final Flashcards
What is Medicare
Individuals 65 and older; individuals under 65 who have qualifying disability (such as end stage renal failure or ALS) can also enroll
What is medicaid
Medicaid acts as a supplemental insurance for those enrolled in Medicare (younger, pregnant woman, people with disability)
What is Chip
Chip was created in 1997 to extend health coverage to uninsured children in families with moderate incomes. (Families with incomes too high for Medicaid but too low to afford private insurance premiums)
When was Medicaid and medicare created
1965
What is an HMO
Health Maintenance Organization- provides wide range of health services- pay a fixed monthly fee (includes copayments for visiting specialist and hospitals).
What is a PPO
Preferred Provider Organization- offers variety of healthcare providers, operates on fee for service basis, allowing patients to use any healthcare professional.
What is a DRG
Diagnosis related group- classification system for hospital reimbursement based on diagnoses, procedures, patient age, and expect length of stay (hospitals received a fixed fee for each drg)
Fee-for-service
Allows healthcare providers to bill for each individual service they perform, leading to more fragmented, often unnecessary care.
Capitation
A payment model providing healthcare providers with a fixed amount per patient, promoting preventive care and cost control, as it discourages unnecessary tests and services.
What happened in 1935
Social Security Act establishes the foundation for the modern safety net.
Health trend
The elderly population is increasing, leading to a rise in chronic diseases such as diabetes, heart disease, and cancer.
Demographic
Chronic conditions in older adults account for approximately two-thirds of total healthcare costs, highlighting the need for targeted health interventions and policy changes.
what led to decrease in mortality rates in 20th century
Significant improvements in hygiene practices
Public Health outcome (people and animals)
A rise in new infectious diseases such as Avian flu, Ebola, and MRSA pose major public health challenges with the potential for widespread impact.
WHO
Importance of Nutrition: The CDC emphasizes the critical role of proper nutrition in preventing chronic diseases and promoting overall health and well-being. (food)
Facility overview
The majority of hospitals in the United States are community hospitals, with approximately 5,000 total, of which around 3,000 operate as non-profit entities, serving diverse populations across the nation.
private facility
Typically funded by individuals or for-profit insurance models, focusing on providing lucrative care options.
Public facility
Funded by governmental agencies ensuring healthcare access to underserved populations.
Volunteer Facilities:
Funded through charitable donations and grants, designed to provide care at reduced costs to those without health insurance.
Health promotion
Programs aiming to reduce the risk of illness and promote healthy lifestyles through education and community initiatives.
Disease prevention
A service category offering various assistance and activities tailored to prevent illnesses in populations.
Diagnosis and Treatment:
The most utilized healthcare services are primarily offered in hospitals, encompassing a wide range of medical interventions.
Rehabilitation:
Services focusing on restoring optimal functionality after an illness, injury, or surgery, often involving therapy and support.
Chronic Care:
Deals with the ongoing management and monitoring of chronic conditions, ensuring patients receive timely interventions.
Federally Funded Health Centers:
Provide comprehensive primary and preventive care, often serving low-income populations and the uninsured, supported by the Health Resources and Services Administration (HRSA).
Free Clinics:
Nonprofit or faith-based initiatives that offer care to uninsured individuals at little or no charge, relying on volunteer healthcare professionals.
Patient care partnership
Replaces historical health rights with a more informative Bill of Rights focusing on essential patient rights, including informed consent for treatment.
Key points for patient care
High-quality hospital care, ensuring patients receive appropriate medical attention.
Safe and clean environment for all patients, reducing the risk of healthcare-associated infections.
Patient involvement in care decisions, fostering a shared decision-making approach.
Protection of patient privacy and confidentiality throughout the healthcare process.
Assistance with understanding and managing the discharge process to ensure smooth transitions.
Support with billing claims and insurance processes to reduce future financial burdens.
right to privacy, patient centered care, high quality, clean and safe, billing help, help with leaving
Hospital Employment
The hospital sector stands as the second-largest business sector in the U.S., employing approximately 40% of the nation’s healthcare workforce, highlighting the vital role hospitals play in the economy.
Hospital economy
Hospitals account for roughly one-third of national health expenditures, underscoring the need for efficient management and reform innovations in hospital finance.
Public Hospitals:
Operated by government agencies, these hospitals often aim to serve vulnerable populations who may lack the ability to pay for services.
Private Hospitals:
Operated for profit, they are typically owned by corporations or religious organizations, often focusing on profitability and the need for consumer satisfaction.
Mission of Health and Human Services
The primary mission is to enhance the health and well-being of the American population through effective services and advancements in healthcare access.
Key responsibilities include the administration of Medicare and Medicaid, managing public health initiatives, disease control, and supporting biomedical research.
HMO (Health Maintenance Organization):
A managed care organization limiting patient choice to network providers in exchange for lower out-of-pocket costs, utilizing a prepaid health insurance model to control costs.
PPO (Preferred Provider Organization):
Flexible health insurance plan covering both in-network and out-of-network providers, with significantly higher costs for out-of-network care.
