Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Introduction to Health Systems > Chapter 1 Delivering Healthcare part 1 > Flashcards

Chapter 1 Delivering Healthcare part 1 Flashcards

1
Q

How is the United States’s healthcare system unique compared to everywhere else?

A

Americans are not automatically covered by health insurance
Different people obtain healthcare through different means

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is US healthcare delivery complex?

A

Many organizations and individuals are involved in healthcare.
It is also a massive system with a vast array of health care institutions
Various types of healthcare professionals are involved
Multitudes of government agencies are involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Does US healthcare delivery function as a rational and integrated network of components designed to work together coherently?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the characteristics of the US system?

A

A multiplicity of financial arrangements for health care services
Numerous insurance agencies or MCOs that employ various mechanisms for insuring against risk
Multiple payers that make their own determinations regarding how much to pay for each type of service
A diverse array of settings where medical services are delivered
Numerous consulting firms offering expertise in planning, cost containment, electronic systems, quality, and restructuring of resources.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Negative aspects of the US healthcare system

A

Little standardization
Problems of duplication, overlap, inadequacy, inconsistency, and waste due to lack of a central government agency to oversee coordination.
A complex and inefficient system due to lack of system-wide planning, direction, and coordination.
Cost containment remains an elusive goal d/t everyone’s individual interests needing financial incentives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which country consumes more healthcare services as a proportion of its total economic output than any other country in the world?

A

The United States

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two primary objectives of an acceptable healthcare delivery system?

A

Enable all citizens to obtain needed healthcare services
Ensure that services are cost-effective and meet certain established standards of quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the components of the quad-function model?

A

Financing
Insurance
Delivery
Payment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the source of insurance for most Americans?

A

Employer-based

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is financing necessary?

A

To obtain health insurance or pay for healthcare services.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the purpose of insurance?

A

To protect the insured against financial catastrophe by providing expensive healthcare services when needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

To what does the term delivery refer?

A

The provision of healthcare services by various providers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define the term provider

A

Any entity that delivers healthcare services and either independently bills for those services or is supported through tax revenues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the payment function deal with?

A

Reimbursement to providers for services delivered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

From where do the funds to pay the provider come?

A

The premiums paid to the MCO or insurance company, with the exception of the out-of-pocket amount charged immediately to the pt
With gov’t insurance plans, the money comes from tax revenues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who is covered under Medicare and under what gov’t is it run?

A

The elderly and certain disabled individuals
Federal gov’t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who is covered under Medicaid? Under what gov’t is it run?

A

The indigent
Jointly by federal and state gov’ts

18
Q

Who is covered under CHIP? Under what gov’t is it run?

A

Children from low-income families
Federal-state partnership

19
Q

What are the two main reasons some employed individuals remain uninsured?

A

Some small businesses cannot get group insurance at affordable rates
In some work settings, participation is voluntary, and many people do not join because they can’t afford the cost of health insurance premiums.

20
Q

Define premium cost-sharing

A

When employees are required to pay a portion of the cost of health insurance premiums

21
Q

Define healthcare reform

A

The expansion of health insurance to cover the uninsured

22
Q

What was the most sweeping healthcare reform in recent US history?

A

The Patient Protection and Affordable Care Act of 2010, or the ACA

23
Q

What was one of the main objectives of the ACA?

A

To reduce the number of uninsured

24
Q

What was a requirement of the ACA in terms of insurance?

A

All US citizens and legal residents must be covered under public or private insurance

25
Q

Define universal coverage

A

Coverage that enables all citizens and legal residents to have health insurance

26
Q

Trends in insurance coverage after the ACA

A

Uninsured rate declined among all race-ethnicity categories
Females experienced a greater decline in uninsured rate compared to males

27
Q

Consequences of Trump’s repeal and replace ACA

A

Uninsured rates soared

28
Q

When was there a fundamental change in healthcare delivery and what was it?

A

The 1990s
Involved a tighter integration of the basic functions through managed care

29
Q

Define utilization of health services

A

The quantity of healthcare consumed

30
Q

Describe managed care

A

A system of healthcare delivery that
1. Seeks to achieve efficiency by integrating the 4 functions of healthcare delivery
2. Employs mechanisms to control utilization of medical services and
3. determines the price of services and consequently, how much the providers are paid

31
Q

Define enrollee

A

The individual covered under the health plan

32
Q

Define health plan

A

The contractual arrangement between the MCO and the enrollee, including the collective array of covered health services that the enrollee is entitled to

33
Q

What is managed care good at?

A

Implementing effective cost-saving measures without compromising access and quality

34
Q

What external influences shape the basic character of the health services delivery system?

A

National political climate
Economic development
Technological progress
Social and cultural values
Physical environments
Population characteristics

35
Q

What are the 10 basic characteristics that differentiate the US healthcare delivery system from most other countries?

A
  1. No central agency governs the system.
  2. Access to health care services is selectively based on insurance coverage
  3. Healthcare is delivered under imperfect market conditions
  4. Insurers from a third party act as intermediaries between the financing and delivery functions
  5. The existence of multiple payers makes the system cumbersome
  6. The balance of power among various players prevents any single entity from dominating the system
  7. Legal risks influence the practice behavior of physicians
  8. Development of new technology creates an automatic demand for its use
  9. New service settings have evolved along a continuum
  10. Quality and value are fast becoming the hallmarks of care delivery
36
Q

Definition of global budgets. Does the US have them?

A

Allocation of pre-established total expenditures for a healthcare system or subsystem.
No, because the US healthcare system is not administratively controlled by a department or agency.

37
Q

What is the implication of private delivery of health care?

A

The majority of hospitals and physician clinics are private business, which operate independently of the government

38
Q

What is the role of federal and state governments in healthcare delivery?

A

Determine public-sector expenditures and reimbursement rates for services provided to Medicare, Medicaid, and CHIP beneficiaries.
Formulates standards of participation through health policy and regulation

39
Q

Define standards of participation

A

Providers must comply with the standards established by the gov’t to be certified to provide services to Medicare, Medicaid, and CHIP beneficiaries

40
Q

Define access

A

The ability of an individual to obtain healthcare services when needed

41
Q

How can Americans access healthcare services?

A
  1. Health insurance through their employers
  2. Covered under a gov’t healthcare program
  3. Can afford to buy insurance with their own private funds
  4. Can pay for services privately
  5. Can obtain charity or subsidized care

Introduction to Health Systems (66 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions