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HSC 310 > Midterm Review from Quizlet > Flashcards

Midterm Review from Quizlet Flashcards

1
Q

Poorhouse

A

Provide food and shelter for people who are poor

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2
Q

Pesthouse

A

Facility to quarantine people with diseases

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3
Q

Dispensaries

A

Outpatient clinics with free care. Help the poor and give physicians experience

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4
Q

First hospitals

A

1850s, bad conditions, lack of resources, unhygienic practices, houses of death

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5
Q

What were some scary health care practices at the time (pre-industrial)?

A

no schooling, blood letting, no licensure, no real science

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6
Q

AMA

A

American Medical Association; 1847

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7
Q

What is the primary purpose of the AMA in the beginning

A

Protect the financial interest of physicians

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8
Q

Germ Theory of Disease

A

Louis Pasteur boiling technique

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9
Q

Medical education

A

Medical education reformed and licenses required

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10
Q

Domestic Character

A

family and home (a lot of families helping, home remedies, praying for you)

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11
Q

Biggest cost of health care

A

traveling expenses and low wages

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12
Q

Baylor plan

A

Dallas, 1200 teachers paid per month for hospital care

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13
Q

Blue Shield

A

Med expenses, nonprofit med care insurer in the US

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14
Q

Harry Truman

A

Wanted national HC program but AMA opposed (socialized med)

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15
Q

Union negotations

A

SC ruled health care can be an employee benefit - insurance grew

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16
Q

Deinstitutionalization

A

1940s and 50s psychotropic meds

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17
Q

Where exactly did people with mental illness receive treatment before and after psychotropic meds?

A

Before, they would go to jails or be like tied up and taken away. After meds, they went to community centers where we mange them and their meds

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18
Q

Amendment to the SSA and YEAR

A

1965 Medicare and Medicaid Progams

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19
Q

Medicare Expands

A

Allows ppl with disabilities (unable to work for 48 months) to be covered with insurance and also what other groups… this group has a specific condition?

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20
Q

Clinton

A

Wanted to reform the healthcare system, but ppl feared taxes

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21
Q

CHIP

A

Children’s Health Insurance Program, the program is funded both fed and by the states, it covers children whose parents make too much money to be covered Medicaid, but no enough money to afford private insurance

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22
Q

Medicare Part D

A

covers prescription drugs, worked with other insurances

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23
Q

Which is more politically charged and why? Medicaid or CHIP?

A

Medicaid is more politically charged, we don’t want to pay for adults

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24
Q

ACA (and YEAR)

A

ACA passed on 2010. Also known as Obamacare. Goal of this was to make affordable healthcare insurance available for more ppl.

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25
Q

Supreme court ruled on 2 aspects of ACA

A

Individual mandate and medicaid expansion. The individual mandate passed but the medicaid expansion didn’t

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26
Q

What group was the medicaid expansion targeted toward (hint: has to do with FPL)?

A

133% of fed poverty level

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27
Q

What was the AMA’s stand regarding the ACA? What was their position regarding earlier legislation aimed at healthcare reform?

A

The AMA supported the ACA but they haven’t always supported healthcare reform, like Clinton and Truman

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28
Q

Financing

A

Employer/Individual buys insurance

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29
Q

Insurance

A

Agency/government determines insurance package

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30
Q

Delivery

A

Provider delivers services

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31
Q

Payment

A

Reimbursement of the provider via insurance/out of pocket

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32
Q

What is the approx percent of GDP that we spend on healthcare?

A

17-18%

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33
Q

Why is the government successful in regulating private practice?

A

Because medicare and medicaid cover over half of healthcare expenditure so if medicare and medicaid won’t fund it you won’t do it, everyone wants to be reimbursed from medicare and medicaid

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34
Q

Managed Care

A

They have contracts with healthcare providers and medical facilities to provide care for members at reduced costs HMO, PPO

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35
Q

HMO

A

Health Maintenance Organization

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36
Q

PPO

A

Preferred Provider Organization and these are more popular

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37
Q

Military Tricare

A

Insurance arm of the military health care system

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38
Q

Veterans’ Health Administration

A

-Including hospitals, outpatient clinics, nursing homes and various other facilities
-Vulnerable populations

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39
Q

IHS

A

IHS services are administered through a system of 12 Area offices and 170 IHS and tribally managed service units

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40
Q

Medicaid

A

Finances healthcare for the indigent, but not all poor

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41
Q

Medicare

A

Finances medical care for those 65+, ppl with disabilities, those with end-stage renal disease

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42
Q

CHIP

A

to make sure that kids whose parents were making too much to qualify for Medicaid, but are burdened by the cost of the cost of premiums from their employer-based health insurance are covered