DRG (Diagnostic Related Group):
A system that caps payments for services rendered, ensuring efficient use of hospital resources and standardizing reimbursement.
Premium
The monthly insurance payment required for coverage.
Deductible
The amount of money the insured must pay out-of-pocket before insurance begins to cover costs.
Co-pay:
A predefined fee that the patient pays at the time of a doctor’s visit, typically dependent on the service received.
Centers for Medicare and Medicaid Services (CMS)
The CMS aims to progressively reduce Medicare fee-for-service payments, enhancing the efficiency of healthcare delivery systems.
Part A
Covers hospital inpatient stays, skilled nursing facility care, hospice, and some home health care.
Part B:
Covers medical and outpatient services, including doctor visits, laboratory tests, and preventive services
Part C:
Also known as Medicare Advantage, it combines Part A and Part B and often includes additional benefits through private insurers.
Part D:
Provides prescription drug coverage, helping beneficiaries afford medication costs.
Intermediate Care Facilities (ICF):
Provide personal care services and social support but do not offer skilled nursing services.
Skilled Nursing Facilities (SNF):
Offer rehabilitation and skilled nursing care similar to hospital settings, ensuring patients recover from surgeries or medical conditions.
Home Health Care:
Supportive services provided at home, which may include assistance with daily living activities, therapy, or skill care services.
Hospice Care:
Focuses on providing palliative care for patients at the end of life, prioritizing comfort and support for both patients and families.
Health Literacy
The capacity to obtain, process, and understand basic health information to allow individuals to make informed health decisions, critical in navigating modern healthcare systems.
World Health Organization (WHO)
An agency of the United Nations devoted to coordinating international health efforts, setting standards, and addressing global health issues.
COBRA (Consolidated Omnibus Budget Reconciliation Act)
Federal law allowing former employees and their families the temporary ability to maintain group health insurance coverage after job loss, extending coverage for a limited duration.
Affordable Care Act (ACA)
Signed: March 23, 2010; a comprehensive health reform law aimed at increasing health insurance accessibility while controlling healthcare costs.
Benefits: Dramatically expands coverage options for millions of Americans and improves the quality of care.
Telemedicine:
Enhances access to healthcare services through remote consultations, particularly beneficial for rural areas with limited medical facilities.
EHR (Electronic Health Records):
Digital record-keeping systems that allow authorized health professionals to access complete medical histories of patients.
EMR (Electronic Medical Records):
Specific to individual practices, containing patient treatment data for use by healthcare providers.
Patient Portal:
A secure online platform providing patients secure access to their personal health records, appointment scheduling, and communication with providers.
CPOE (Computerized Physician Order Entry):
A system that streamlines the process of ordering tests, medications, and facilitating accurate patient prescriptions through technology.
Interoperability:
The capability for various health information systems to exchange and make use of information easily.
Emerging Technologies:
Innovations such as speech recognition, mobile health applications, and wearable devices that enhance the quality and delivery of healthcare services.
1929
first private hospital insurance plan brought on by teachers in Texas through Baylor university medical $6 bucks a year.
1939
Blue Cross and Blue Shield prepaid DR and Hospital
Know
WWII fringe benefits for workers
What are some ways MRSA can spread
Daycares, Gyms, etc
what does public health do
promotes and prevents illness
what are the three things Healthy People 2020 focuses on?
healthy quality of life, increased primary care, and social determinants of health
health savings account
tax deferred/private savings designed to pay for medical expenses tax free
some ways to improve the health of Americans are:
collecting data, deciding if info is reliable, gain understanding of health care needs of that population
increasing number of elderly and living longer increases the prevalence of what?
chronic illnesses
epidemics
cholera, yellow fever, and black plague are all what?
progressive mental deterioration
Alzheimers
a disease of short duration
acute
some causes for increase in cost of health care in U.S.
technology, pharmaceuticals, and research
what fraction of the total health care cost goes to treatment of chronic conditions in elderly?
2/3
HIPAA stand for and purpose?
Health Insurance Portability and Accountability Act
purpose: to protect the unauthorized disclosure of patient health info
besides hygiene, what helped people stop dying from diarrhea and bacteria?
penicillin/antibiotics
what are the majority of hospitals in the U.S.?
community, for profit
how much of federal health spending goes to medicare and medicaid?
60%
direct health services provided by the federal government
TRICARE by DoD, CHAMPVA, and IHS
the four broad categories of health services in the U.S.
health promotion, disease prevention, diagnosis and treatment, rehabilitation
how much of healthcare personnel do hospitals employ
40%
Nursing assistant who complete programs are known as
CNA
Which is true regarding PT assistants and aides
aides usually learn skills on the job, assistants have associates degree
which program came and talked about new masters
applied behavior analysis
audiology
can be any major, but meet prerequierments
which responder does basic life support
EMT
perform advance airway management
endotracheal intubation procedure
MLS has a minor that pair well with
medical laboratory practice
hot meals served to shut ins and elderly
meals on wheels
chiropractors can prescribe with disabilities
False
