Chapter 2 The Health System

Question 1

McGinnis determinants of health

Answer 1

-Biology (30%), Behavior (40%), Social (15%), Medical Care (10%), Environment (5%)

Question 2

Syndromic surveillance

Answer 2

Involves tracking the presentation of certain symptoms as a potential early warning sign of an epidemic

Question 3

Risk spreading

Answer 3

process of distributing the cost of care over a large number of people (done by insurance companies)

Question 4

Indemnity policy

Answer 4

Insurance pays based on services provided (fee-for-service)

Question 5

Cost sharing

Answer 5

-mechanism of requiring patients to pay some fraction of the cost of care (done by insurance companies)
-Co-payment: small fraction of total cost of care and paid directly from patient to provider
-Co-insurance: requires patient to pay fixed fraction of the cost of care

Question 6

Health Maintenance Organization (HMO) Act

Answer 6

-Passed by congress in 1973
-Created Managed Care Organizations
-Limit patients to providers that agree to follow HMO’s guidelines and restrictions
-Controlled costs through capitation and pre-authorization

Question 7

Capitation

Answer 7

primary care doctor given a certain amount of money per patient per year

Question 8

Capitation

Answer 8

Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services.

Question 9

Pre-authorization

Answer 9

require patient to obtain permission before acquiring certain costly services

Question 10

Inpatient prospective payment system

Answer 10

-Instituted by Medicare in 1983
-Hospitals are now paid by diagnosis related groups (based on primary discharge diagnosis) rather than daily rate for hospitalized patients

Question 11

Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer 11

-1985
-Mandate hospitals provide medical screening exam to anyone who comes to teh hospital and on whose behalf a request for treatment is made
-hospitals could no longer discriminate on the basis of ability to pay

Question 12

Cost-shifting

Answer 12

Process by hospitals to use money collected from insured patients to pay for uninsured patients

Question 13

Accountable Care Organization (ACO)

Answer 13

-Modern iteration of HMO
-Group of providers who voluntarily band together to coordinate services
-Key motivating factor is still capitation

Question 14

Crossing the Quality Chiasm: A New Health SyStem for the 21st Century (and what are the 6 pillars of quality)

Answer 14

-Author: Institute of Medicine
-4 recommendations: create an infrastructure to support evidence-based practice, expand use of information technology, align payment incentives, prepare the workforce to better serve patients in a world of expanding knowledge and rapid change
-6 pillars of quality: safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity

Question 15

Gertis 6 dimensions of patient-centeredness

Answer 15

respect for values, needs and preferences; coordination of care; education and communication; comfort; emotional support; involvement of friends and family