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Comparative HC Systems > Exam One > Flashcards

Exam One Flashcards

1
Q

1850- 1900 Healthcare system

A

institutionalization of healthcare
(development of hospitals, centralized coordinated focus)

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2
Q

1900 healthcare system

A

introduction to the scientific method

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3
Q

1945- 1980 health care system

A

-financing of healthcare: Blue Cross Blue Shield
-increasing power of the federal government in health care
- Hill- Burton Act: construction of new hospitals
- Medicare and Medicaid in 1965

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4
Q

What is medicare

A

access to medical insurance for individuals over the age of 65

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5
Q

what is medicaid

A

low income, pregnant women, and other individuals to have better access to insurance and healthcare

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6
Q

1980 to present healthcare system

A

limited resources, restriction of growth, reorganization of the methods of financing and delivering care

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7
Q

Predominant health problems in the 1850-1900

A
  • epidemics of acute infectious diseases
    -bad sewage, poor housing
  • Cholera in NY
    -Yellow Fever in New Orleans
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8
Q

Predominant health problems by 1900

A

-epidemics eliminated
-acute care events that affected individuals one by one
-better surgical technologies and treatment
-discovery of insulin
-discovery of penicillin
-people were living longer -> long term chronic diseases

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9
Q

What accounts for 2/3 or 70% of deaths?

A

heart disease, cancer, and stroke

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10
Q

Current predominant health problems

A

-chronic diseases: genetic makeup, personal lifestyles, and environmental hazards
-population aging
-importance of prevention
-American healthcare system focus on short-term treatment instead of management of chronic conditions
-this includes: payment for and provision of individual episodes of care rather than long-term continuous care
-managed care

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11
Q

Challenges associated with current technology

A

-decreasing importance of personal, non-technical aspects of diseases
-inequitable distribution in society: mortality and morbidity measures for different segments of the population
-increase cost of new technology
-careful evaluation, reduced usage, and more control

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12
Q

Social Organization of healthcare in 1945-1980

A

Growth of health insurance
- the acceleration of government in health care funding (medicare, planning, financing, and monitoring of health care services, single largest source of financing for healthcare, neighborhood health centers)

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13
Q

Social Organization of health care from 1980- Present

A

-resource limitation, restriction of growth, reorganization of systems of financing for provided care
-control of cost through limitations in number of services (Medicare)
-reduction in admissions
-decreased in length of stay
-cost-sharing by the elderly

Employmers: rising health care expenditures as a major threat to the existence of their companies
-demand for lower prices and lower premiums
-private sector

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14
Q

Current social organization of health care

A

Fully & directed concerned and involved in health care issues
-increased cost of care
-physical fitness and exercise
-more educated and motivated to be involved in healthcare

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15
Q

True or False: No single American health care system

A

TRUE

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16
Q

True or False: Healthcare is a private matter

A

TRUE

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17
Q

4 subsystems of organization of health services

A

-Regularly employed middle income families with health insurance coverage (Private Practice, Private Insurance)

  • Unemployed, uninsured, inner-city, minority America (Local Government Health Care)
  • Military medical Care system (well organized system of high quality at no direct cost of recipients)

-Veterans Administration Health Care System (For retired and disabled veterans of the US military service)

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18
Q

Regularly employed middle income families with health insurance coverage (Private Practice, Private Insurance) organization of care

A

-financing: non- governmental sources, private funds, out of pocket, privately financed health insurance plans

-primary care: services coordinated by physicians in private practices (preventive, ambulatory, & psychiatric problems)

-inpatient care: local voluntary, not-profit or for-profit hospital

prevention: public health department (water purification, sewage disposal, air pollution control)

-long-term care: payments from personal funds

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19
Q

b. Unemployed, uninsured, inner-city, minority America (Local Government Health Care) organization of care

A

-Financing: Medicaid and Medicare, and emotional problems: totally public, local government payment

-Primary care: does not have one will likely go to county hospital or health department

-Inpatient care: city/county hospital, nonprofit community hospitals, teaching hospitals

-Prevention: local government health department

-Long term care: hospital stay longer, less well-equipped nursing homes and skilled nursing facilities paid by Medicaid, welfare, or other public funds

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20
Q

c. Military medical care system organization of care

A

Financing: no direct cost to recipients but no choice in services

Primary care: total care, high quality care, centrally organized, self-sufficient, and self-contained

Inpatient care: base hospitals, regional hospitals

Prevention: major focus

Long term care: if a patient is able to return to full active duty or Veterans’ Administration (VA) facilities

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21
Q

Veteran Adminstration Health Care System organization of care

A
  • Financing: copayment required for VA insurance, but some are exempted because they cannot find a job

-Primary care: not integrated, not extensive (hospital care, mental health, long-term care, and primary care if patients cannot receive healthcare somewhere else

-Inpatient care: VA hospitals with salaried full time medical and nursing personnel, self-sufficient units requiring little outside support

-Prevention: major focus is on long term and inpatient care(chronic, emotional, and physical)

-Long term care: largest provider of long-term care in the country, nursing homes, uses local nursing homes and skilled nursing facilities

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22
Q

Utilization of health care services in the United States

A

For health services utilization, status, and attitudes: national probability services

National Hospital Discharge Survey; National Ambulatory Medical Care Survey

Private data collection

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23
Q

What is population size?

