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Government Influence on Health Flashcards

1
Q

Early health insurance was first really seen when?

A

early 19th century

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2
Q

what sparked changes in early health insurance?

A

WWI & Great Depression

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3
Q

What health insurance companies were initially created primarily for elderly protection?

A

Blue Cross & Blue Shield, Social Security (Medicare & Medicaid)

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4
Q

define Health Maintenance Organizations (HMO)

A

provider takes some financial risk; patient uses PCPs & pay monthly fee regardless of service used & must go to HMO provider for coverage, if not must pay out of pocket

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5
Q

define Preferred Provider Organizations (PPO)

A

contract of network of providers to private sector for discounted fee & patient must pay extra fee if using physician outside of network; PPO must approve specialist visit/hospitalizaitions; generally have deductibles & copays

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6
Q

define point-of-service (POS)

A

providers are paid a pre-set payment based on membership/risk & people choose PCPs @ own risk

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7
Q

define Consolidated Omnibus Budget Reconciliation Act (COBRA)

A

health insurance protection for those leaving jobs

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8
Q

Health Insurance Portability & Accountability Act of 1996 (HIPAA) covers what

A

protect PHI, prevents fraud & abuse, administrative supplication & liability reform, application & enforcement of health plan requirements, revenue offsets, & tax-related provisions

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9
Q

define Children’s Health Insurance Program (CHIP)

A

coverage for low-income families not qualifying for Medicaid & in some states pregnant women; federally & state funded

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10
Q

define Affordable Care Act (ACA)

A

health insurance for uninsured & improve coverage of insured to focus on illness prevention, wellness, & equal access to healthcare; makes easy to understand insurance benefits & coverage; expanded Medicaid, & shit more

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11
Q

The affordable care act is also called what

A

Patient Protection & Affordable Care Act (PPACA)

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12
Q

The ACA expanded Medicaid by doing what

A

making certain preventative health measures free, insurance can’t refuse patient bc of pre-existing condition, children covered by parent until 26, companies must provide insurance if at least 50 workers, & creation of state health care

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13
Q

define the World Health Organization (WHO)

A

part of the UN w/the goal of worldwide health promotion & improve health access (thru disease prevention, early detection, & treatment)

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14
Q

what functions does WHO does?

A

coordinate global efforts against health treats & monitors re-emergence of infectious diseases

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15
Q

describe the Centers for Disease Control & Prevention (CDC)

A

under US Dept. of Health & Human Services w/the goal of improving public health by setting guidelines, disease & disability prevention, infection control, & general safety; performs research & disseminates info to public

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16
Q

define the National Institues of Health (NIH)

A

under US Dept of Health & Human Services; conducts public health & medical research

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17
Q

define Medicare

A

covers all people at least 65 yrs, disabled w/SS benefits of at least 2 yrs, & ppl w/end-stage renal disease; composed of 4 parts (A, B, C, D)

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18
Q

define Medicare part A

A

health insurance contributions from employer & employee

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19
Q

define Medicare part B

A

pays for doctor fees & other services (preventative or medically necessary) as long as provider accepts; may need to pay premium & deductible?

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20
Q

define Medicare Part C

A

covers health plans such as HMOs & PPOs

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21
Q

define Medicaire part D

A

covers prescription drug program to lower cost

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22
Q

Medigap

A

health insurance help pays expense not covered by Medicare through private companies; patient pays premium & chooses coverage

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23
Q

Medicaid

A

under social security funded by federal & states where services & qualifications vary by state ; generally for low income, kids who need public assistance, physically disabled & blind

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24
Q

Older Americans Act

A

protect institutionalized elderly thru ombudsman programs

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25
Q

Ombudsman programs

A

programs w/representative or spokesperson generally for elderly

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26
Q

Patient self-determination Act

A

covers living wills & health care proxies & gives directives to any facility getting any federal aid

27
Q

according to the patient self-determination act, any facility getting any federal aid must do what things

A
  • inform patient of rights orally & in writing
  • provide info & assistance in prep advance directions
  • document any advance directives
  • provide written statements to implement rights in decision process
  • affirm no discrimination/effect on care bc of directives
  • educate staff on directives
28
Q

define manipulative experiments

A

changing 1 variable

29
Q

define longitudinal studies

A

some individual observed over period of time

30
Q

define cross-sectional studies

A

compare groups of various ages

31
Q

naturalistic experiments

A

observe only

32
Q

individuals w/disabilities education act (IDEA)

A

federal law governing how states provide early intervention, SPED, & services for kids w/disabilities

33
Q

Individualized Education Plans (IEPs)

A

required by IDEA for kids w/specific learning disability; includes specific goals, placement agreement, development team, & classroom inclusion

34
Q

What learning disabilities qualify for IEPs?

