Chapter 1 - US Health Systems

Question 1

what do most modern countries have?

Answer 1

universal health care

Question 2

Affordable Care Act (ACA)

Answer 2

increased coverage for a lot of Americans, is not Universal Health Care

Question 3

How many Americans are on PRIVATE health insurance?

Answer 3

201.1 million

Question 4

How many Americans are covered by Medicare and Medicaid

Answer 4

103.1

Question 5

What is managed care?

Answer 5

most dominate of the health care systems;

a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.

ex) HMO and PPO

Question 6

Military Coverage

Answer 6

TriCare - mostly free of charge to those who are currently active duty,

provides both preventative and treatment oriented services

Veterans Administration (VA) available for retired vets (9.6 mill. people)

Question 7

Special Populations

Answer 7

vulnerable populations - those who have inadequate resources to address their needs

Question 8

What accommodations do special populations use to receive care?

Answer 8

• Medicare
• Medicaid
• Community Health Centers
• Migrant Health Centers
• Free Clinics
• Hospital Emergency Departments

Question 9

Medicare

Answer 9

• one of the largest sources of health insurance
• majority of insured are elderly or disabled
• 22 mill. people

Question 10

Medicaid

Answer 10

• third larges source of health insurance
• provides coverage for low-income adults, children and elderly, and disabled
• covers 17.3% of population
• increased significantly due to ACA

Question 11

Children’s Health Insurance Program (CHIP)

Answer 11

• provides coverage to children in uninsured families that do not qualify for Medicaid
• 8.1 million children
• Started by Hillary Clinton

Question 12

Integrated Delivery Systems (IDS)

Answer 12

insurance companies pay a lump sum of money to hospitals to take care of you at the hospital and outside the hospital in order to decrease re-hospitalization rates

Question 13

Accountable Care Organizations:

Answer 13

Focused on providing:

• Emphasis on primary care
• Coordination of all care (including behavioral, social and public health)
• Accountability for health outcomes

Question 14

Long-Term Care

Answer 14

provided in various settings to consumers who have chronic health issues and disabilities that prevent them from doing their ‘regular daily tasks’

Question 15

Examples of long-term care facilities:

Answer 15

• Consumers homes
• Assisted Living Facilities (ALF)
• Skilled Nursing Homes (SNF)

Question 16

Public Health System

Answer 16

• mission to improve and protect community health
• amount of Federal funding for PH initiatives vary on location
• ACA established ‘Prevention and Public Health Fund’ to improve health outcomes and increase health care quality

Question 17

Main Characteristics that set the US apart from other counties in HC:

Answer 17

1) no central governing agency and little integration and coordination
2) technology driven and focusing on acute care
3) high in cost, unequal in access, and average in outcome
4) imperfect market conditions
5) Government as Subsidiary to the private sector
6) fusion of market justice (distribution on the basis of people’s willingness and ability to pay for their care) and social justice (well being of community over well-being of self)
7) multiple players and balance of power (looks at multiple players and how they affect the individual and the individuals care)
8) quest for integration and accountability (must advocate for self as a patient)
9) access to HC services selectively based on insurance coverage (HC to those who can afford it)
10) legal risks influence practice behaviors (doctors order more tests to cover their backs incase of being sued)

Question 18

System Framework:

Answer 18

• System Inputs (Resources)
• System Structure
• System Processes
• System Outputs (Outcomes)
• System Outlook (Future Directions)

Question 19

System Inputs:

Answer 19

both human and non-human resources

personnel, technology, financing and reimbursement

Question 20

System Processes

Answer 20

carried out through hospitals, clinics and LTC providers, OP clinics, community based settings

Question 21

System Outputs

Answer 21

refers to critical issues and concerns

primary objective: provide cost-effective health services that meet quality standards of nation

Question 22

System Outlook

Answer 22

must look forward - project the future