A

total number of people in the population & the distribution of population by age group

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24
Q

what is utilization?

A

actual use of health care services

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25
Q

What is the census count of the population?

A

333 million as of August 2022

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26
Q

Composition of US population

A
  • Womens (females) are living longer than men
  • aging: increased longevity and relatively low fertility
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27
Q

Fertility trends in the US

A

Fertility as decrease per children born per 1,000 women 15 to 44 years old

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28
Q

what is fertility

A

measure of reproduction

29
Q

birth rates in the US

A

increased for a couple of years, but started to decrease

30
Q

what is birth rate

A

total number of births to total population (per 1000 population)

31
Q

Age specific fertility rates

A

<20- decrease
20-24: decrease
25-29: decrease
30-34: increase then decrease
35-39: increase
40-44: increase
45-54: increase

32
Q

Decline in fertility in the US population

A

-Female labor force participation

-Marital dissolutions

-Delayed average age of first marriage and childbearing

-Reduced desired family size

-Demographic transition: change from a high-fertility, high morality to a low fertility and low mortality

-Abortion rate is 11.4 per 1,000 women aged 15-44 and there is a decreased in the amount of abortion

33
Q

Life expectancy mortality trends in the United states

A
  • Life expectancy: reflects a cohort effect for estimated years of life remaining (at birth and age 65)

-Can be caused by heterogeneity of the population, complex social problems

-Racial disparities show

-white males live longer than black men (8 years)

-White females lives longer black women (5 years)

34
Q

what is life expectancy

A

reflects a cohort effect for estimated years of life remaining (at birth and age 65)

35
Q

infant mortality in mortality trends in the united states

A
  • the United States is 5th lowest

-racial differences in infant mortality:
more black infants per 1,000 live births are dying than white

36
Q

what is infant mortality

A

the number of infants who die in the 1st year of life (per 1,000 live births)

37
Q

Maternal mortality trends in the united States

A

racial disparities: Black US women 2.9 times as likely to die from complications of childbirth than white women

38
Q

what is maternal mortality

A

death of a woman while pregnant ot within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes

39
Q

Chronic diseases account for ____ of all deaths in the United States

A

70%

40
Q

What is the percentage of nation’s healthcare cost going to chronic disease?

A

86%

41
Q

What are the leading causes of death?

A
  • heart disease (1 out of 3)

-cancer ( 1 in every 7 men and 8 in females)
-466 incidence or 20,169 deaths per 100,000 individual in NC in 2015

  • stroke ( 1 in 18 deaths a year) (610,000 new and 185,000 will survive and have another)
42
Q

Infectious disease is a specific cause of death

A
  • HIV/AIDS 36.7 million people living in 2015
    HIV incidence: 9,513 new HIV infections
43
Q

cancer mortality in the United States

A

cancer mortality for lung cancer
males: 58.9 per 100,00 and death 44.5/100,000
females: 46.8 per 100,000 and death 30.7/100,00

44
Q

Five year cancer survival rates

A

about 15.5 million cancer survivors in the US

-Prostate cancer: 98.9%

  • Breast cancer: 89.4%
  • Non-hodgkin Lymphoma: 70%
  • Pancreas cancer: 7.2%
45
Q

Other causes of mortality

A

motor vehicle accidents
2.28 million injuries annually an 38,824 deaths in 2020 (increasing number of deaths)
-alcohol impaired driving accounted for 30% of fatalities

firearms
45,222 deaths in 2020

death for homicide and legal intervention
-24,576 total homicides in 2020

46
Q

Access to Health Care services

A

-usual sources of care among children

-60% of women over 40 had mammography between 2011-2013

-Dental visit: 890 million annual visits: 83% (aged 2-17), 62% (age 18-64), 62.4% (age 65+)

47
Q

what is primary prevention

A

Primary prevention: averting the occurrence of a disease

-Health promotion and education
-Establishing standards of appropriate sanitation
-Immunizations
-Removing occupational hazards
-Protections from carcinogens

48
Q

what is secondary prevention

A

-halting the progression of disease from its early, unrecognized stage to a more severe one and preventing the complication or consequence of disease