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43
Q

Long Term Care

A

Home health care, adult daycare, adult foster emergency response, skilled nursing facilities, subacute, specialized LTC

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44
Q

Third Party Payers

A

-an entity that pays medical claims on behalf of insured
-pt is first party, provider is second party, intermediary is third party
-the wall of separation between financing and delivery

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45
Q

Technology

A

-First world countries love technology and think it’s better than simple, preventive measures
-We want the best technology for healthcare and often don’t look at cost

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46
Q

Moral Hazard

A

-Behavior that increases the use of unnecessary technology, tests, services because the pt isn’t paying out of pocket
-The pt wants to get all they can from health insurance, medicare, medicaid, etc.
-Clinician wants to make the pt happy. Sometimes the clinician makes more money w/o impacting the pt

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47
Q

Imperfect Market

A

Interference of third party payers, ppl don’t shop for healthcare, pt’s don’t bear the cost directly which leads to overuse

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48
Q

Lobbyists

A

-Lobbyists for professional organizations, drug companies, employers, physicians, large health systems
-All protect their own financial interests and not always the interest of the pt
-Self-interests of payers are often at odds.

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49
Q

Defensive Medicine

A

Practice ordering unnecessary tests and procedures because of fear of litigation. The US is a more litigious society than other countries which basically means we will sue

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50
Q

Market Justice

A

-This approach to healthcare is very individualistic and on the terms of self-interest and personal effort.
-It’s based on the individual resources and choices for the distribution of healthcare with the smallest sense of gov collaboration

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51
Q

Social Justice

A

Allocates goods and services according to the individuals needs, it stems from the shared responsibility and concern for communal well being

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52
Q

What are magnet hospitals?

A

hospitals that attract top nursing talent, great nursing

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53
Q

Access

A

Access to healthcare is very important, and access itself means the timely use of personal health services to achieve the best health outcomes

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54
Q

Indicators of health

A

health indicators are quantifiable characteristics of a population, such as low birth rate, obesity or diabetes

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55
Q

Examples of health indicators

A

Spirituality, death rates, mental health, physical wellbeing

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56
Q

Determinants of Health

A

The range of personal factors that influence the health status of individuals or populations
EX: genetics, behavior, environment or physical influences

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57
Q

Illness

A

a person’s perception of how he/she feels

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58
Q

Disease

A

Diagnosis based on a clinician’s determination

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59
Q

Acute

A

Relatively severe, episodic, often treatable. Myocardial Infarction or aneurysm

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60
Q

Subacute

A

Between acute and chronic, has some acute features.
Artificial ventilation, head trauma care

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61
Q

Chronic

A

less severe, long and continuous duration, person may not fully recover. Asthma, arthritis, diabetes, and COPD

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62
Q

Primary

A

Immunizations and education - upstream

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63
Q

Secondary

A

BP screenings, cholesterol testing

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64
Q

Tertiary

A

Glucose monitoring/control for pt with diabetes; wheelchair cushion to prevent pressure ulcers

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65
Q

Incidence

A

the number of new cases of disease in a defined population within a specific period, such as month or a year. High levels of incidence could indicate an epidemic

66
Q

Prevalence

A

the number of cases of a given disease in a given population at a certain point of time

67
Q

What does non-profit really mean in regards to non-profit hospitals?

A

funded by charity; religion or research education funds. They benefit the community; they don’t pay federal income or state and local property taxes

68
Q

Clinical information systems

A

electronic health records

69
Q

Administrative Information Systems

A

payroll

70
Q

Decision Support System

A

Workload management, predict pt volumes

71
Q

Internet/E-health

A

learning about health on the web

72
Q

Class I

A

Bandabes and gauze

73
Q

Class II

A

Wheelchairs and crutches

74
Q

Class III

A

Pacemakers and breast implants

75
Q

Inpatient

A

defined as on overnight stay in the hospital

76
Q

Hill Burton Act

A

fed grant to the states to increase number of hospitals in the 50s/60s

77
Q

Medicare reimbursement change in the 1980s reverse effects of Hill Burton Act

A

less hospital beds

78
Q

Primary Care

A

refers to the first contact providers of care who are prepared to handle the great majority of common problems for which pt’s seek care

79
Q

Secondary Care

A

Medical specialist and other health professionals who typically don’t have initial contact with pts, but provide secondary care

80
Q

Tertiary Care

A

pt’s being treated require a higher level of care in a hospital

81
Q

Primary Prevention

A

an intervention that occurs before onset of the disease

82
Q

Secondary prevention

A

early detection of disease or risk factors and intervention during an asymptomatic phase

83
Q

Tertiary prevention

A

an intervention that occurs after the initial occurrence of symptoms but before irreversible disability occurs

84
Q

What idd the ACA mandate for nonprofit hospitals?

