The Powerpoint Flashcards
What is the purpose of the country’s healthcare system?
A country’s health care system is organized to provide the diagnosis and treatment of individuals health problems
What is health?
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
How do DO’s embrace “health” more consistently than other healthcare professionals?
whole person approach, they help pt’s develop attitudes and lifestyles that don’t just fight illness but also prevent disease.
How can the environment influence health?
Can provide exposure to toxins and unsafe
conditions, including due to employment
How can the social environment influence health?
Those with a lower socioeconomic status have
more health risks
What is the #1 cause of death in 2007?
Cardiovascular disease
What is the goal of healthcare?
restore
health or prevent exacerbation of health
problems
What is primary prevention?
Eliminate risk factors for a disease
What are some examples of primary prevention?
– use automobile seat belts – use condoms – protect from ultraviolet light – tobacco cessation programs – dietary modifications
What is secondary prevention?
Early detection of disease so treatment is more
effective
What is tertiary prevention?
Focuses on treatment of identified disease to
reduce the incidence of later complications
Which 2 prevention systems does healthcare focus on?
Secondary and tertiary
What is system management?
Each component of a health care system must
be managed
What are some elements in management?
– Administration
– Planning
– Regulation
– Evaluation
In what ways can healthcare systems be judged as successful?
– the quality of the health care provided
– the equity achieved in the provision of health care
– the efficiency with which health care is provided
Has the # of healthcare workers in the US increased or decreased?
Increased from 15.5 million in 2009 from 12.2 million in 2000
What type of care do most people need most of the time for health and illness?
Primary care
What types of components does primary care involve?
immunization, prenatal care, periodic health
examination for early disease prevention, treatment for
illness
What is secondary care?
– services are available in physicians’ offices and
hospitals
– Includes most surgical procedures, diagnostic, and
treatment interventions of specialists
What are some examples of secondary care physicians?
radiologists, cardiologists,
ophthalmologists
What is tertiary care?
highly specialized diagnostic, therapeutic and
rehabilitative services that require staff and
equipment beyond what an average community
hospital has available
What are some examples of tertiary care services?
open heart surgery, organ
transplantation, complex chemo-therapy and radiotherapy
for cancer, preservation of very low birthweight
premature infants
What are the most numerous inpatient care facilities?
Acute care community hospitals
Has the # of hospitals increased or decreased from 2000-2008?
Increased from 4915 to 5010
Has the # of beds in hospitals increased or decreased from 2000-2008?
Decreased from 823,560 to 809,069 (typically cuz better care has been administered)
What are the 4 ways of categorizing hospitals?
– by control
– size
– function
– average length of patient stay
What are 4 functional categories of hospitals (by like what they do)?
- general
- special
- rehabilitation and chronic disease
- psychiatric
What are 4 categories of hospitals by control of ownership?
– government federal
– private, not-for-profit
– private, for-profit
– government nonfederal
What are community hospitals?
Community hospitals are all nonfederal, shortterm
general, and special hospitals whose
facilities and services are available to the public
What are some examples of special hospitals?
obstetrics and
gynecology; eye, ear, nose and throat;
rehabilitation; orthopedic
What defines short vs long term stay hospitals?
Whether is it > or < 30 days
How is average stay length calculated?**
Dividing the # of inpatient days by the # of admissions
What accounts for the largest portion of healthcare spending in 2008?
Hospitals (38%)
Which agency counts and classifies hospitals?
American Hospital Association (AHA)
Are most hospitals federal or nonfederal?
Nonfederal (96%)
Are most nonfederal hospitals community or specialty?
Community (86%)
Are most community hospitals for profit or not for profit?
Not for profit (80%)
Why are the # of hospital beds shrinking?
– higher fixed costs in staff, facilities, and equipment
that adversely affect smaller hospitals
– the increasing difficulty in hiring and retaining
appropriate staff in rural hospitals
– the increasing economies of scale for larger and larger
hospitals as the availability of expensive technology
increases
– when a hospital performs a procedure more
frequently, the quality of each one goes up
What are the main fxns of hospital administration?
