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Nursing semester 1 > Intro Chapter 2 > Flashcards

Intro Chapter 2 Flashcards

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1
Q

How do you describe the US healthcare delivery system

A

Multi tiered

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2
Q

What does the DHHS oversee

A

All health related concerns of the general public international

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3
Q

What subdivisions are included in the DHHS

A 
WHO
CDC
HUD
OSHA
EPA 
FDA
USDA 
Disaster response
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4
Q

What is the DHHS emphasis

A

Monitoring, policy development, and ensuring healthcare accessibility

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5
Q

What is Medicare and the parts of Medicare

A

Medicare is an insurance program funded by the US government for those over 65 who paid into Social Security

Includes
Part A
Part B 
part C 
part D
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6
Q

Describe Medicare part A

A

Free to everyone Eligible, covers essential hospital costs but has a limited number of days

Also covers disabled and end stage renal disease patients

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7
Q

Define premium

A

Amount of money paid each month to an insurance company

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8
Q

Define deductible

A

Specified amount of money the patient pays before an insurance company will pay a claim

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9
Q

Describe Medicare part B

A

Covers doctors visits and outpatient services

Requires premium and deductible only covers 80% of expenses

Frequently Used with private insurances

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10
Q

Describe Medicare part C

A

A combination of A, B, and D only has one premium

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11
Q

Describe Medicare part D

A

Covers prescribed drugs on formulary (restrictions)

has premium and deductible

many elder people drugs are not covered

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12
Q

What is Medicaid

A

We aid everyone

Health insurance for the poor pregnant and very young (under five)

Only has a premium if dental and vision added
WIC

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13
Q

At would level is Medicaid dispersed

A

STATE

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14
Q

What is CHIP and who is it available for

A

CHIP Was created for children to have a fordable means to access healthcare
If above poverty line

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15
Q

What is Texas Health steps

A

An early and periodic screening, diagnosis, and treatment program specifically for children under Medicaid

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16
Q

Private health insurance

A

Private or employer sponsored

“BCBS”

Premiums requires

May have Deductibles or co pays

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17
Q

Subcategories of private health insurance

A

HMO

PPO

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18
Q

HMO information dump

A

Coordinated through primary doctor

few plans out there

Specified amount of money for each patient

no reimbursement (prospective payment)

primary controls health care (i.e. referrals diagnostic test and health services)

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19
Q

PPO information dump

A

Patient selects from a list of approved doctors and specialists

in the majority

yes reimbursements for preestablished fees (retrospective reimbursement)

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20
Q

Affordable care act a.k.a. Obamacare

Intentions

A

Meant to improve quality of healthcare, improve access, and lower costs

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21
Q

Where are the three major shifts to the success of the law

A

Employers offering healthcare insurance

Increase participation in CHIP

Expended Medicaid coverage by state

22
Q

What items on the affordable care act were revoked

A
  1. The mandated coverage in which people were being fined after not having insurance coverage
  2. Tax credits which reduce the cost burden to some individuals
23
Q

Key provisions Of the affordable care act

A

Guaranteed coverage regardless of pre-existing condition

insurance companies must justify premium increases of more than 10% per year

preventative services at little to no cost yearly wellness exams screenings

24
Q

How is healthcare delivery described

A

By the place it is being delivered

25
Q

Primary care

A

In doctors offices

least expensive

Addresses problem before it gets worse

26
Q

Secondary care

A

In hospitals

most expensive

27
Q

Tertiary care

A

Skilled nursing facilities/ rehab

second most expensive

28
Q

How would you describe disease prevention

A

Strategies for certain populations of people

29
Q

Primary prevention

A

Target: healthy people

Done by: health promotion and disease prevention

(I.E: health education, of lifestyle vaccines, washing hands)

AVOID IT

30
Q

Secondary prevention

A

Target: population at risk for disease

Done by: screenings (not diagnostic) early disease detection

examples: pap smears pelvic exams colonoscopies

REDUCE RISK

31
Q

Tertiary prevention

A

Target: those who have the disease

Done by: health management and prevent complications

Examples: Education, strategies for compensation

ALREADY HAVE IT BUT MANAGE IT

32
Q

Can primary prevention happened in tertiary care

A

Yes the setting and strategies do not have to match

33
Q

Define screening

A

Assesses the need for further evaluation

34
Q

What is the best screenings have

A

Strong reliability and validity

35
Q

Define reliability

A

Repeatability with the same results every time

36
Q

Define validity

A

Accuracy

High sensitivity and specificity

37
Q

Sensitivity

A

True positive those who truly need a follow up

38
Q

Specificity

A

Decrease in false positive show true negative

39
Q

What is true in regards to disease

A

It is least expensive to prevent disease than to treat it

40
Q

What are the major concerns of healthcare delivery

A

Cost
access
quality

41
Q

What are things that drive healthcare costs up

A

Diagnostic tests
pharmaceuticals
specialists
increasing population of elder people (living longer with more disease

42
Q

Why are diagnostic related groups a problem to health delivery

A

They interfere with quality healthcare by providing standardized non-individualized healthcare

dictating how much an insurance company will pay for hospitalizations and outpatient services

they stereotype diseases saying they all cost same and they all require the same tests don’t cover extra

43
Q

Do nursing shortage is increased cost

A

Yes

44
Q

Factors in Cost containment

A

Managed care: determine when and where insured can receive service (I.Einsurance companies)
•increases costs

Care management: advocacy for the ill moving through healthcare delivery system
•decreases costs
•hospice

Nurse case managers: assure continuity and quality of care move patient through healthcare delivery system
•decrease cost

45
Q

Access to healthcare challenges

A

Time: hours of operation are limited

Transportation: long distance with no car
• there are volunteer groups that pick up and take patients to appointments

Insurance: many people don’t have insurance and do not have the money to go get seen

46
Q

Quality of healthcare

A

Facility must be accredited by the joint commission (TJC) and the Center for Medicare Medicaid services (CMS) who provide funding; increase quality of care

47
Q

Self-determination act

A

Patient has a right to:

Advanced directives
: documents saying what can and can’t be done to patient if a person cannot speak for themselves
(A WILL)

informed consent
: Full explanation of procedure (outcomes, complications) understanding of the procedure, treatments and what would happen if the patient didn’t receive treatment
• must be free from coercion
• must be able to understand

refusal to treatment

48
Q

HIPPA

A 
patient confidentiality, 
on a need to know basis
Verbal
written online
leaving items out with information
49
Q

Americans with disability act

A

Equal Access to opportunities to those with disabilities

50
Q

Equal opportunity act

A

Provide services to those who do not have the same opportunities because of location or economic status

i.e. headstart

Nursing semester 1 (19 decks)

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