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HLED 210 > Public Health Exam 3 > Flashcards

Public Health Exam 3 Flashcards

1
Q

Inpatient

A

Patients remain in the facility for at least 24 hours

  • hospitals
  • nursing homes
  • rehab
  • drug treatment
  • nutritional hospice; fed through IV
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2
Q

Outpatient

A

Patients remain in facility for less than 24 hours
-diagnostic testing
-hospitals
-one on one clinician visits-blood work, physical therapy
-emergency clinics
-community health centers “safety nets”
LOC-neighborhood clinics, in shopping malls, walmart, in schools, good for medicaid

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3
Q

Categorization Characteristics for Hospitals

A

General-St. Joseph’s
Specialty-Seattle Children’s Hospital
-nonprofit-funds set aside for the poor (90%)
-for-profit-single owner, high prices, had ER’s, not very many left
-investor-owned-people pooled together and opened hospital, profits go back to investors; for-profit (3%)

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4
Q

Three Types of Assessment for Quality

A

Structure-physical building, organizational infrastructure EX:clean, not falling apart, not just visual
Process-procedures and formal process of delivery EX:handwashing, medicine admission, electronic, wash hands 2x, paperwork waiting time, sometimes inconvenient
Outcome-results from care EX:did you get better, are you sick again
National Committee for Quality Assurance (NCQA) gives report card for institutions

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5
Q

Criteria to Determine Quality of Care

A

On the NCQA report card
Access and Service-access to needed care and good customer service; surveys (fail b/c usually only angry patients and burden to patients), staff interviews
Qualified Providers-available, meets needs, licensed
Staying Healthy-quality of services that help people stay healthy;review records to see if disease came back and how often
Getting Better-services to recovery(rehab, AA, smoking cessation); staff and clinical records/interviews
Living with Illness-(type 2 diabetes, asthma) quality for managing illness, prvision of specific services(eye exam for diabetes), keep track of meds and symptoms; interviews with staff, clinical records

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6
Q

Benefits of Electronic Medical Records (4 from book, 7 from class)

A

Improve patient safety,
Support the delivery of effective patient care, facilitate management of chronic conditions, improve efficiency
CLASS:
Health info and data (not filling out same sheets each time)
Results management (all providers can see everything)
Order entry/management (straight from doc to pharmacy)
Decision support management(computer reminders to encourage follow-up and evidence based guidelines)
Communication and connectivity(between doctors, and between doctor and patient)
Patient support(tools for patient education and involvement in decision making)
Administrative processes(27% spent on paperwork)
Reporting and population health (better efficiency and completeness of required reporting and speed/completeness of PH surveillance)

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7
Q

Approaches to Ensure Quality Care is Provided

A

Continuing education or recertification
Integrating financial compensation with quality using pay-for-performance
Protocols/step by step advice to diagnosing and treatment
Hospital privileges and approval to perform specific procedures
Accreditation of additional orgs including clinical practices
Malpractice liability
Disclosure of medical errors-saying sorry reduces chance of being sued

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8
Q

Experience Rating

A

Replaced community rating

Means that employers and employees pay based on their groups’ use of services in previous years

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9
Q

Community Rating

A

Implied that the cost of insurance was the same regardless of the health status of a particular group of employees

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10
Q

Cap

A

Limit on total amount that insurance will pay for a service per year, per benefit period, or per lifetime

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11
Q

Copayment

A

An amount that the insured is responsible for paying even when the service is covered by the insurance

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12
Q

Coinsurance

A

The percentage of charges that the insured is responsible for paying

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13
Q

Deductible

A

Amount that an individual or family is responsible for paying before being eligible for insurance coverage

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14
Q

Out-of-pocket Cost

A

Cost of health care that is not covered by insurance and is responsibility of the insured
May be due to caps on insurance, deductibles, copayments, or balance billing