-Early diagnosis and treatment
-Discovering disease while it is effectively treatable

49
Q

what is tertiary prevention

A

the prevention (elimination) of the effects of disease once it has been identified

-Adherence to a medical regimen
-Rehabilitation and exercise program
-Control of stress
-Maintenance of optimum weight and diet

50
Q

Lesson from the history of public health

A
  • state and local matter

-primary mission of public health: prevention and control of acute infectious disease rather than chronic disease

-major public health problems today: chronic, long-term conditions

-the role of the private sector

  • the healthcare system of the United States is relatively unplanned and poorly coordinated
51
Q

State government public health activities

A

-principal entity responsible for protecting the public’s health
-power to enact and enforce laws to protect and promote the health and the safety of the people

-state health agencies
-directed by health commissioner and single organization fairly well integrated

function and activities carried out by state health agencies such as health statistics, general education, etc

financial source: about 50% from the state, 33% from the federal government, and 20% from licensing fees and reimbursements

52
Q

Local government public health activities

A
  • serve a single city (country) or a group of counties

-broad or narrow functions

-responding directly to a mayor, county administrator, or board of supervisors

-depend on state or federal funds (50% of budget)

-function: individual, pragmatic, and person

-inadequate financing: the weakest link in the public health chain

53
Q

Health promotion and disease prevention in the US and role of private sector

A
  • actual causes of death in the U.S. in 1990
    about 50% of deaths: attribute to lifestyle and personal actions

-role of physician in health promotion and education
reimbursement for treatment activities and more competent

-other barriers to health promotion
limited access to medical care and no insurance coverage for health promotion and education

54
Q

Overall approach to the Affordable Care Act

A
  • Requirement for US citizens and legal residents to have health insurance (reduce amount of uninsured_

-Creation of state based HI exchanges

-Creation for separate exchanges for small employers and companies

  • Impose new regulations on health plans in state exchanges, in individual and group markets

-requirement for medium and large employers (>50) employers to provide HI or pay penalties

55
Q

Exemptions of Affordable Care Act

A

granted for financial hardship (lowes tplan exceeds 8% of income), religious objections, American Indians, those without HI for <3 months, incarcerated

56
Q

Penalty on Individuals without HI (health insurance)

A

pay a tax penalty of $695 per year up to maximum of $2,085 per family or 2.5% of household income

57
Q

Second pillar of ACA

A
  • The ACA prohibits insurers from basing premiums on preexisting health conditions
58
Q

Subsidies for health coverage

A
  • Premium, advanced premium tax credit for indiv/families with income between 100 and 400% of FPL to buy HI in the state exchanges
  • refundable premium tax credit
    -advanced premium tax credit

ii. Legal immigrants barred from enrolling in Medicaid during the first 5 years: eligible
iii. Employers who are offered HI coverage by the employers are not eligible

59
Q

what is refundable premium tax credit

A

individuals’ taxable income will be reduced by the amount of subsidy on the tax forms

60
Q

what is advanced premium tax credit

A

the government will pay to the insurer in advance of an individual’s completion of the tax forms

61
Q

Premium subsidies

A

Poorer you are the less out a person paycheck

300-400% no more than 9.5% can be taken out of a person paycheck

62
Q

State insurance exchanges

A

will determine eligibility of Medicaid, individual subsidies, and enroll people and companies into HI plans

63
Q

HI plan options

A

i. Platinum: insurer pays 90% of cost

ii. Gold: 80%

iii. Silver: 70%

iv. Bronze: 60%

-The subscriber pays remaining percentage up to out-of-pocket maximum
-Catastrophic coverage for individuals less than 30

64
Q

Determining HI Rates

A

i. Only age, geographic location, family composition, and tobacco may be used
1. Health status and gender may not be used

65
Q

Employer-sponsored HI: Large employers

A

-Employers with >50; must offer HI coverage

-HI must be provided for employees working >30 hours a week

-Grandfather provision

66
Q

what is grandfather provision?

A
  1. Allowing continued use of existing HI plans as long as the employer does not change them much
67
Q

Expansion of Medicaid

A

-optional for states

-expanded medicaid to non-Mediciad eligible between 19-64 with household incomes up to 138% FPL

-benchmark benefit package that meets “essential health benefits” available through state exchanges

-States receiving 100% federal funding in 2014-2016; 95% federal funding in 2017; 94% in 2018; 93% in 2019; & 90% in 2020 and subsequent years

  • increase in payments to primary care costing
68
Q

Expansion of CHIP (Children’s HI Program)

A

i. Requiring states maintaining current income eligibility for children in Medicaid and CHIP until 2019
ii. In 2015, states will receive 23% increase in CHIP match rate up to 100%

Comparative HC Systems (1 decks)

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