota sampling, purposive sampling, and snowball sampling

126
Q

This is the extent to which results are similar if the measurement tool is reapplied in a consistent way

A

Measurement reliability

127
Q

This is the extent to which the measurement tool accurately measures the intended concepts

A

Measurement validity

128
Q

There are two categories of data for HPR:

A

Primary sources and existing sources

129
Q

What are two primary data collection tools used?

A

Interviews

Administration of questionnaires

130
Q

Why are existing data or secondary data widely used in HPR?

A

They tend to be more generalized and are more efficient in terms of saving time and cost than are primary data

131
Q

What can be the most satisfying step in the research process?

A

Applying research findings to scientific theory and policy formulation

132
Q

Communicating HPR has the potential for multiple audience types, there are three potential groups:

A

Research community
Stakeholders
The public

133
Q

What is the most common way to communicating results to the scientific community?

A

Publishing an article on the research in a peer reviewed scientific journal

Or, professional conferences
Or working papers and monographs

134
Q

If stakeholders are the audience, investigators cannot?

A

Assume any prior knowledge of the subject and terminology

135
Q

When the intended audience is the general public, investigators can rely on?

A

Mass media to publicize significant research findings

136
Q

What are the barriers to the implementation of research in policy and some ways to overcome these barriers?

A 
Relevance
Type of study 
Priorities
Timetable
Communication
Scope
Values
Leadership
Rapport
Skills
Subject matter
Methodology
Statistics
Computer application software 
Writing
Public relations

Healthcare Policy 780 (3 decks)

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