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15
Q

Premium

A

Price paid by purchaser for the insurance policy on a monthly or yearly basis

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16
Q

Portability

A

Ability to continue employer-based health insurance after leaving a job
usually pay full cost of insurance
Federal law COBRA ensures 18 months of portability

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17
Q

Medicare

A

Federal Government supported health insurance for people who are over 65, disabled, get social security or have end stage renal disease (kidney failure)
Coverage varies between 4 parts
Funding comes from taxes on people who work; 2.9%, 1.45% by employer, 1.45% by employee

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18
Q

Part A of Medicare

A

Automatically enrolled in at age 65
Get hospital care, follow up nursing, and hospice
No premiums or deductibles

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19
Q

Part B of Medicare

A

Voluntarily enrolled
Supplemental to part A
Get diagnostics, blood work, therapeutic care, MRIs
Have to pay premiums and copayments(medigap from private insurance will pay)

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20
Q

Part C of Medicare

A 
Combo plans-"medicare advantage plans"
Run by insurance companies
Functions like normal health insurance
They manage part A, 
Includes B and D for 1 premium
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21
Q

Part D of Medicare

A 
D for Drugs
Voluntary plan
Covers prescriptions
Have to have A and B to get D
Has premium and deductible
22
Q

Medicaid

A

Federal and State government supported health insurance
For “poor” <133% of federal poverty level ($24,862); disabled, children, and pregnant women
Funding comes from federal gov input-pay varying amount based on per capita state income; whatever state decides to pay federal will match it
Quite comprehensive coverage-nursing homes, prescriptions, preventive, inpatient and outpatient services, eyeglasses, transportation
SCHIP-medicaid supplement only for children, reimburses providers, helps prevention; 25 million children
Old people on medicaid spend 3X more than children
Providers will only serve a certain % of medicaid patients b/c little reimbursement

23
Q

Various Employment-Based Insurance

A

Classic fee-for-service
HMOs-uses capitation(paid fixed amount to provide services to an enrolled member regardless of services provided)
Preferred Provider Plans (PPOs)-insurance system decides to work with only a limited number of clinicians called preferred providers; providers agree to set of conditions that include reduced payments and more
Point of Service Plans (POSs)-patients in an HMO may choose to receive their care outside the system provided by the health plan; will pay more out-of-pocket
Mixed Models-combine plans

24
Q

Characteristics of Uninsured and Underinsured

A

Uninsured: healthy, young, choose not to purchase through employer; poor/ near-poor who don’t qualify for medicaid; self employed/small company employee that are paid well but still choose to not purchase insurance because premiums are higher than at big orgs
Underinsured: individuals and families who have obtained health insurance through employment at smaller firms that is often not comprehensive; individuals who purchase less comprehensive plans on their own

25
Q

Consequences of Being Uninsured and Underinsured

A

Less preventive care; diagnosed at later stages; receive less treatment once diagnosed; less likely to have regular source so use ER for routine; increased mortality rate (20,000 a year); large debt and bankruptcy leaving other patients to pay higher rates to make up for unpaid(1/4 bankrupt)

26
Q

Consequences of Being Uninsured and Underinsured

A

.

27
Q

Scoring Guidelines for HC Systems

A

Healthy Lives-life expectancy, infant mortality, HALEs at age 60, limitations in activities among adults over 65, missed school days by children due to illness or injury
Quality-preventive, curative, rehabilitative;control of chronic disease, availability of services (inc mental health) after hours and on urgent basis, hospital quality inc ration of observed to expected mortality, preventive measures in nursing homes
Access-availability of care using measures like insurance coverage including percentage of un/underinsured, as well as impact of cost of insurance
Efficiency-Inappropriate, wasteful, or fragmented care using such measures as: ER use for routine care, hospital addmissions for preventable conditions, short-term readmission rates, and costs of administration
Equity-disparities in health services and health outcomes by racial/minority status and income using measures like access to preventive and acute services, control of chronic diseases, insurance coverage, and measures of healthy lives

