dynamics of health midterm Flashcards
Legislation passed in 2010 requiring US citizens and permanent residents to have minimum essential health insurance coverage
the most significant change in the past 10 years
Affordable care act
Expenses related to medical treatment and services
Health care costs
Government program providing health coverage to low-income individuals and families
Medicaid
Government program providing health coverage to individuals aged 65 and older, and certain younger individuals with disabilities
Medicare
Health coverage provided by private companies
Private insurance
Reasons for rising healthcare costs
Factors contributing to the increase in expenses related to medical treatment and services-technology medication aging increased prevalence of chronic diseases
Decline in mortality
Reduction in the number of deaths due to improvements in hygiene in the 20th century
highest cause of death in the U.S.
Heart Disease
Health professionals needed for opioid addiction
Medical practitioners required to treat individuals suffering from opioid addiction will need more behavioral health and social workers
Projected population by 2050
⅓ Hispanic, ⅓ White, ⅓ African American
Downside of improved healthcare and longevity
People will live longer with more chronic disease
Preventive services included in ACA
Mammography colonoscopy and immunizations
chronic diseases are associated with
personal lifestyle
Delivery of healthcare services remotely using technology-became common during pandemic
telehealth
Virulent antibiotic resistant bacteria strain
MRSA (methicillin resistant staph aureus)
Use of computers to store and exchange health information
health IT
Factors that influence health outcomes, including birthplace, living conditions, education, and employment
Social determinants of health
Health insurance company offering coverage to individuals and families(private insurance)
Blue cross/blue shield
direct health services provided by the federal government
Tricare, ACA, Indian Health Service, Medicaid, Medicare
US DOES NOT HAVE
CENTRALIZED healthcare delivery systems
Services aimed at promoting and maintaining good health(prenatal nutrition)
Health promotion service
Services focused on preventing the occurrence of diseases (smoking cessation)
Disease prevention service
Services involved in identifying and addressing medical conditions (x-ray and lab) most used
Diagnosis and Treatment
Services for managing long-term medical conditions (diabetes care)
Chronic care
Services aimed at restoring physical or mental abilities ( head injury and stroke)
Rehabilitation
Organizations providing free healthcare services to underserved populations
National associations of free clinics
Largest comprehensive safety net of primary and preventative care. Healthcare facilities offering comprehensive primary care services to underserved populations
Federally qualified health centers
privately funded non for profit community organizations that provide healthcare at little or no costs to low income individual
free medical clinics
Healthcare facilities receiving financial support from the federal government-established for those in financial need. Offer comprehensive prenatal, dental, pharmacy, and behavioral health. The ACA provides funds to expand the health centers.60% receiving these services are members of a minority population
Federally funded health centers
Free clinics receive little or no state funds
Free clinics do not receive significant financial support from state governments
Free clinics are necessary…
after establishing Affordable care act
The majority of people who are uninsured and would use Free medical clinics
Individuals who do not have health insurance through their employer and have incomes below the federal poverty level
Both Medicaid and Medicare
created through the social security act
second largest business in the U.S.
Hospitals
Major Forces Affecting the Development of Hospitals
Transformation of nursing into a profession requiring training
Development of specialized technology
Patients needing acute care
advances in Medical Education
Medical institutions owned and operated by churches, businesses, corporations, and physicians
Private Hospitals
For-profit medical institutions operated for the financial benefit of corporations
Proprietary Hospitals
Medical facilities providing long-term care and specialized services non for profit -include OB GYN
majority of hospitals
Community Hospitals
Medical institutions owned by local, state, or federal agencies
Public hospitals
Medical facilities providing long-term care and specialized services
Community hospitals
Government healthcare program providing services to veterans and active duty military personnel
Tri-care
Government insurance program for children from low-income families
CHIP
Major breakthroughs in the treatment of mental illness
Development of Pharmaceuticals and National Institute of Mental Health.medications and research institution focused on mental health
Medications for the treatment of opioid abuse
Naloxone, methadone, suboxone
Certified Community Behavioral Health Clinics (CCBHCs)
Mental health and substance abuse
1 in 8 ER visits are due to
mental health disorders
more than 1/2 patients with mental and behavioral health disorders do not get treatment because
they do not know where to get help
affordable care act requires all health insurances to include mental health: True or false
True
Patients most important legal rights
informed consent
Replacing the AHA’s Patients’ Bill of Rights, this plain language brochure informs patients about what they should expect during their hospital stay with regard to their rights and responsibilities.
