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Pharmacy Practice I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

3 Values of the Healthcare System

A
  • Access
  • Cost
  • Quality
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2
Q

Almshouses

A

Served the destitute & poor

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3
Q

Asylums

A

For patients with untreated chronic mental illness

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4
Q

Pest Houses

A

Quarantined people with contagious diseases

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5
Q

Dispensaries

A

Delivered outpatient charity care in urban areas

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6
Q

Anesthesia

A
  • 1846
  • Horace Wells
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7
Q

Handwashing

A
  • 1847
  • Ignaz Semmelweis
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8
Q

Pasteurization

A
  • 1860
  • Louis Pasteur
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9
Q

Antiseptic Surgery

A
  • 1865
  • Joseph Lister
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10
Q

Advances in X-Ray

A
  • 1895
  • Wilhelm Rontgen
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11
Q

Penicillin

A
  • 1929
  • Alexander Fleming
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12
Q

Howard University School of Medicine (1869)

A

Established to prepare black physicians to practice medicine

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13
Q

Harvard Medical School (1871)

A

Changed the academic year to follow the European Model

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14
Q

Meharry Medical College (1876)

A

Established to prepare black physicians to practice medicine

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15
Q

Johns Hopkins University (1893)

A

Changed admission requirements to medical school to include an undergraduate degree

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16
Q

Flexner Report (1910)

A

Found widespread inconsistencies in medical training

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17
Q

Council on Medical Education (1910)

A
  • Formed by AMA
  • It pushed for state law requiring graduation from medical school for licensure
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18
Q

5 Components of the Roemer Model

A
  • Management
  • Resource Production
  • Organization of Programs
  • Delivery of Services
  • Economic Support
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19
Q

Health

A

State of complete physical, mental, & social well-being & not merely the absence of disease or infirmity

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20
Q

Hill-Burton Act (1946)

A

Increased access to healthcare services by providing funding for more hospitals

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21
Q

Pure Food & Drug Act (1906)

A

Had to do with labeling (Regulation)

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22
Q

2 Major Factors Explaining the Decline in Infant Mortality Rates

A
  • Changes in standard of living or lifestyle (improvements in hygiene, diet, & housing)
  • Advances in public health measures
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23
Q

Leading cause of death in 1900s

A
  • Primarily infectious diseases
  • Vaccinations helped to change this
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24
Q

Leading cause of death in 2000s

A
  • Chronic Diseases:
  1. Heart Disease
  2. Cancer
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25
Q

Food, Drug, & Cosmetic Act (1938)

A
  • Regulation
  • Safety & Effectiveness
    *
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26
Q

Medicare & Medicaid (1965)

A

Had to do with funding

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27
Q

Baylor University (1929)

A
  • Enrolled school teachers in Blue Cross to cover hospital costs
  • Emergence of prepaid health services (3rd Party)
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28
Q

Kaiser Permanente (1938)

A

For healthcare services for workers on Grand Coulee dam

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29
Q

Blue Shield (1939)

A

For physician’s fees

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30
Q

National Ependitures

A
  • 18.3% of GDP is healthcare
  • An average of $10,172 per person
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31
Q

Healthcare System

A

Combination of resources, organization, financing (economic support), & management that work together in the delivery of health services to a population.

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32
Q

5 Characteristics of Access

A
  • Availability
  • Accessibilty
  • Affordability
  • Accomidation
  • Acceptability
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33
Q

5 Dimensions of Access

A
  • Financial
  • Physical Access
  • Geographic
  • Temporal (time off from job)
  • Cultural (Language Barrier)
34
Q

Up-Stream

A
  • Preventative
  • (Primary Care)
35
Q

Down-Stream

A
  • Reactive
  • (Secondary & Tertiary)
36
Q

3 Factors of Access

A
  • Predisposing (higher chance of getting disease)
  • Need (Defined by individual or physician)
  • Enabling (Income, insurance, convienence, health belief theroy, severity, benefits, motivation, self-confidence)
37
Q

Who defines the 3 Core Functions of Public Health

A

IOM (Institute of Medicine)

38
Q

3 Core Functions of Public Health

A
  • Assurance
  • Policy Development
  • Assessment
39
Q

Morbidity

A

Incidence of disease

40
Q

Continuum of Care

A

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.

41
Q

Who pays for the uninsured?