A

they have to prove they are actually helping the community

85
Q

Gatekeepers

A

1st contact; control access to services and refer specialists

86
Q

Coordination of care

A

organizing and sharing pt information, ensure high-quality referrals

87
Q

Outcomes of primary care

A

better overall health, less doctor vists

88
Q

ADLs

A

Activities of Daily Living- basic self care - eat, bathe, etc.

89
Q

IADLs

A

Instrumental Activities of Daily Living - more complex - shopping, driving

90
Q

Palliation

A

relieve or alleviate - such as pain management - in quality of life

91
Q

What are the options for people who make too much money for Medicaid, but would struggle to pay the $6,000 per month LTC facility bill?

A

The family has to take care of them, sell or give away all assets for Medicaid to pay or go broke paying for it

92
Q

HHS

A

Community LTC is overseen by the Department of Health and Human Services

93
Q

What agency organizes MOW?

A

SS, Churches and senior centers

94
Q

People who are admitted to LTC facilities see a greater _____ than those who age in place and receive community LTC

A

declines in ADLs and IADLs

95
Q

ALF

A

Assisted Living Facility - provides personal care, 24 hour supervision, social services, recreational activities, nursing & rehab services
-appropriate for ppl who can’t function independently but don’t require SNF.

96
Q

SNF

A

Skilled Nursing Facility - typical nursing home at the higher end of institutional continuum
-Pt’s generally transferred from hospital to SNF after acute episode, & the care needs of the pt’s have become more complex, requiring higher levels of staffing for SNFs

97
Q

Subacute

A

Post acute services for ppl who remain critically ill during post acute phase of illness/injury or who have complex conditions that require ongoing monitoring & treatment/intensive rehab.
-4 categories of subacute care services: extensive care, special care, clinically complex, intensive rehab

98
Q

Specialized

A

Provide services for individuals w/ distinct medical needs. Some examples: specialized units for pt’s requiring ventilator, wound care, intensive rehab, closed head trauma, or dementia care

99
Q

Primary care providers (PCP) education

A

focuses on a variety of areas in health care

100
Q

Specialized providers education

A

focuses on tech and dealing w/ illness episode

101
Q

Stark Laws

A

-Prohibit a physician from doing self-referral to facilities in which they have ownership interest.
-Prohibit physicians who have a financial relationship w/ a third-party from referring to a third party

102
Q

Hospitalists

A

specialize in care of hospitalized pt’s results: higher quality of care and improved pt satisfaction

103
Q

Maldistribution of HC workers

A

-refers to surplus/shortage of HC workers geographically: urban areas have more PCPs per 100,000 ppl than rural areas
-speciality: 58% specialists and 42% PCPs result: high volumes of expensive care; not enough care for vulnerable pop; not enough preventative care

104
Q

Critical access hospital reimbursement

A

101%

105
Q

What provisions of the ACA are critical access hospitals exempt from?

A

the readmissions, they allow readmission without losing money

106
Q

HMO

A

Healthcare Maintenance Organization, usually cheaper premiums, capitation, typically need a referral, out of network providers may not be covered

107
Q

What aspects of primary care are not reimbursed and likely should be?

A

Coordination or care and educating patients and preventive care

108
Q

What pays for most institutionalized LTC

A

Medicaid and out of pocket

109
Q

PPO

A

Preferred Provider Organization, higher premiums, uses discounted fee-for-service, offers more choice of providers

110
Q

Insured

A

Being covered by insurance

111
Q

Enrollee

A

A person signed up for something

112
Q

Beneficiary

A

A person who gains advantage of something. Like a trust, will, or life insurance policy

113
Q

Underwriting

A

The act of seeing how much risk the person may be, such as underlying illnesses and charging them more for the services they may need

114
Q

What is the largest reimbursement system for HC in the US?

A

Employer based health insurance

115
Q

Cost sharing

A

sharing of costs of health care so that the insurer assumes at least part of the risk

116
Q

What can cost sharing theoretically prevent?

A

Overutilization of HC services

117
Q

Deductible

A

the amount the insured must first pay before any benefits by the plan are payable

118
Q

Copayment

A

the amount that the insured has to pay out of pocket each time health services are received after the deductible amount has been paid

119
Q

Coinsurance

A

cost sharing in the form of a percent amount (80/20)

120
Q

Stop-loss provisions

A

this is the same as the annual out of pocket maximum
-Its the maximum amount of money required to be apid each year by the unsured

121
Q

Means-tested

A

limited eligibility to the people below a predetermined income level

122
Q

What is a means-tested program in the US?