– Finance – Personnel – Provision of services (maintenance, housekeeping, laundry, and dietary) – Community/public relations – Development (fundraising)
What is the hospital medical division?
The physicians (which have their own respective specialties)
What is the fxn of the executive committee?
provides overall coordination and sets
general policy
What is the fxn of the Joint conference committee?
serves as liaison between the
medical staff and the hospital’s governing board
What is the fxn of the credentials committee?
reviews applications to join the
medical staff and controls the periodic reappointment process
What is the fxn of the Infections control committee?
is responsible to prevent
infections and monitors and corrects any outbreaks that do
occur
What is the fxn of the Pharmacy and therapeutics committee?
reviews
pharmaceutical agents for inclusion in the list of drugs
approved for use in the hospital
What is happening to complementary and alternative medicine trends in hospitals?
It’s growing
What are some examples of complementary and alternative therapies?
acupuncture, massage therapy, guided imagery for
stress reduction, pet therapy, and music/art
therapy
What are some examples of for-profit enterprises?
Pharmaceutical companies, commercial health insurance companies, nursing homes, some hospitals
What is the administration like in not-for-profit hospitals?
• has a board of trustees, usually prominent
persons who give or raise a substantial amount of
money for the hospital or represent an important
community institution
• The person with the title President of the hospital
can either be the leader of the board of trustees
or the paid chief executive officer (CEO)
• If the CEO has the title of President, then the top
operations person is usually called the executive
director or executive vice-president
How can a hospital remain as a not-for-profit status?
Excess profit is distributed back to investors or to community health. Not for its own profit. lol
What % of nursing homes are for-profit?
66%
Where does more than 1/2 of the nursing home financial support come from?
Public funds (medicaid, medicare, etc.)
Why do some patients end up getting medicaid when they are in the nursing home when they didn’t have it before coming in?
Institutional care is very expensive.
How can we bypass nursing homes because they are so expensive?
improved home care services and
improved health promotion, disease prevention, and
self-care programs for the growing U.S. elderly
population
What is a managed care organization (MCO)?
• Traditionally, the patient contracted directly
with the provider of care and a third-party
provided payment
• With managed care, the patient contracts with
the MCO for the provision of care, and the
MCO is paid for the provision of that care,
often by the patient’s employer
• The MCO determines what care the patient is
entitled to and under what circumstances
What is outpatient/ambulatory care?
care given to a person
who is not a bed patient in a health care
institution (most physician-pt contacts)
How many ambulatory visits were there in 2008?
1.2 billion, which is up from 1 billion in 2000
Where do most ambulatory medical care visits take place?
Doctors offices (48%)
How many ambulatory care visits per person was made in 2008?
Americans averaged 4.05 physician visits per person
Who made the most primary care visits, men or women?
Women made up 58.2% of all physician office visits
What is the main reason why men seeked ambulatory care?
Injury
What are the main forms of payment for ambulatory care visits?
– Private insurance (59%) – Medicare (21%) – State Children’s Health Insurance Program (SCHIP) or Medicaid (15%) – Self-pay and other sources (6%)
What are the fxns of the Emergency Department?
• provide care to critically ill and injured patients (true
emergencies)
• serve as a secondary, well-equipped private physician’s
office with more sophisticated resources
• a source of patient admissions to the hospital
• provide care to persons who are not injured or critically
ill but cannot reach their private physician, regular
clinic, or HMO, are geographically out-of-region, or
have no insurance coverage and nowhere else to go
when sick
What are the 3 categories of patients that present to ED’s?
nonurgent (shouldnt be at a ED), urgent (needs care within a few hrs), and emergent (yup, be at an ED).
Did insured or noninsured patients visit ED’s more?
Noninsured (41.6/100 people rather than 19.9/100 insured people)
What are some examples of public health agency clinics?
– tuberculosis control – child health (immunizations and examinations) – prenatal care – sexually transmitted disease control – mental health problems
What % of the US workforce in 2009 was in healthcare?
11.1%
What is the physician/population ratio?
