Healthcare Flashcards
WOrld health organization defines health:
a state of complete physical, mental, and social well-being and not merely the absence of disase or infirmity.
Hollistic model of health includes:
spirituallity
ADLs:
Acitivities of Daily living: eating, bathing, dressing, toileting, maintain continence, getting out of chiar or bed
Primary Care
Longitudinal relationship between patient and clinician.
Incidence:
number of new caseses within a time period
Prevalence
total number of cases at a point in time.
Team nursing
approaches patient care as a team
Nursing model primary:
nurse stays with patient
When does discharge planning begin?
When the patient is admitted.
In 2007, how many hospitals exisited? what is the current trend?
5K. INvestor owned hospitals have increased non profit have decreased.
WHat are the measures of health status for population:
Demographics, direct measures of health and illness (morbidty - death rate, or mortality - sickness rate….these could be crude rates or specific rates of speicifc casuation or attached to demographics), Utlization and quality.
Medicare parts consist of what:
Part A - Hospital expenses, Part B - medical and physican office visits, or Part D - outpatient precription drugs,. Part D 2003, was added as part of the medicare prescription drug improvement legislation. OUtpatient prescription drugs only.
What children’s plan falls under medicad?
Children’s health insurance plan (CHIP)
Healthcare Managed Organization Staff model example:
Kaiser Permanente
Medicaid and Medicare paid how much?
about 33%
Government has paid about how much as a payer of helath care
66%
HMO
Health maintenance organization - responsible for fianncing and delivery of healthcare
IPA
INdepdent Practice Association. Physicians are legal members, but practice independently. IPA usuually has a board to govern IPA. THe physicians are paid on a basis of capitation, a set amount of $$ per enrollee regardless whether or not that person seeks care. IPA contract is not usually exclusive, so individual doctors or the group may sign contracts with multiple HMOs.
Health Maintenance Organzation Act of 1973
fed law to enrouage creation of HMOs
ERISA
Employee Retirment Income Security Act - fed law enacted to protect the interest of employee benefit plans and their beneficiaries by reqiuring disclosure, establishing stanrds of conduct for plan fiduciaries,
What are two amendments of ERISA?
COBRA (Consolidated Omnibus Budget REconcilation act of 1985), provides some employees and beneficiareis with the right to continue their coverage under employer sponsor group health benefit plan for a limited time aftert he occurance of certain events that would otherwise cause termination of such coverage, such as the loss of employement..
HIPAA of 1996 also prohitbs a health benefit plan from refusing to cover an employees pre-existing medical considtions in some cercomestances (genetic info and disability for example).
What are other relevent amendments to ERISA?
New borns and mothers health protection Act, mental health parity act, and woments health and cncer rights act
PPO
Preferred Provider Organization. PPOs earn money by charging an access fee to the insurance comapny for the use of their network. The network. Because the patient is picking up a substanial portion of the first dollars of coverage, PPO are the least expensive types of coverage.
Sub acute care includes:
Assisted Living, Long term care, home health, palliative care and hospice.
Primary preventive care?
Smoking cessation….to prevent disease
Secondary preentive care?
Mogmograhm…..meant to catch disease early.
COTH hospitals?
Teaching hospitals.
Non-profit have a community benefit requirement?
tax exempt status - 501(c)(3)
Physicians, Credentials committee, and executive committee, will all approve physicians. then the ng board has the ultimate authroity to hire?
Medical Staff (physicians)
Primary care physicians care for patients, how?
longintudinally
HOpsitalists?
Manage inpatient care soley….care for broad patient categories.
