Exam 1 Flashcards
3 Values of the Healthcare System
- Access
- Cost
- Quality
Almshouses
Served the destitute & poor
Asylums
For patients with untreated chronic mental illness
Pest Houses
Quarantined people with contagious diseases
Dispensaries
Delivered outpatient charity care in urban areas
Anesthesia
- 1846
- Horace Wells
Handwashing
- 1847
- Ignaz Semmelweis
Pasteurization
- 1860
- Louis Pasteur
Antiseptic Surgery
- 1865
- Joseph Lister
Advances in X-Ray
- 1895
- Wilhelm Rontgen
Penicillin
- 1929
- Alexander Fleming
Howard University School of Medicine (1869)
Established to prepare black physicians to practice medicine
Harvard Medical School (1871)
Changed the academic year to follow the European Model
Meharry Medical College (1876)
Established to prepare black physicians to practice medicine
Johns Hopkins University (1893)
Changed admission requirements to medical school to include an undergraduate degree
Flexner Report (1910)
Found widespread inconsistencies in medical training
Council on Medical Education (1910)
- Formed by AMA
- It pushed for state law requiring graduation from medical school for licensure
5 Components of the Roemer Model
- Management
- Resource Production
- Organization of Programs
- Delivery of Services
- Economic Support
Health
State of complete physical, mental, & social well-being & not merely the absence of disease or infirmity
Hill-Burton Act (1946)
Increased access to healthcare services by providing funding for more hospitals
Pure Food & Drug Act (1906)
Had to do with labeling (Regulation)
2 Major Factors Explaining the Decline in Infant Mortality Rates
- Changes in standard of living or lifestyle (improvements in hygiene, diet, & housing)
- Advances in public health measures
Leading cause of death in 1900s
- Primarily infectious diseases
- Vaccinations helped to change this
Leading cause of death in 2000s
- Chronic Diseases:
- Heart Disease
- Cancer
Food, Drug, & Cosmetic Act (1938)
- Regulation
- Safety & Effectiveness
*
Medicare & Medicaid (1965)
Had to do with funding
Baylor University (1929)
- Enrolled school teachers in Blue Cross to cover hospital costs
- Emergence of prepaid health services (3rd Party)
Kaiser Permanente (1938)
For healthcare services for workers on Grand Coulee dam
Blue Shield (1939)
For physician’s fees
National Ependitures
- 18.3% of GDP is healthcare
- An average of $10,172 per person
Healthcare System
Combination of resources, organization, financing (economic support), & management that work together in the delivery of health services to a population.
5 Characteristics of Access
- Availability
- Accessibilty
- Affordability
- Accomidation
- Acceptability
5 Dimensions of Access
- Financial
- Physical Access
- Geographic
- Temporal (time off from job)
- Cultural (Language Barrier)
Up-Stream
- Preventative
- (Primary Care)
Down-Stream
- Reactive
- (Secondary & Tertiary)
3 Factors of Access
- Predisposing (higher chance of getting disease)
- Need (Defined by individual or physician)
- Enabling (Income, insurance, convienence, health belief theroy, severity, benefits, motivation, self-confidence)
Who defines the 3 Core Functions of Public Health
IOM (Institute of Medicine)
3 Core Functions of Public Health
- Assurance
- Policy Development
- Assessment
Morbidity
Incidence of disease
Continuum of Care
A concept involving an integrated system of carethat guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care.
Who pays for the uninsured?