27.7/10,000
What are the functions of a primary care physician?
Primary care is the provision of integrated,
accessible health care services by clinicians who
are accountable for addressing a large majority of
personal health needs, developing a sustained
partnership with patients, and practicing in the
context of family and community.
What are some primary care physician specialties?
Physicians that practice family medicine, internal
medicine, pediatric medicine, geriatric medicine,
and obstetrics/gynecology are generally
considered primary care physicians.
Why are PCP’s called the “gatekeeper’s?”
They are the ones who are usually seen first for illness and are the ones who make referrals for specialized care.
What are physician assistants (PA’s)?
PAs conduct physician exams, diagnose and
treat illnesses, order and interpret tests,
counsel on preventive health care, assist in
surgery, and can write prescriptions
Though the government is less involved with healthcare than any other industrialized country in the world, what populations does it serve?
The government provides health care to
populations not profitable to care for or are
otherwise difficult: sick poor, mentally ill,
Native Americans living on reservations, short
and long term care for the elderly, and
infectious disease control
Where does the federal government’s authority concerning healthcare services come from?
– the powers to tax and spend to provide for the
general welfare
– the ability to regulate interstate and foreign
commerce
How does the legislative branch of the government influence healthcare?
legislative branch, Congress (Senate &
House of Representatives), enacts laws to
protect people’s health (e.g. laws about clean
water or workers health) and to effect the
framework for the delivery of health care
How does the executive branch of the government influence healthcare?
The executive branch writes regulations for
administering legislation
How does the judiciary branch of the government influence healthcare?
The judicial branch (courts) determines if
legislation is constitutional and if regulations
exceed the original statutes
What is the goal of the U.S. Department of Health and Human Services (DHHS, part of the executive branch of the government)?
The mission of the DHHS is to protect and promote the
health, social and economic well-being of all Americans
and in particular those least able to help themselves -
children, the elderly, persons with disabilities, and the
disadvantaged - by helping them and their families
develop and maintain healthy, productive, and
independent lives.
What is the goal of the FDA?
The Food and Drug Administration (FDA) protects
the public against food, drug, and medical device
and product hazards and ensures drug potency
and effectiveness
What are the goals of the CDC?
– preventing and controlling disease and personal injury
– directing foreign and interstate quarantine operations
– developing programs for health education and health
promotion
– improving the performance of clinical laboratories
– developing the standards necessary to ensure safe
and healthful working conditions for all working
people
The Indian Health Service (IHS) provides care for native americans and alaska natives who are where?
Who live ON or NEAR indian reservations
Who is eligible for VA services?
A veteran is anyone who has served 90 days or
more in an armed service and who received an
honorable or general discharge. There are
complex rules for eligibility for many classes of
veterans
Who is eligible for services from DOD hospitals and clinics?
members of the armed forces, their
dependents, surviving dependents of service
people killed while on duty, and military
retirees and their dependents in DOD facilities
and by civilian providers
What is the main insurance for the military?
Tricare
What 2 things are types of therapeutics?
equipment and pharmaceuticals
What % of the total national health expenditures was on therapeutics?
12.8%
What are National Health Expenditures (NHE)?
– health consumption expenditures
– investment in health care structures and
equipment
– noncommercial health care research to procure
future health care expenditures
In 2009, how much $ was spent on healthcare? How much of this is part of the GDP?
In 2009, $2,486 trillion was spent on health
care
– This was 17.6% of the gross domestic product
In 2009, the US rate of health expenditures was 46% higher than which next highest country?
Netherlands
What accounts for the majority of NHE’s?
The increase in expenditures is due in part to the
increasing use of expensive technology-based diagnostic
and procedural interventions, particularly at the
beginning and end of life
What are the sources of the NHE?
– 12% of the NHE were paid out-of-pocket
– 32.2% by private insurance
– 38.9% by public insurance
– 7.5% by other programs and third-party payers
– 3.1% were public health activities
– 6.3% investment in research, structures, and
equipment
What are out-of-pocket expenditures?