28
Q

Short-term Inpatient Facilities

A

Hospitals-stay until treatment no longer improves

  • staff and nursing 24 hours a day for ER
  • joint commission on accreditation of hc orgs (JCAHO); determines if meets standards
  • hospital governance; board, not healthcare providers, community members, provider representative
29
Q

Long-term Inpatient Facilities

A

Stay for 3 months or more
Not operated by HC facilities
Provision of care-provide acts of daily living (eating, bathing, dressing)
Skilled Nursing-must have nurse at your despair, receive as long as you’re improving
Rehab-in:intense physical therapy where you have to stay; out:normal physical therapy

30
Q

Nursing Homes

A

Long-term inpatient facility

  • not just for old people
  • some have to meet regulations set by states
  • medicare decreased amount paid for it, led to no doctors so patients received bad care
31
Q

Assisted-Living Facilities

A

Long-term inpatient Facility

  • retirement community
  • go when you or your partner start to need help
  • lets couples stay together
  • very expensive
32
Q

Home Heath Care and Hospice Care

A

Not Inpatient
HHC-need for longer time; respite care-care given to caregiver so they can take time off
H-end of life care, keeps you comfortable til you die

33
Q

Technology and Quality of Care

A

Rapid increase in areas with high financial compensation(heart surgery, hip replacement, mammograms) but not all can access b/c poor
Human genome mapping led to better understanding of diseases and new diagnostic/therapeutic approaches
Can use for evidence based stuff

34
Q

Medical Malpractice

A

State law-can differ between states
Civil law not criminal so decided by jury based upon preponderance of the evidence-more likely than not
Builds upon negligence law
MUST EST.-duty was owed(provider undertook treatment), duty was breached(provider didn’t reach standard), breach caused an injury(based on proximal cause, could be system or provider), damages occured(direct-lost earnings, medical expenses;indirect-pain/emotional distress;punitive-when conduct is intentionally harmful or grossly negligent)

35
Q

Disclosure of Medical Errors

A

Says patients must be informed of all outcomes including unanticipated, facts about event, presence of error or systems failure, expression of regret, a formal apology
Disclosure began in 2001
Deaths are slightly more common than breast cancer or car accidents
May be due to deficiencies in diagnostic or therapeutic process on part of clinician
System Error can be cause-problems in delivery of care

36
Q

History of Health Reform

A

Theodore Roosevelt- 1912; social security system
Great Depression-Wilber Commission; encouraged more universal plan-spread out among a group
Franklin Roosevelt-1935; “socialized medicine”, single payer system, everyone said no b/c of freedom
WWII-employer based began
Medicare/Medicaid-1965
Pres Nixon-1971, wanted employer mandated insurance-not accepted
Senator Ted Kennedy-1971, wanted single payer plan for everyone (no MM)-not accepted
Prepaid Health Plans-1973; HMOs, like a medical savings account
Managed Competition-Clinton, 1990s, universal coverage, insurance comps compete for customers; didn’t pass
President Obama-2010

37
Q

President Obama’s 8 Basic Principles

A
  1. Protect families’ financial health
  2. Make health coverage affordable
  3. Aim for universality
  4. Provide portability of coverage
  5. Guarantee choice
  6. Invest in prevention and wellness
  7. Improve patient safety and quality of care
  8. Maintain long-term fiscal sustainability
38
Q

Protect Families’ Financial Health

A

Exchanges-market place of insurance
A-competitive market for purchase of health insurance to keep prices low
B-essential benefits-every ins package has to have; ex:vaccines, having a physical each year
C-levels of coverage; increasing level increases cost and amount covered (bronze 60%, silver 70%, gold 80%, platinum 90%)
D-out-of-pocket expenses and caps-placing a max amount on how much anyone can pay each year, higher plans have higher caps; no more lifetime caps, can have yearly cap
E-no one can be denied for a preexisting condition; can get kicked off for fraud