- Public Health
- FQHC (Federally Qualified Health Centers)
- They can negotiate the best they can for themselves
- Charities
Indemnity
- Paying up front, patient fills out form for reimbursment
- Less Control
- Fee-for-Service basis
Managed Care
- An organized way to manage the cost, use, & quality of health care system
- An integration of the financing & delivery of health services
Managed Care Organizations (MCO)
Either provide the services directly or enters into contracts to provide them
Fee-for-Service (Key Points)
- Focus on individual patients
- Centers on acute care
- Incentives for overservice
- Patient initiated & few access barriers othe than financial ones
Managed Care (Key Points)
- Focus on population
- Emphasizes disease prevention & health maintenance
- Incentives for underservice
- Controls & resticts patient-access to providers
Provider Network
A group of providers contracted to supply a full range of primary & acute healthcare services
4 Characteristics that Differentiate Types of MCOs
- Risk-bearing
- Physician type
- Relationship Exclusivity
- Out-of-Network Coverage
Prepaid Group Practices
- PGPs
- Allowed patients to prepay on a monthly basis for all services provided by the practice
Health Maintenance Organization Act (1973)
- HMOs
- Employers had to offer an HMO (if available) along with traditional fee-for-service plan
- Generally do not provide coverage fro medical care that is received out of network
- An organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis
Health Insurance Portability & Accountability Act of 1996
- HIPAA
- Protects patient privacy
Employee Retirement Income Security Act of 1973
- ERISA
- Intially a pension law
- Preempts state regulation of employee health benefits
Co-Insurance
80% of cost is coverec by insurance
Co-Payment
Amount paid by the patient at the time of the visit to the provider
Deductible
- Amount that has to be met before the insurance kicks in
- The patient’s 20%
Premium
Amount per month that the patient has to pay to have insurance
Pharmacy Benefit Manager
- Most often a third party administrator (TPA) of prescription drug programs but sometimes can be a service inside of an integrated healthcare system.
- They are primarily responsible for processing and paying prescription drug claims.
Resources
- Knowledge
- Facilites
- Commodities
- Workforce (Doctors, Pharmacist, Nurses)
Management
- Planning
- Regulation
- Administration (Legislation, Executive, Judical)
Organization
- Ministry of Health (DHHS)
- Other Public Agencies
- Voluntary Agencies
- Enterprises
- Private Market
Economic Support
- Personal Household
- Charity
- Insurance (Voluntary)
- Social Security
- Governmental Revenues
- Foreign Aid
Delivery of Services
Components of the Continuum
- Primary Care
- Secondary Care
- Teriary Care
- Care of Special Populations & Disorders
- Prenatal
Primary Care
Prevention
Secondary Care
Early Detection
Tertiary Care
Treatment
NIH
National Institutes of Health
- It is the primary agency of the United States government responsible for biomedical and health-related research
CDC
Centers for Disease Control and Prevention
- Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability
FDA
Food and Drug Administration
- Responsible for protecting and promoting public health through the regulation and supervision of food safety, tobacco products, dietary supplements,prescription and over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions,medical devices, electromagnetic radiation emitting devices (ERED), cosmetics, animal foods & feed and veterinary products.
HRSA
Health Resources and Services Administration
- It is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable
Adverse Selection
When someone waits until they are sick to get insurance.
Moral Hazard
When the insured over-use health services
Cost-Spreading
Everybody on a plan pays into a pool & it lessens th ecost for everyone across the board, but it only works when the healthy peopl also pay
- Includes:
- Co-Insurance
- Co-Payment
- Deductible
- Premium
Consolidated Omnibus Budget Reconciliation Act
COBRA
- Temporary continuation of coverage after qualifying event
- Loss of employment: 18 months
- Change in family/dependent status: 36 months
- Disability: 29 months
Continuum of Care (Components)
- Prenatal Care/Healthy Birth
- Health Promotion
- Primary Disease Prevention
- Diagnosis of Disease
- Treatment of Acute Disease
- Secondary Disease Prevention
- Teriary Disease Prevention
- Treatment of Chronic Illness or Disease
- Reabilitative Care
- Long-Term Care
- Palliative Care
2 Trust Funds at Risk of Being Depleted:
- MediCARE
- Social Security
DRGs
Diagnostic Related Groups
- EX: a hospital is paid $5000 for a week, by the insurance company, to cure a patient with pneumonia. If they send the patient home early, before they are cure & the patient comes back in a short amount of time with the same disease, the hospital cannot rebill the insurance for further treatment of that patient.
Preferred Provider Organizations
A managed care organization of medical doctors, hospitals, and otherhealth care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer’s or administrator’s clients.
Health Savings Account
- A tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP).
- The funds contributed to an account are not subject to federal income tax at the time of deposit.
Some Reasons for Health Care Reform
- Create more access
- Lower cost
- Disease prevention
- Better quality
Joint Commission
A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement.
What approaches to controlling MedicAID cost exist?
DRGs
Spending Down
When one is above the poverty line, but medical expenses drops that person below the poverty line, qualifying them for MedicAID.
