Chapter 3 Evolution of Health Services

Question 1

Almshouse

Answer 1

A poorhouse: common ancestor of both hospitals and nursing homes. Unspecialized institution existing during the 18th and 19th centuries. Mainly served general welfare functions. Provided shelter to homeless, insane, elderly, orphans, disabled and sick who had no family

Question 2

Balance Bill

Answer 2

Practice where provider bills the patient for leftover sum after insurance has only partially paid the charge initially billed

Question 3

Cost Shifting

Answer 3

AKA Cross-subsidization; shifting of costs from one entity to another as a way of making up losses in one area, but charging more in other areas

Question 4

Cultural Authority

Answer 4

General acceptance and reliance on the judgement of the member of a profession because of their superior knowledge and expertise

Question 5

Fee for service

Answer 5

Payment of separate fees to providers for each separate service, ie exam, test administration, hospitalization

Question 6

Gatekeeping

Answer 6

Use of primary care physicians to coordinate health care services needed by enrollees in a managed care plan

Question 7

Global Health

Answer 7

Efforts to protect the entire global community against threats to people’s health and to deliver cost-effective public health and clinical services to the world’s population

Question 8

Globalization

Answer 8

Various forms of cross-border economic activities driven by the global exchange of information, production of goods and services more economically in developing countries, increased interdependence of mature and emerging world economies

Question 9

Means Test

Answer 9

Program in which eligibility depends on income

Question 10

Medicaid

Answer 10

Joint federal-state program of health insurance for the poor

Question 11

Medical Tourism

Answer 11

Travel abroad to receive elective, nonemergency medical care

Question 12

Medicare

Answer 12

Federal program of health insurance for the elderly, certain disabled individuals, people with end-stage renal disease

Question 13

Organized Medicine

Answer 13

Concerted activities of physicians, mainly to protect their own interests, through such associations such as the American Medical Association

Question 14

Part A (Medicare)

Answer 14

Component of Medicare that provides coverage for hospital care and limited nursing home care

Question 15

Part B (Medicare)

Answer 15

Federal government-subsidized voluntary insurance for physician services and outpatient services

Question 16

Pesthouse

Answer 16

Facility operated by local governments in 18th-19th centuries to quarantine people who had contracted contagious disease such as cholera, smallpox, typhoid or yellow fever. Predecessors of contagious-disease and TB hospitals

Question 17

Prepaid plan

Answer 17

Contractual arrangement under which a provider must provide all needed services to a group of members (enrollees) in exchange for a fixed monthly fee paid in advance to the provider on a per-member basis (called capitation)

Question 18

Socialized Medicine

Answer 18

Any large-scale government-sponsored expansion of health insurance or intrusion in the private practice of medicine

Question 19

Title XVIII

Answer 19

Title 19 of the Social Security Amendment of 1965; the Medicare Program

Question 20

Title XIX

Answer 20

Title 19 of the Social Security Amendment of 1965; the Medicaid program

Question 21

Voluntary Health Insurance

Answer 21

Private health insurance (in contrast to government-sponsored compulsory health insurance)

Question 22

US Healthcare

Answer 22

Shaped by anthro-cultural values of social, political, and economic antecedants
Evolution of medical science and technology
Reform ahs taken center stage in American politics
Tracing the transformations in medical practice

Question 23

Colonial Times in America

Medical Services - Preindustrial era

Answer 23

Medicine lagged behind other countries
Treatment attitudes emphasized natural history and common sense
Strong domestic charter

Question 24

(Medical Services Preindustrial Era) 5 factors making medical profession an insignificant trade

Answer 24

Medical practice was in disarray
Medical procedures were primitive
Institutional core was missing
  - Almshouse and pest houe
  - Mental Asylum
  - Dreaded hospital
Demand was unstable
  - Fee for service
Medical Education was substandard

Question 25

(Medical Services ) Post industrial area

Answer 25

Physicians - Delivered scientifically and technically advanced services to insured patients - Became organized medical profession - Gained power, prestige, and financial success

Question 26

(Medical Services ) Post industrial area | 7 factors in professional sovereignty growth

Answer 26

``` Urbanization Science and technology Institutionalization Dependency Autonomy and organization Licensing Educational Reform ```

Question 27

(Medical Services ) Post industrial area | Health care took shape during this period

Answer 27

``` Specialization in Medicine - Gatekeeping Reform of mental health care Development of public health Health services for veterans Birth of worker's compensation ```

