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FDN3 > Health and Society/PD > Flashcards

Health and Society/PD Flashcards

Business of Medicine, Implicit Bias, Global Health, AOSC, Ethics

1
Q

What are the different types of private insurance based on funder and plan structure?

A
  • By funder
    • Self-funded/self-insured
    • Group health insurance
    • Individual/non-group
    • Medicare/medicaid
  • By plan structure
    • Indemnity (unmanaged care)
    • Managed care
    • High Deductible Health Plan (HDHP)
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2
Q

Why is it important to have a sensitive case definition when you are investigating an outbreak?

A

It is important to identify every case

  • Isolate and control the infection early
  • Especially if the disease is highly contagious with terrible or unknown outcomes
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3
Q

What is a high deductible plan?

How does it work?

A

A plan with low premiums and a high deductible

Deductible is at least $1400 for an individual or $2800 for a family

The total yearly pocket expenses cannot be more than $6900 for an individual or $13,800 for a family

Limits apply to in-network services

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4
Q

What is the leading cause of death in Africa?

A

Communicable disease

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5
Q

Which “regulatory unit” would investigate potential conflicts of interest in research?

A

The ORI - Office of Research Integrity

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6
Q

Systemic differences in which 3 systems are the biggest sources of health disparities?

A
  • Operation of health care systems
  • Legal regulatory environment
  • Discrimination
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7
Q

Gathering specific information about an individual to prevent group sterotypes from leading to potentially inaccurate information is an example of which strategy for mitigating implicit bias?

A

Individuation

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8
Q

Give two examples of public health insurance

A

Medicare

Medicaid

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9
Q

In an outbreak, what is the difference between a primary and secondary case?

Why is it important to distinguish between them?

A

Primary = from the implicated source

Secondary = infection from human infected with a primary case

Secondary cases must be exculded when you are trying to identify the source of the infection

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10
Q

What is indeminity health insurance?

How does it work?

A

Indemmity health insurance = unmanaged care

The insurer pays a percentage of whatever the hospital bill is

No networks, referrals, or requirements for a primary care provider

(These plans are less common now as insurers are doing more to control their costs)

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11
Q

Who sets the income that is “medicai eligible?”

A

States

Federal government levels teh playing field

  • States with higher per-capita income get less fed. government support
  • States with lower per-capita income get more federal government support
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12
Q

In what scenarios would you use a very specific case definition?

A
  • Mild infections
  • Limited resources
  • When you are in the analysis/risk assessment stages
    • You need to eliminate the influence of the false positives after the danger/panic time period is over
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13
Q

What is an implicit bias?

A

A preference for a social group that is unconscious and automatic

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14
Q

Rank the managed care plans from most to least flexible

A
  • PPO (Preferred provider organization) = most flexible
  • EPO (Exclusive provider organization)
  • POS (Point of service)
  • HMO (Health maintenence organization = least flexible
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15
Q

Who bears the risk in a self-insured/self funded employee-sponsored insurance plan?

How do these plans work?

A

The employers

The company keeps the premiums paid by employees in their own accounts, and the insurance company just administeres insurance (interfaces with hospitals, etc).

This is usually found in larger companies

The emplyer has freedom about the plans that they offer to employees

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16
Q

Give 4 exampels of managed care plans

How do they work in general?

A

PPO, EPO, POS, HMO

Each has some requirements for PCPs, referrals, in network benefits. Plans vary by fee for service vs. capitation, as well as flexibility vs. affordability

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17
Q

In what scenarios would it be appropriate to quarantine a patient?

A

A patient has a severe infection or suspicion for a possibly new or re-emergent disease

Quarentine until diagnosis is confirmed; if positive, until symptoms are over

(I think this is accurate, based on the practice test)

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18
Q

When should you practice beyond your scope?

A

Never

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19
Q

What requirements are needed to initiate a trial involving human participants with a severe condition?

A
  • Feasibility
  • Protocol and consent
  • Recruitment plan
  • Scientific and ethical review
  • IRB submission and approval
  • Funding (internal, external, or both)
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20
Q

What is the WHO’s definition of equity?

A

“Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.”

Applies to health determinants, access to resources, and human rights norms

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21
Q

What constitutes an emerging infection?

