HCM 330- Section 1 Flashcards
List Healthy People 2010 goals or domains
o Increase quality and years of healthy life: help individuals of all ages increase life expectancy and improve quality of life.
o Eliminate health disparities: among different segments of the population. Differences that occur by gender, race or ethnicity, education, or income, disability living in rural localities, or sexual orientation.
Inputs to Health
o Individual’s Health Status:
♣ Heredity – you are born with gene’s (ex. Blood Pressure)
♣ Lifestyle – the number one impact (cause) on health (ex. Smoking, Drugs, Drinking, Eating Habits)
♣ Environment – (ex. Air Pollution, Sanitation, Low Income Neighborhoods); interact with it everyday, type/quality of environment may prevent/promote disease, components include: physical, social economic
♣ Medical Care Services (Org/deliver of health services) – this has the least impact on whether or not we are healthy (ex. Testing, More Technology); refers to a system of arrangements that exist in our society for mediating between humans and vulnerabilities of disease, focus of US system is on personal health services rather than public health services rather than public health services
Types of ambulatory care services and delivery sites
o Physician offices, dental offices, mental health services, physical therapy, diagnostic testing, hospital emergency dept., urgent care centers, ambulatory care clinics/surgery centers, outpatient centers
o Physician offices most common—labs, MRIs, X-Rays, Mammograms, Eye care, podiatry, home health, family planning
o Personal health/medical services given to a person who isn’t institutionalized (does not require an overnight stay)
o Majority of physician-patient contacts in the U.S. occur in ambulatory setting
o 70% of surgeries are performed in ambulatory care setting(2000)
o Most common ambulatory care is physician practice arrangements (solo practice, group practice, hospital based, health center based)
In what setting the majority of health care professionals are employed?
Private health care setting
Attempts to prevent against moral hazard
♣ Deductibles: dollar amount paid by insured before insurance starts to pay
♣ Co-payments: fixed dollar amount paid by insured for each type of service
♣ Coinsurance: percentage of cost of each health service that insured pays with remaining portion paid by insurance company
♣ Exclusions for services: cosmetic surgery other than repair damage, pre-existing medical conditions
Government agency responsible for overseeing Medicare and Medicaid
Center for Medicare and Medicaid Services (CMS)
Why physicians like PPOs
Less risk on providers and more control over cost
What is Demand Pull-inflation
consumer’s willingness to purchase services is greater than supply offered at constant dollars
Factors responsible for demand-pull inflation
Insurance/3rd party coverage that has increased consumers’ “buying power” and is biggest factor; aging population; higher incomes have increased ability to purchase more insurance/health care; inappropriate utilization of services (demand); population growth; more education that has created higher expectations of care
Andersen Model – Predisposing, Enabling, Need factors.
o Predisposing: exist prior to use of services; can predict/profile ahead of time the use of services: i.e. age, gender, race, occupation, education, marital status, residence, (aged tend to use more than younger, females more than males)
o Enabling: allows/permits a person to act on a value he/she has for medical services: i.e. family income, health insurance, community resources, location
o Need: biggest predictor of use and illness level; whether perceived (disability, symptoms, diagnosis, general state) or evaluated (symptoms, diagnosis)
Donabedian’s Structure – process – outcome paradigm
o Structure: consider characteristics of system—like number, type, size, location of hospitals, number and qualifications of health providers. Most tangible/easily identified, reveal more about access to care than quality of care
o Process: consider components of interaction between physician and other type of health providers and patients, focusing on technical quality of care and interpersonal interaction among participants
o Outcome: concentrate on patient’s subsequent health status following intervention; least tangible/most difficult aspect of quality of care to measure
What is an Epidemic
occurs when new cases (incidence rates) of a certain disease in a given human population, during a given period substantially exceed what is expected (based upon recent experience)
What is a Pandemic
epidemic of infections disease that spreads through human populations across large regions
Who provides most long-term care services
o Formal: Nursing homes, home health care, hospice, assisted living facilities, adult day care.
o Informal: Family caregivers
Who regulates medical technology
o FDA- regulates medical devices
o In private sector- institute of medicine (IOM)
o Most decentralized; AHRQ office of health technology assessment assesses to determine appropriateness of Medicare reimbursement