A

disabilities that impair use/understanding of language (listening, speaking, reading, writing, spelling, or calculating)

35
Q

What disabilities/problems do not qualify for IEPs?

A

issues from physical/cognitive disabilities, emotional illness, or emotional/cultural disadvantages

36
Q

Head start

A

government pre-K for disadvantages

37
Q

list efforts or methods for cost containment in healthcare

A

diagnostic-related groups, value-based compensation/bundled payments, combination of services, outpatient services, mass/bulk purchasing, early intervention & prevention, environmental protection, energy conservation

38
Q

what are diagnostic related groups (DRGs)

A

people w/certain diagnoses put as 1 payment & put limit on cost of care

39
Q

what is value-based compensation/bundled payments

A

providers paid amount for each diagnosis instead of fee for every service or test

40
Q

what is combination of services

A

utilizing large labs/joining of multiple agencies (ex: 5 clinics use Sonora quest)

41
Q

Agency for Healthcare Research & Quality (AHRQ)

A

agency to make healthcare safer, more accessible, equitable, affordable, better quality, avoid waste, & keep cost down

42
Q

Omnibus Budget Reconciliation Act of 1987 (OBRA)

A

regulations for long-term care & home health care, require training & evaluation for nursing & geriatric assistants, cover certain rights

43
Q

what rights are covered by OBRA of 1987? (10)

A

free choice of physician, treatment care, & research participation; freedom from abuse & restraint; privacy & confidentiality; accomodations of needs & choice; voice grievances w/o fear; organize & participate in group activities; information; manage personal funds & possessions; unlimited access to familes; remain in facilities w/exceptions

44
Q

US Dept. of Health & human services (USDHHS)

A

goal to protect health of all Americans & gives most grant money

45
Q

Office of National Coordinator for Health Information Technology (ONC)

A

monitors private & secure health info exchange w/goal of quickly exchanging PHI among providers

46
Q

public health

A

provides services directed by USDHHS, recommend mandates, provides wide range of services

47
Q

Veteran’s Adminstration (VA)

A

healthcare for veterans & families; largest US integrated health care system

48
Q

Joint Commission

A

nonprofit ensuring healthcare quality

49
Q

What does the Joint Commission stand for

A

The Joint Commission on Accreditation of Healthcare Organizations

50
Q

Worker’s Comp

A

health insurance for treatment of injured workers from state paid by state & employer, reimbursing wages lost due to injury

51
Q

TRICARE

A

insurance for all active military & families, military personnel survivors, & retired

52
Q

What are the 8 rights onPatient’s Bill of Rights

A

information, choice of provider, access to emergency services, autonomy, complaint & appeal, privacy, justice, & patient responsibilities

53
Q

Supplemental nutritional assistance program (SNAP)

A

food stamps, supervised by social security

54
Q

WIC

A

special supplemental food program for pregnant & lactating women, infants, & kids through 4 yrs

55
Q

Commodity Supplemental Food Program (CSFP)

A

run by US Food & Nutrition Services for pregnant & postpartum women, infants, kids through 6 yrs, & adults +60 yrs

56
Q

Senior Farmers’ Market Nutrition Program (FMNP)

A

food program associated w/WIC giving coupons & food from farmer’s markets & roadside stands

57
Q

WICFMNP demographic

A

for infants, kids thru 4 yrs, pregnant & lactating women

58
Q

SFMNP demographic

A

for adults +60 yrs

59
Q

Child Protective Services (CPS)

A

run by each state in charge of children’s safety & health

60
Q

Children’s defense fund

A

nonprofit focusing on minorities, low income, & special needs for health, education, safety, & financial standard of living

61
Q

Early intervention

A

state program for kids under 3 yrs w/disability/developmental delay to help kids progress in development

62
Q

Save the Children

A

global organizations focusing on health, education, & safety that help communities rebuild after disaster by providing food, medical care, & education

63
Q

United Nations Children Fund (UNICEF)

A

focus on education, health, & safety; globally provides education, immunizations, clean water & sanitation, nutrition, & emergency relief

HOSA: Human G&D (15 decks)

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