A

A disease for which at least one of the following is true:

  • New in humans
  • New to a population/geography
  • More individuals are contracting it than usual
  • Has new attributes
    • Ex: Drug-resistant bacteria
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22
Q

What constitutes an epidemic?

A

An increase in the number of cases of disease above what is expected

Depends on time, place, and population; relative to baseline

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23
Q

Rank the managed care plans from most affordable to least affordable

A
  • HMO (Health maintenence organization = most affordable
  • POS (Point of service)
  • EPO (Exclusive provider organization)
  • PPO (Preferred provider organization) = least affordable
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24
Q

Which “Regulatory Unit” would be involved in grant submission?

A

The OSR - Office of Sponsored Rsearch

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25
Q

Imagining in detail what it would be like to be a person in a steroytyped group is an example of which strategy for mitigating implicit bias?

A

Perspective takingq

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26
Q

What are the advantages of high-deductible insurance plans?

A
  • High network availability
  • Lower premiums
  • Cheaper option for rare insurance users
  • Avoid market rates
  • HSA (health savings account) elligible
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27
Q

Who bears the risk in employer-sponsored group health insurance?

How do these plans work?

A

The insurance company bears the risk

The company pays the premiums of its employees to an insurance company

These plans are subject to state requirements (Small companies must cover essential benefits, medium companies must cover 60% of essential benefits)

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28
Q

Why is maternal mortality a good measurement of the quality of a healthcare system?

A

The main culprits causing maternal mortality can be fixed with adequate resources

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29
Q

What are the 5 major causes of maternal mortality?

A
  • Hemorrhage
  • Infection
  • Eclampsia
  • Obstructed labor
  • Abortion
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30
Q

What are the requirements for a PPO plan?

  • PCP?
  • Referall to see a specialist?
  • In-network benefits?
  • Non-emergency out-of-network benefits?
  • Emergency coverage?
A
  • PCP? No
  • Referall to see a specialist? No
  • In-network benefits? Yes
  • Non-emergency out-of-network benefits? Yes
  • Emergency coverage? Yes
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31
Q

What does the Nuremberg Code state?

A

The voluntary consent of the human subject is absolutely essential

32
Q

Who administers…

Medicare?

Medicaid?

CHIP?

A
  • Medicare
    • Federal government through CMS (Center for Medicare and Medicaid services)
  • Medicaid
    • State with federal CMS oversite
  • CHIP
    • State with federal CMS oversite
33
Q

What are the basic ethical principles and applications of the Belmont Report?

A

Ethical principles

  • Respect for persons/patient autonomy
  • Beneficience
  • Justice

Applications

  • Informed consent
  • Assessment of Risks and Benefits
  • Selection of Subject
34
Q

Who is covered by medicaid?

A

Eligivility varies by state with federal guidelines

  • Low income people
    • Especially children, pregnant women, seniors, and people with disabilities
  • People with disabilities
    • No need to have worked in the past
  • Medically needy
    • High medical expenses but not low income
  • Immmigrants
    • Legal: waiting periods amy be relaxed at state’s option
    • Undocumented: State’s option
35
Q

Why do diseases continue to emerg?

A
  • 60-80% originated in animals
    • Human-adapted microbe genetics
  • World travel and global interdependence
  • Economic development and land use
  • Poverty and social inequity
  • Climate change
36
Q

What are the requirements for a POS plan?

  • PCP?
  • Referall to see a specialist?
  • In-network benefits?
  • Non-emergency out-of-network benefits?
  • Emergency coverage?
A
  • PCP? Yes
  • Referall to see a specialist? Sometimes
  • In-network benefits? Yes
  • Non-emergency out-of-network benefits? Yes
  • Emergency coverage? Yes
37
Q

Which groups constitute “vulnerable populations” under the…

Belmont Report?

Common Rule?

A

Belmont Report

  • Racial minorities
  • The conomically disadvantaged
  • The very sick
  • The institutionalized

Common Rule

  • Pregnant women
  • Fetuses
  • Neonates
  • Children
38
Q

What are the requirements for a EPO plan?

