Study guide for the final part 4 Flashcards

1
Q

What are the American beliefs in regards to the concepts of health and healthcare?

A

Biomedical model focused

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2
Q

What are Americans’ beliefs and values and implications?

A

Strong belief in the advancement of science
A champion of capitalism
Entrepreneurial spirit and self determination
Principles of free enterprise and distrust of the gov’t

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3
Q

Principles of market justice

A

Health care: economic good
Free market conditions assumed
Markets’ efficiency assumed in equitable allocation of health resources
Production and distribution determined by market-based demand
Distribution based on ppl’s ability to pay
HC viewed as an economic reward of personal efforts and achievement
Ppl know what is best for them given information
Works best with minimum interference from gov’t

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4
Q

Principles of social justice

A

Health care: social resource
Requires active gov’t involvement
Assumes that gov’t is more efficient in allocating health resources equitably
Medical resources allocation determined by central planning
Ability to pay is inconsequential for receiving medical care
Equal access to medical care viewed as a basic right

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5
Q

Implications of market justice

A

Individual responsibility for health
Benefits based on individual purchasing power
Limited obligation to the collective good
Emphasis on individual wellbeing
Private solutions to social problems
Rationing based on ability to pay: demand-side rationing or price rationing

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6
Q

Implications of social justice

A

Collective responsibility for health
Everyone entitled to a basic package of benefits
Strong obligation to the collective good
Community wellbeing supersedes that of the individual
Public solutions to social problems
Planned rationing of health care: supply-side rationing

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7
Q

Limitations of market justice

A

Principles fail to rectify critical human concerns
Does not always protect society
Market justice does not work well in health care delivery

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8
Q

Why does market justice fail to rectify critical human concerns?

A

Health care related to human productivity and achievement, and basic human dignity

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9
Q

Why does market justice not always protect society?

A

Ill health is not always confined to an individual

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10
Q

Why does market justice not always work well in HC delivery?

A

Economic prosperity did not reduce the number of uninsured

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11
Q

What is the role of federalism and PH?

A

The Constitution
-Promote and provide for the general welfare
-Regulate international affairs and interstate commerce
“Health” is not found in the US Constitution
Federal gov’t involved in health matters through the states
Initial duties limited to preventing the importation of epidemics and assisting states and localities with episodic communicable dz

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12
Q

Describe the shifts in relative roles of gov’ts

A

Major roles of local gov’ts before 1875
States’ extensive involvement after 1875
Expanded federal gov’t’s role since the Great Depression (Social Security, Medicare, Medicaid)
New Federalism during the 1980s: decreased federal influence
Expansion of the federal gov’t’s role in the 21st century in response to new PH threats

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13
Q

What are the major levels of governmental public health?

A

National: federal health agencies such as DHHS and its components
Tribal: Indian Health Service
State: state health agencies such as HDs and human service agencies
Local: local PH agencies, often called local health departments

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14
Q

What range of activities do federal health agencies address?

A

Include, but not limited to:
-Research
-Training
-Primary care
-Health protection

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15
Q

What are the key public health service agencies?

A

Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
Centers for Dz Control and Prevention (CDC)
National Institutes of Health (NIH)
Food and Drug Administration (FDA)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Agency for Toxic Substance and Dz Registry (ATSDR)
Agency for Healthcare Research and Quality (AHRQ)

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16
Q

Describe characteristics of specialization in medicine

A

It’s a hallmark in American medicine
58:42 specialist to generalist ratio
Also specialized fields in allied health professions

17
Q

What is a consequence of preoccupation with specialization?

A

Lack of a rational coordination of medical care

18
Q

Describe the gatekeeping model of HMOs

A

Has been occurring since early 1900s
Initial contact with GP required for a referral to a specialist

19
Q

What were the 3 main developments that pushed insurance to become employer-based?

A

Wage freezes during WWII
1948 Supreme Court decision
1954 tax ruling

20
Q

What occurred during the wage freezes during WWII in terms of health insurance?

A

Employers were offering health insurance in lieu of wage increases

21
Q

What was the 1948 Supreme Court decision relating to health insurance?

A

Legitimized health insurance as a negotiable item in union-management bargaining

22
Q

What was the 1954 tax ruling in relation to health insurance?

A

Employer contributions for health insurance became exempt from taxable income for employees

23
Q

What are the types of generalist physicians, what do they do, and what types of pts do they see?

A

PCPs
Trained in family medicine or general practice, general internal med, and pediatrics
Provide preventative medicine
Pts with problems that are less severe and occur frequently

24
Q

Training of specialist physicians

A

Must seek certification in a medical specialization
Takes more yrs of advanced training plus yrs of practice

25
Q

Aspects of primary care

A

The first contact to the HC system
“Gate-keepers” in managed care
Longitudinal: f/u in tx and coordinate care; serve as pt advisors and advocates
Focuses on the whole person
Trained in ambulatory care settings

26
Q

Aspects of specialty care

A

Sees pt after a general practitioner
Requires referral from a PCP to see a pt
Episodic, more focused and intense cases
Deals with specific dzs or body organs
Trained in inpt hospitals, using state-of-the-art tech

27
Q

How is there an imbalance in physician supply?

A

More PCPs needed in the future
Shrinking PCPs: older or near retirement PCPs, fewer med students choosing primary care