Question 28

(Medical Services ) Post-industrial area | Rise of private health insurance

Answer 28

``` Technological, social, and economic factors Early blanket insurance policies Economic necessity and the Baylor Plan Successful private enterprise Self-interests of physicians Combined hospital and physician coverage Employment-based health insurance ```

Question 29

(Medical Services ) Post-industrial area | 20th-century challenges

Answer 29

Failure of national health care initiatives during the 1990s - Political inexpediency - Institutional dissimilarities - Ideological differences - Tax aversion Creation of Medicare and Medicaid Regulatory role of public health agencies

Question 30

Medical Care in Corporate Era | Globalization of Healthcare

Answer 30

Four modes of economic interrelationships - Telemedicine - Medical Tourism - Foreign direct investment in health services - Health professionals move to other countries

Question 31

Medical Care in Corporate Era | 3 Aspects of Globalization

Answer 31

US corporations expanded overseas Medical care by US providers in demand overseas Global health discipline

Question 32

Era ofHealth Care Reform | 6 Factors in passing the ACA

Answer 32

Democratic party held presidency and majorities in congress Public option was dropped Closed-door deliberations Benefits were overstated Backing of major industry representatives Obama tied reform proposals to economic growth

Question 33

Era of Health Care Reform | Patchy legacy of ACA

Answer 33

Partially reduced number of uninsured Americans. 27 mil uninsured in 2017 Medicaid became main vehicle for expanding insurance - mainly low income helped Preexisting conditions were helped Regulatory mandates contributed to cost spiraling Erosion of competition also kept premiums high Negative effects on employer-based insurance Better preventative care, affordability, care for chronic conditions, medication adherence, and health status CHCs were helped financially Overcrowded EDs continued

Question 34

Fresh Challenges and Current Status

Answer 34

Most Supreme Court cases were decided in favor of ACA Texas v, United States to be decided (2021) Tax Cuts and Jobs act, 2017 repealed the individual mandate Full repeal and replacement is highly unlikely Most Americans now approve of ACA, but want changes Trump made several reforms although the political environment remained hostile

Question 35

Summary

Answer 35

Need for health insurance recognized in Great Depression US insurance began as private endeavor Creation of Medicare and Medicaid ACA passes without seeking consensus among Americans - Provisions helped low-income Americans - Put greater financial burdens on the middle class

Question 36

Why did professionalization of medicine start later in the US than in some Western European nations?

Answer 36

``` Medical Practice in disarray Medical procedures were primitive Institutional core was missing Demand was unstable Medical education was substandard ```

Question 37

Why did medicine have a domestic - rather than professional - character in the preindustrial era? How did urbanization change that?

Answer 37

Medical services, when deemed appropriate by the consumer, where purchased out of one's private funds Citizens were moving away from rural areas where they had access to family and neighborhoods where family-based care was traditionally given - creatd increased reliance on specialized skills of paid professionals

Question 38

Which factors explain why the demand for the services of a professional physician was inadequate in the preindustrial era? How did scientific medicine and technology change that?

Answer 38

Most physicians located in more populated communities. Extensive use of folk remedies, and economic conditions Advances in techniques and sanitation, along with new drugs gave legitimacy and complexity

Question 39

How did the emergence of general hospitals strengthen the professional sovereignty of physicians?

Answer 39

Allowed symboiotic relationship. Hospitals kept physicians satisfied in order to keep beds filled

Question 40

Discuss the relationship of dependency within the context of the medical profession's cultural and legitimied authority. What role did medical education reform play in galvanizing professional authority?

Answer 40

Patients depend on medical profession's judgement and assistance Society expects a sick person to seek medical help and try and get well

Question 41

How did the organized medical profession manage to remain free of control by business firms, insurance companies and hospitals until the latter part of the 20th century

Answer 41

Historically, was prohibitied by law. Labeled as commercialisim.

Question 42

Discuss how technological, social and economic factors, in general, created the need for health insurance

Answer 42

Medicine offered new and better treatments Health care had become more desirable People could predict neither future needs nor the costs of medical care

Question 43

Which conditions during World War II period lent support to employer-based health insurance in the US?

Answer 43

Congress imposed wage-freezes to control inflation. Employers offered health insurance to workers in lieu of wages

Question 44

Discuss, with particular reference to the roles of a) organized medicine b) the middle class c)American beliefs and and values, why reform efforts to bring in national health insurance have historically been unsuccessful in the US

Answer 44

a) Power and prestige of physicians | b/c) American values of individualism, self-determination, distrust of the governement

Question 45

Which particular factors that earlier may have been somewhat weak in bringing about national health insurnace later led to passage of Medicare and Medicaid?

Answer 45

Government intervention was not desired by most Americans, but public would not oppose reform initiatives to help the underprivileged and vulnerable classes

Question 46

On what basis were the elderly and the poor regarded as bulnerable groups for who special goverment-sponsored programs need to be created

Answer 46

Could not afford increasing cost of helath care | Due to socioeconomics, the health status of these groups is signifincantly worse that that of hte general population

Question 47

Which areas of health care delivery can be attributed to public health services?

Answer 47

Infectious deseases posed greatest health threat

Question 48

Explain how contract practice and prepaid group insurance were prototypes of today's managed care plans

Answer 48

Prepaid medical are as an alternative to traditional fee-for-service practice, would stimulate competition among health plans, enhance efficiency and control the rising healthcare expenditures

Question 49

Discuss the main ways in which current delivery of helath care has become corportized

Answer 49

Consolidation of purchaing power, integrated health care organizations, larger systems

Question 50

In the context of globalization in health services, what are the main economic activies as discussed in the chapter?

Answer 50

Corporatization of medicine Cross-border economic activities characterized by transnational movement and exchange of goods, services, people and capital

Question 51

From the standpoint of health insurance, what were the main accomplishments of the Affordable Care Act

Answer 51

Affordable marketplace options for health care Ability to be insured for pre-existing conditions Insurance from parents to age 26