  • PCP?
  • Referall to see a specialist?
  • In-network benefits?
  • Non-emergency out-of-network benefits?
  • Emergency coverage?
A
  • PCP? Sometimes
  • Referall to see a specialist? No
  • In-network benefits? Yes
  • Non-emergency out-of-network benefits? No
  • Emergency coverage? Yes
39
Q

What is a DALY?

How is it calculated?

What does it mean?

A

DALY is a disability-adjusted life year

DALY = years of life lost + years lived with disease

It is an indicator of the socio-economic well-being of a country; DALYs are highest in resource-limited countries

40
Q

What is the purpose of health insurance?

A

To share risk (of high healthcare costs) among a group of people

41
Q

What is the difference between a “difference” and a “disparity?”

A

Difference = differences between groups that may be due to clinical appropriateness, need, and patient preferences

Disparity = differences that are not physiologic and may be related to systemic differences in the operation of health care systems, legal regulatory environment, or discrimination

42
Q

Which “Regualtory Unit” would be relevant to studying recombinant DNA or stem cells?

A

The IBC - Institutional Biosafety Committee

43
Q

What is the difference between Medicare parts A, B, C and D?

A
  • A = Hospital insurance (Original medicare)
    • Helps pay for hospital stays, skilled nursing facility, hospice
  • B = Medical insurance (Original medicare)
    • Mostly outpatient services
    • Medications administered by physician are covered
    • Home health/equipment
  • C = Medicare Advantage (Optional)
    • Offered by private insurance companies that ahve contracted with medicare
    • Includes A, B, sometimes D
  • D = Rx
    • Private plans that cover prescription costs
44
Q

List 5 strategies for combating implicit bias

A
  1. Stereotype replacement
  2. Positive countersterotype imaging
  3. Perspective taking
  4. Individuation
  5. Increase opportunites for contact with countersteroptypic examplars
45
Q

Who is covered by medicare?

A

People who have worked and turned 65 or become disabled

People with end stage kidney disease

Eligibility is uniform throughout the US

46
Q

What are the requirements for a HMO plan?

  • PCP?
  • Referall to see a specialist?
  • In-network benefits?
  • Non-emergency out-of-network benefits?
  • Emergency coverage?
A
  • PCP? Yes
  • Referall to see a specialist? Yes
  • In-network benefits? Yes
  • Non-emergency out-of-network benefits? No
  • Emergency coverage? Yes
47
Q

What “regulatory unit” is relevant to human research?

A

The IRB - institutional review board

48
Q

What study prompted the protection of pregnant women and fetuses under the common law?

A

The study of thalidomide and DES (Diethylsetilbestrol)

49
Q

What is the significance of the Tuskegee study?

A

Black male prisoners were subjected to untreated Syphilis for 40 years as part of a research study

This eventually led to the Belmont report, which gives extra protections from research studies to racial minorities, prisoners, the very sick, and the intitutionalized

50
Q

What is the difference between isolation and quarantine?

A

Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick

Isolation separates confirmed sick people from healthy people

51
Q

Which statement/document/law underscores the importance of voluntary consent in human research?

A

The Nuremberg Code

52
Q

What is the strict, legal definition of futility in healthcare?

A

Strictly legally speaking, a treatmet is futile if (at least) one of the following is true

  • The treatment leads immediately to cardiac arrest
  • There is no physiological basis for the treatment
    • Ex: putting a cast on someone’s arm to prevent heart attack
  • The treatment has been tried before and been ineffective
    • Ex: Trying CPR again after it failed an hour ago
53
Q

Which “Regulatory Unit” woudl be important in animal studies?

A

The IACUC - Institutional Animal Care and Use Committee

54
Q

What are the disadvantages of high-deductible insurance plans?

A
  • People with chronic illness
  • May lead to care avoidance
  • Higher out of pocket expenses for office visits, procedures, and emergencies
  • Disqualified if you are covered by another non-HSA-qualified plan
55
Q

Identifying your sterotype about a specific group and replacing it with accurate information is an example of which strategy for mitigating implicit bias?

A

Sterotype replacement

56
Q

What is the leading cause of death worldwide?

