Health Care Flashcards
What school was used as the model school for the Flexner Report 1910
John’s Hopkins Medical School
What did the Flexner Report 1910 do?
Solidified an educational model that favored the lab over bedside, hospital over home and physician as researcher over practitioner
A lot of med schools closed after the report, especially schools that educated….
female, black and working class students
Who was the founder of the PA profession?
Eugene Stead MD
Most medical care is delivered in …
small healthcare settings.
32% solo or 2 physicians
60% practice of 5 physicians or less
What are social determinants of health?
NOTE THE THINGS IN () ARE JUST EXAMPLES.
- economic stability (employment, debt, income)
- education (language, levels of education, literacy)
- food (hunger, access to health)
- social & community (social integration, support system, discrimination)
- neighborhood & environment (housing, transportation, parks, safety)
- health & healthcare (coverage, quality of care, provider availability)
Affordable Care Act did what?
Gave uninsured way to be insured.
- income based subsidies to uninsured
- employer mandate
- individual mandate
- medicated expansion
Mechanisms for Affordable Care Act
Private: each state creates insurance exchange for individuals w/o coverage and small employers
Public: The medicaid expansion. Medicare, Medicaid, CHIP, VA
Under the Affordable Care Act health insurers …
- couldn’t turn applicants down with a h/o illness or charge more
- cannot terminate coverage
- must renew coverage
- return at least 80% of premiums in form of health service benefits
What is the most common type of health insurance provider
Employer based coverage
What makes you qualified for Medicare if you are 65
Disabled or if you need hemodialysis and are eligible for social security
Describe A, B, C & D parts of medicare
A: hospital services
B: Outpatient, physician services
C: HMOS that administer benefits “Medicare Advantage” (approved by medicare run by private)
D: Meds, rx drugs
Who is eligible for Medicaid
Varies by state. Usually low income, children, parents of dependents, pregnant women, disabled
Can someone have dual eligibility with Medicare and Medicaid?
Yes, if they are chronically ill and need long term care
What does Medicaid cover?
most clinical services and Rx
Define “Churn”
movement in and out of the program. Occurs bc of changes in income and employment.
What population is most likely affected by churn?
hourly paid employees
Who is the primary payer for long term services and support?
Medicaid
How is Medicare financed?
federal income tax, payroll taxes, premiums paid my enrollees
How is medicaid financed?
state and federal taxes. Every dollar the state spends the federal government matches it
Does medicare or medicaid give low reimbursement rates for providers?
Medicaid
What is S-CHIP?
The state childrens health insurance program developed in 1997
Who does S-CHIP cover?
children in low income families who do not qualify for Medicaid
How is private health insurance sponsored ?
Employer sponsored or private, nongroup (individual market
Private employer sponsored insurance is financed…
jointly through employer and employee
who uses private non group/individuals financed?`
self employed or retired
How does the premium work for those in private non group insurance?
Premium correlates with risk.
Low risk people= low premium