39
Q

Subsidies

A

Government will help pay for part of insurance if income is 133%-400%
Medicaid expanded to all under 133%
Gov only covers for certain % of what you’d pay for silver

40
Q

Catastrophic Plans

A

If under 30 yrs of age have a plan for only catastrophic issues
Has very high deductible; $10,000 or more
Can have this instead of exchange

41
Q

Make Health Coverage Affordable

A

Act will not decrease money spent by gov on HC but trying to decrease for individuals
A-costs of HC-reduce fraud and abuse
B-administrative costs-make more efficient, limits on costs, maxs spent on paperwork and employees, will make plans cheaper b/c comp is spending less, if go over limit get fined/shut down, applies to gov too, ,
C-Consumer Operated and Oriented Plans (CO-OPs)-states can create their own co-op and offer ins through gov not companies, must be approved
D-taxation-Cadillac Tax-2018 40% tax to employer for offering platinum, taxes help pay for subsidies

42
Q

Aim for Universality

A

A-eligibility-must be legally present in the US to get any insurance; leaves 25-30 million uninsured
B-individual mandates-everyone must be covered; starting in 2016 those not covered get fined $2,000-$2500
C-employer offered health insurance-no employer mandate, but get tax penalty if over 50 employees and no insurance; offering must be affordable (silver)
D-increased eligibility for Medicaid-some states opt out but need their own plan

43
Q

Provide Portability of Coverage

A

Can leave work but in 30 days have to buy an exchange until you find a new job

44
Q

Guarantee Choice

A

Choice of exchange, company, health clinic
A-community health centers-increase in fed funding
B-national health service corps-increase funding
C-new funding for medicare and medicaid
D-increase in medicaid funding-to cover primary care, pay providers more

45
Q

Invest in Prevention and Wellness

A

A-preventive services-medicare gives annual physical now instead of just one at 65, all recc vacc are covered (determined by congress task force)
B-medicare and medicaid-medicaid paying for more services
C-employer offerings to employees-2015 employers can offer employees up to 50% savings for good health behaviors
D-loan repayment programs-2017-funding for loan repayment if PH grad serves underserved for 3 years
E-health form legislation-restaurant chains if over 5 must show all nutritional info on menu, employers must offer stuff for nursing mothers

46
Q

Improve Patient Safety and Quality Care

A

A-innovation center-center looks at diff ways to deliver HC and reduce costs and errors;look at payments, hospital reimbursed for episode of care;pilot program-docs working together to converse about single patient
B-medical malpractice-reduce errors from 30% to 10%, docs order too many tests; crazy expensive docs insurance
C-health information technology-nothing specific stated about medical records standard; electronic good but too many systems

47
Q

Maintain Long-tern Fiscal Sustainability

A

A-reduce costs-reduce medicare payments to physicians, pay less but get more patients to make up, increase medicare expenditure, justification of increasing insurance costs by comps
B-increasing revenue-new money coming in from penalties (employers not offering silver, individual mandate), taxes-if make S$200,000 or J$250,000 a year (includes unearned income, and ins costs by employer) new taxes, amts won’t be changed w/ inflation

48
Q

Strategies to Reform the Health Insurance System

A

Eliminate restrictions on health insurance
Require individuals to purchase health insurance
Develop exchanges
Develop essential benefit packages
Limit overall costs of health insurance to individuals and families

49
Q

Insurance Reform’s Effect on People Under 30

A 
SCHIP more money-children
18-26 year olds can stay on parents plan
Under 30 can buy catastrophic plan
Medicaid being expanded
Exchanges and subsidies
50
Q

Insurance Reform’s Effect on People Over 60

A

More money for medicare
Over 60 can get charged 3X more than young for insurance
Smokers charged 1.5X more
if smoke and old get charged 4.5X more
New medicare tax-S$200,000 and J$250,000 pay an extra .9% (3.8% total) on income tax but only pay on amount over $200/250,000

HLED 210 (1 decks)

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