A

Ischemic heart disease

57
Q

What are the 4 major roles of the IRB (Institutional Review Board)

A
  • Reviews and approves research projects involving human subjects or identifiable private information obtained from human subjects
  • Assists investigators in planning and conducting experiments in accord with the highest scientific, humane, and ethical principles and in conformity with relevant laws, regulations, and policies
  • Liaison between investigators and the federal government
  • Safeguards rights and welfare of human subjects
58
Q

Who is covered by CHIP?

A

CHIP = Children’s health insurance program

Covers children of middle-income families who are not medicaid elligible

Legal immigrant waiting periods can be relaxed at states option

Coverage for undocumented immigrants

59
Q

You are interviewing a woman for a position traditionally held by men. Beforehand, you imagine, in detail, an effective woman leader.

This is an example of which strategy for mitigating implicit bias?

A

Positive countersterotype imaging

60
Q

Name 3 all-inclusive government health care systems in the United States

A

Veterans Health Administration

Indian Health System

TRICARE

61
Q

Who bears the risk in a fully-insured, individual (non-group) insurance plan?

How do these plans work?

A

The insurance company bears the risk

Indivduals buy health insurance directly from the insurer or on the health insurance marketplace

The individual is responsible for 100% of the premium

Coverage must follow the essential health benefits standard

62
Q

If a patient lacks decision making capacity and an advance directive is unavailable, how are decisions made about treatment?

A

A surrogate decision maker

63
Q

What are the two standards for surrogate decision making for adults?

A
  1. Substituted Judgement: Surrogate attempts to make decisions based upon the known values of the patient
  2. Best Interest: Descisions are bade based upon what a “reasonable person” would wish done in the given case. One should consider reduced suffering, quality of life, and risks and benefits of proposed intervention
64
Q

A surrogate decision maker who is using best interest standards should take into accout…

A
  • Reduced potential suffering
  • Quality of life
  • Risks and benefits of proposed treatment
65
Q

If a surrogate is using the patient’s values to make a decision about their treatment, they are using…

A

Substituted judgement

66
Q

If a surrogate is basing treatment desisions upon what a reasonable person would wish for, they are using…

A

Best interest standards

67
Q

Name 3 surrogate desision court cases

A
  1. Karen Anne Quinlan
  2. Nancy Cruzan
  3. Terri Schiavo
68
Q

Describe the Karen Anne Quinlan case

A

The first “right to die” case

  • Karen Anne Quinlan was a 22 year old woman in a persistent vegetative state
  • Physicians refused the family’s request to remove her ventilator
  • The court decided that family members can act as guardians and patients can be removed from ventilators
69
Q

Describe the Nancy Cruzan case

A
  • Nancy Cruzan was a 33 year old woman in a persistent vegetative state
  • Her family requested that her feeding tube be removed, but physicians refused
  • The court decided that states have the right to determine the level of evidence necessary for substituted judgement
70
Q

Describe the Terri Shiavo case

A
  • Terri Shaivo was a 27 year old woman in a persistent vegetative state
  • Terri’s husband requested that her feeding tube be removed
  • Terri’s parents challenged the decision
  • Extended/multiple court cases (lasting 15+ years!); Pro-life groups and governors (Jeb bush) got involved to affect the outcome (significant because of how much it blew up)
71
Q

How is a living will different from an advance directive?

A

A living will is a type of advance directive that is written down

72
Q

What is the difference between a healthcare proxy and a surrogate decision maker?

A

A healthcare proxy is a type of surrogate decision maker appointed by the patient while they still have decision-making capacity

73
Q

What is the order for determining a surrogate decision maker?

A

Highest to lowest priority:

  1. Court appointed
  2. Proxy appointed by the patient
  3. Family
    1. Spouse
    2. Adult children
    3. Adult siblings
  4. Friend
  5. Physician consulting with hospital ethics committee
74
Q

How shoudl physicians assist surrogates in making decisions for the patient?

A
  • Discuss the process
  • Give a recommendation (especially if the surrogate wants one)
  • Get help from other healthcare workers (ethics committee)
75
Q

When should “best interest” standards be used in surrogate decision making?

A
  • When it is unclear what decision the patient would have made
  • When a reliable surrogate is unavailable or doesn’t know what to do

FDN3 (3 decks)

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