A

Medicaid

123
Q

Which of the above percents does the enrollee typically pay?

A

20-25%

124
Q

Medicare overview

A

covers who, 65+, ppl with end stage renal disease, and certain younger ppl with disabilities
-doesnt cover dental, vision, hearing aids, and many long term care systems Administered by - Centers for Medicare and Medicaid Services
-Financed by Fed government

125
Q

Medicare A

A

-hospital care; covers inpatient services, home health, hospice, and rehabilitation in a SNF All working individuals pay this tax. Paid on all income earned.Paid equally Covers - inpatient hospital services to those that are: 65 and older People with disabilities that are entitled to Soc. Security those with end stage renal disease

126
Q

Medicare B

A
  • covers certain screening and preventative services; funded by general taxes Outpatient Coverage such as doctor’s office visits and outpatient hospital services
127
Q

Medicare C

A
  • covers vision, hearing, and dental; combination of part A & B
128
Q

Medicare D

A
  • covers prescription drugs; offered by private insurance companies
129
Q

Why are there new restrictions, with the ACA, that require more documentation and quality reporting of home health services?

A

There are now more restrictions because people that were utilizing home health services were not reporting and documenting the services and were getting thousands, sometimes millions of dollars of care for free.

130
Q

Are there premiums for Med B?

A

-Medicare recipients have an income-related premium, this means the rich will pay more per month in medicare B premiums

131
Q

How did the ACA address the donut hole?

A

They phased out the coverage gap by gradually reducing the share of the total drug costs

132
Q

Donut Hole

A

coverage after your initial coverage period. You enter the donut hole when your total drug costs including what you and your plan have paid for your drugs reaches a certain limit.

133
Q

Who is entitled to IHS benefits and why?

A

An individual who has not reached the age of 19 years old and is a child of Indigenous American/ alaskan native an eligible in. I am not positive of why this is, but I assume it is because the parents of the child are, and for example the kid may have been adopted by its guardians.

134
Q

Per capita, expenditures for inmates are ____ than expenditures for IHS beneficiaries

A

Greater

135
Q

Prospective Payment System

A

A method of reimbursement in which medicare payment is based off of a fixed, predetermined amount. Examples are how much a hospital is paid for an MRI for a Medicare patient.

136
Q

Retrospective payment system

A

The amount paid is determined by what the provider charges or says it is to cost after tests and services have been administered (fee-for-service)

137
Q

Distributive

A

benefits everyone, not only certain groups of ppl

138
Q

Redistribute

A

take money or power from one group and give it to another, this makes health policy politically chargedExample Medicare and medicaid

139
Q

Decentralized

A

the fed government isn’t in power, typically states have more power

140
Q

Medical Model

A

This can contribute to higher cost of healthcare if the pt got a test done that didn’t need to be done

141
Q

Admin costs

A

Billing and insurance makeup the largest part of administrative health care costs.

142
Q

Defensive medicine

A

overutilization of tools to protect oneself

143
Q

Shopping

A

compare international expenditures, assess private sector insurance premiums and government spending to maintain expense levels and prevent unnecessary spending

144
Q

Quality assurance

A

Refers to activities and programs intended to “assure” or promise improvement in quality of care in a defined medical setting or program.

145
Q

Risk management

A

the goal is to reduce and prevent adverse events in a healthcare setting

146
Q

AHRQ

A

Agency for Healthcare Research and Quality, clinical practice, protocols, improving

147
Q

Federally Qualified Health Centers

A

Community based health care providers that receive funds from HRSA to provide primary care in underserved areas.

148
Q

Hospital Readmission Reduction Program

A

This is a medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and reduce avoidable readmissions.

149
Q

Individual mandate

A

all legal residents of the United States either have what the law had designated as “minimum essential coverage” or pay a penalty tax

150
Q

Categories of Maldistribution

A

geographical and specialty vs PCP

151
Q

Asynchronous

A

not real time, x-rays

152
Q

17% of GDP

A

healthcare expenditure

153
Q

What is the function of the NIH

A

med research

154
Q

What happened when their was a decline in hospital procedures

A

outpatients clnics boomed

155
Q

Joint Commission

A

certifies hospitals, they receive reimbursement from government

156
Q

If you are uninsured, how much HC services do you use?

A

less, barely any

157
Q

Synchronous

A

live and happening in real time

158
Q

what drove employer based HC

A

union negotiations after WWII

159
Q

State licensure

A

the hospital gets to open its doors

160
Q

Who is legally responsible for hospital operations

A

board of trustees

161
Q

“Does the ACA mandate the federal government to control healthcare services”

A

False

162
Q

What was the ACA’s purpose

A

Insurance reform

HSC 310 (3 decks)

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