High quality care
help with billing
autonomy(make your own decisions)
privacy
Patient care partnership
HHS (Health and Human Services) is responsible for
Medicare, Medicaid, public health, biomedical research, food and drug safety, disease control and prevention, Indian health, and mental health services.
Public health focus
on community
abbreviation for National Institutes of Health; the federal agency that funds and conducts biomedical research
NIH
Example of capitation
HMO
fixed amount for each service
Captitation
Mandatory Medicaid Services
home health, hospitals, ambulatory care, mental health services
nations largest public health insurance
Medicaid
Amount you pay monthly, quarterly, semiannually or annually to purchase different types of insurance
Premium
cheaper, fixed rate, only in network providers, need a referral for a specialist
HMO
more expensive premium, can see out of network providers, do not need a referral
PPO
like an HMO but do not need referrals to see a specialist
EPO
elderly population growth
50% by 2030
any disease or condition that lasts a long time (usually longer than six months or a year). It usually can’t be cured and therefore requires ongoing treatment and management. Examples include arthritis and asthma.
Chronic conditions
activities of daily living (bathing toileting eating)
ADL
instrumental activities of daily living preparing meals, housekeeping, managing finances
IADL
a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes
Dementia
most common form of dementia progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning
Alzheimer’s disease
Medicare A
hospital insurance
Medicare B
Covers outpatient hospital stays and diabetic supplies, DME (durable medical equipment), patients on long term disabilities, X-rays, dialysis, vaccines, and respiratory nebulizers
Medicare C
Medicare Advantage Plan pay a premium -private medical insurance
Medicare D
Prescription drug coverage
primary payer of long term services
Medicaid
most common ADL in long term care
bathing
a facility that generally provides housing, group meals, personal care, support services, and social activities in a community setting
assisted living facility
the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
lack of literacy causes medical errors
health literacy
providing end of life care
Hospice
care given at a facility during day time hours; generally for individuals who need some assistance and/or supervision but are not seriously ill or disabled; usually reside outside of the facility
Adult day care
ACA young adults…
can stay on parents coverage until 26
A list of health care services mandated to be covered in insurance plans offered by American Health Benefit Exchanges
Ambulatory care prescription maternity care rehabilitation lab service
Essential Health Benefits
A program under the affordable care act to improve quality and reduce cost of care for patients readmitted to the hospital for pneumonia, congestive heart failure, or accurate myocardial infarction. Medicare reduce his perspective payments to hospitals that failed to meet the criteria for readmission for these three diagnosis
Hospital Readmission Reduction Program
create incentives for hospitals and healthcare providers to coordinate patient care
ACO (Accountable Care Organization)
The Tax and Jobs Act of 2017 impacts the Affordable Care Act by…
taking away the individual mandate
NHE
National Health Expenditures slowed between 2010-2014
An expansion of the Medicaid program under the ACA gives states the ability to expand Medicaid to cover all adults living up to 138 percent of the federal poverty level.
Not all states
Medicaid expansion
people who do not qualify for Medicaid but do not make enough money to buy insurance
Coverage gap
ACA disparity
in states that did not expand medicaid
refers to the procedures, equipment, and processes by which medical care is delivered
medical technology
what does HIPAA (Health Insurance Portability and Accountability Act) do?
Provides Confidentiality for the patient
A list or database created and maintained by a healthcare facility to record the name and identification number of every patient who has ever been admitted or treated in the facility
Master Patient Index (MPI)
mechanism of electronic communication among organizations so data can be incorporated from one system to another
Interoperability
scanner technology and machine-readable bar codes such as UPC
bar coding technology
