Final Flashcards
We are ranked #__ in healthiest nation
37
Due to size and diversity
US healthcare characteristics is partially governed by
market conditions and population condiitons
Era 1 of healthcare
1850-1900. Institutionalization of healthcare.
Dr. Krikbride plans: Systems of mental asylum or to group people with common illnesses.
Era 2 of healthcare
1900-1940's (WWII) Medical education is same across country. Advancement in science. Hill Burton Act. Requirements include: -No discrimination (started in 1963) -Must do some free care for community -Economic Viability -Must adopt medicare and medicaid
When did the Hill Burton Act pass?
1946 during 79th US congress
Era 3 of healthcare
1940-1980 Change in structure of healthcare.
FDRs new deal: medicare and SS
Era 4 of healthcare
1980s to present Limited resources and restricted growth
Healthcare reform in 1990 with Clinton admin.
Obama and trump elected to the platform.
Fear vs fact rules public.
ACO
Accountable care organization.
Groups of doctors, hospitals, and health care providers who voluntarily come together to give coordinated, high quality care to their medicare patients.
ACOs have a minimum of ___ lives
requirements for advancing ___ practices
Promote ___ services
5,000
Evidence based
Preventative
MCO/HMO
Pt must select from panel of providers. Managed care organizations.
What percent of total healthcare spending is attributed to eyecare
1-2%
% of Comprehensive eye exams does by OD and MD
OD: 85%
MD: 15%
OD comprehensive exams vs medical exam percentages
80% and 20%
Percentage of comprehensive exams done by OD and MDs that get reimbursed by medicare
45% OD
55% MD
Per capita primary eyecare spendings
$100
OD sources of revenue in %
30% patient payment
30% vision insurance
20% medical insurance
20% government
3 aspects of public health
Assessment
Policy development
Assurance
Tertiary prevention
Secondary prevention
Primary prevention
Primordial prevention
tertiary: Treating someone for the disease they have. Prevent from getting worse.
Secondary: Screening high risk populations. People are asymptomactic.
Primary: Treating diabetes or consulting a smoker is primary for preventing future eye issues. treating the risk factor. Support, educate, and promote healthy eye behaviors.
Primordial: Preventing pt from getting risk factor/primary
3 ways to think about health
- Medical tradition- focused on individual
- Environmental. External factors affect health.
- Social. Interactions of pt and environment.
Health disparities
- Health inequalities. What we cannot change. Race, gender, age, geographic region.
- Health inequities. What we can change. Income, education, access to fitness, food
Equality vs equity
Equality: Everyone gets same thing
Equity: Justice. Fairness. Providing people with the resources and opportunities they need.
Situational vs generational poverty
Situation: Laid off job. Still have baseline life skills. Have ability to pick yourself up by bootstraps.
Generational: Bon into it. Have only known being poor. Will view world very differently.
What is epidemiology?
The study of populations. Rate and distribution of disease.
The study of how and why diseases and other conditions are distributed within the population the way they are.
Father of epidemiology
Dr. John Snow.
1854 Soho London
Descriptive Epidemiology
Place, person, and time. Search for clues. Formulate hypothesis. No comparison group.
Analytic epidemiology
Host, environment, agent.
How and why
Clues available. Test hypothesis. Comparison group.
Triad for descriptive and analytic epidemiology
Descriptive: Place, person, time
Analytic: Host, environment, agent.
3 directions of analytic studying
Cohort study: Person was exposed to disease. What will happen next?
Case control study: Person has disease. Where did they get it?
Cross sectional study: Consider both.
Incidence
Rate of risk. New cases.
Dropping into the bathtub.
Prevalence
Measurement of all cases- new and old that are present at a certain time. Excludes people who have gotten better or who have died.
When to use incidence?
When discussing acute cases. Contagious.
When to use prevalence?
When discussing chronic cases. glaucoma.
Sensitivity
True positive rate. Percentage of sick people who are correctly identified as having the condition.
Specificity
True negative rate. Percentage of healthy people who are correctly identified as not having the condition.
False positive rate=
1 - specificity