A
  • Public Health
  • FQHC (Federally Qualified Health Centers)
  • They can negotiate the best they can for themselves
  • Charities
42
Q

Indemnity

A
  • Paying up front, patient fills out form for reimbursment
  • Less Control
  • Fee-for-Service basis
43
Q

Managed Care

A
  • An organized way to manage the cost, use, & quality of health care system
  • An integration of the financing & delivery of health services
44
Q

Managed Care Organizations (MCO)

A

Either provide the services directly or enters into contracts to provide them

45
Q

Fee-for-Service (Key Points)

A
  • Focus on individual patients
  • Centers on acute care
  • Incentives for overservice
  • Patient initiated & few access barriers othe than financial ones
46
Q

Managed Care (Key Points)

A
  • Focus on population
  • Emphasizes disease prevention & health maintenance
  • Incentives for underservice
  • Controls & resticts patient-access to providers
47
Q

Provider Network

A

A group of providers contracted to supply a full range of primary & acute healthcare services

48
Q

4 Characteristics that Differentiate Types of MCOs

A
  • Risk-bearing
  • Physician type
  • Relationship Exclusivity
  • Out-of-Network Coverage
49
Q

Prepaid Group Practices

A
  • PGPs
  • Allowed patients to prepay on a monthly basis for all services provided by the practice
50
Q

Health Maintenance Organization Act (1973)

A
  • 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
51
Q

Health Insurance Portability & Accountability Act of 1996

A
  • HIPAA
  • Protects patient privacy
52
Q

Employee Retirement Income Security Act of 1973

A
  • ERISA
  • Intially a pension law
  • Preempts state regulation of employee health benefits
53
Q

Co-Insurance

A

80% of cost is coverec by insurance

54
Q

Co-Payment

A

Amount paid by the patient at the time of the visit to the provider

55
Q

Deductible

A
  • Amount that has to be met before the insurance kicks in
  • The patient’s 20%
56
Q

Premium

A

Amount per month that the patient has to pay to have insurance

57
Q

Pharmacy Benefit Manager

A
  • 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.
58
Q

Resources

A
  • Knowledge
  • Facilites
  • Commodities
  • Workforce (Doctors, Pharmacist, Nurses)
59
Q

Management

A
  • Planning
  • Regulation
  • Administration (Legislation, Executive, Judical)
60
Q

Organization

A
  • Ministry of Health (DHHS)
  • Other Public Agencies
  • Voluntary Agencies
  • Enterprises
  • Private Market
61
Q

Economic Support

A
  • Personal Household
  • Charity
  • Insurance (Voluntary)
  • Social Security
  • Governmental Revenues
  • Foreign Aid
62
Q

Delivery of Services

A

Components of the Continuum

  • Primary Care
  • Secondary Care
  • Teriary Care
  • Care of Special Populations & Disorders
  • Prenatal
63
Q

Primary Care

A

Prevention

64
Q

Secondary Care

A

Early Detection

65
Q

Tertiary Care

A

Treatment

66
Q

NIH

A

National Institutes of Health

  • It is the primary agency of the United States government responsible for biomedical and health-related research
67
Q

CDC

A

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
68
Q

FDA

A

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.
69
Q

HRSA

A

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
70
Q

Adverse Selection

A

When someone waits until they are sick to get insurance.

71
Q

Moral Hazard

A

When the insured over-use health services

72
Q

Cost-Spreading

A

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
73
Q

Consolidated Omnibus Budget Reconciliation Act

A

COBRA

  • Temporary continuation of coverage after qualifying event
    • Loss of employment: 18 months
    • Change in family/dependent status: 36 months
    • Disability: 29 months
74
Q

Continuum of Care (Components)

A
  1. Prenatal Care/Healthy Birth
  2. Health Promotion
  3. Primary Disease Prevention
  4. Diagnosis of Disease
  5. Treatment of Acute Disease
  6. Secondary Disease Prevention
  7. Teriary Disease Prevention
  8. Treatment of Chronic Illness or Disease
  9. Reabilitative Care
  10. Long-Term Care
  11. Palliative Care
75
Q

2 Trust Funds at Risk of Being Depleted:

A
  • MediCARE
  • Social Security
76
Q

DRGs

A

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.
77
Q

Preferred Provider Organizations

A

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.

78
Q

Health Savings Account

A
  • 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.
79
Q

Some Reasons for Health Care Reform

A
  • Create more access
  • Lower cost
  • Disease prevention
  • Better quality
80
Q

Joint Commission

A

A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement.

81
Q

What approaches to controlling MedicAID cost exist?

A

DRGs

82
Q

Spending Down

A

When one is above the poverty line, but medical expenses drops that person below the poverty line, qualifying them for MedicAID.

Pharmacy Practice I (2 decks)

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