– direct payments to providers for noninsured
services
– extra payments to providers of insurance-covered
or managed-care-covered services that bill at an
amount higher than the insurance/managed care
company pays for the service
– deductibles
– coinsurance
What is a deductible?
a flat amount that an individual or
family must pay out-of-pocket before the
insurance company will begin paying during some
set time period (usually a calendar year)
What is coinsurance/co-pay?
a share of each
service that the patient is to pay. It may be a
percentage, for example it may be 20%
What are third-party payers?
All responsible for paying for health care other
than the patient and the patient’s family and
the health care provider are termed “thirdparty
payers”
What are some examples of third-party payers?
the patient’s or family member’s employer; private insurance or managed-care organization; charity organizations; Workers Compensation; and federal, state, and local governments
Has the rates of private health insurance from 1990-2011 increased or decreased?
decreased from 73% to 64%
When was medicare established by congress?
1965
What is medicare part A?
hospital insurance (covers limited skilled nursing care also)
What is medicare part B?
covers
physician and some other health professional services,
hospital outpatient care, and some other services
What is medicare part C?
permits Medicare
beneficiaries to enroll in managed care organizations
What is medicare part D?
designed to lower the cost of
prescriptions for Medicare beneficiaries
In what ways are each parts of medicare funded?
– Part A is funded primarily from Social Security taxes
– two-third of Part B is funded from general revenues
with the balance from enrollee premium payments
– Part D is funded through premiums
What is the RBRVS system of medicare payment for physicians?
payments for services are
determined by the resource costs needed to
provide them
How is the cost of providing services determined?
– physician work
– practice expense
– professional liability insurance
How are hospitals reimbursed from medicare?
Hospitals are reimbursed on an episode-ofcare
basis, the amount of payment for each
case determined by a formula based on a
fiscal construct called the Diagnosis Related
Group (DRG), one form of the prospective
payment system (PPS)
In 2009, 46 million enrollees racked up how much $ in medicare expenditures?
$502 billion
What is medicaid?
Medicaid is a needs based program that provides
coverage for some health services for some of the
poor on a “means-tested” basis (income based)
How does a person get medicaid?
A person must apply for Medicaid to receive it
and only those persons with incomes and other
assets below a certain level specified by law are
eligible for coverage
How are providers reimbursed for medicaid?
Providers are generally reimbursed on a feefor-
service/episode-of-care basis like
Medicare. (it’s basically the same as medicare, but for poor people)
How much of the medicaid expenditures were for the elderly?
25% (remember, those nursing homes are really expensive!)
How much of the medicaid expenditures were for the disabled?
42%
What is the State Children’s Health Insurance Program (SCHIP)?
SCHIP provides health coverage
for uninsured children who are not eligible for
Medicaid
Who regulates each SCHIP programs?
the state
What are some examples of non-governmental organizations (NGOs)?
– American Heart Association
– The Red Cross
– The Visiting Nurse Association
What are some of the services of NGO’s?
– perform services not rendered by other health care
agencies
– pursue research or service objectives
– work to advance the interests of a population subgroup
– engage in public and political education and advocacy
– carry out certain tasks when asked by government
agencies
What are some examples of professional organizations?
– American Osteopathic Association (AOA)
– Pennsylvania Osteopathic Medical Association
(POMA)
How are healthcare systems generally evaluated?
– quality of health care
– equity of heath care
– efficiency of health care
How are some of the structures to which quality is measure for healthcare system performance?
Structure encompasses the conditions under which
the care is provided (facilities, equipment, human
resources, non-profit status, academic affiliation,
governing structure)
How are some of the processes to which quality is measure for healthcare system performance?
Process encompasses the activities that constitute health care (includes diagnosis, treatment, rehabilitation, prevention, and patient education)
How are some of the outcomes to which quality is measure for healthcare system performance?
Outcomes are changes, desirable and not desirable, in
individuals and populations that can be attributed to
health care
Has life expectancy increased or decreased from 1990-2011?
Increased (75.4 to 78.7 for every1)
How high is the US ranked for life expectancy in the world?
In 2004, U.S. ranked 10th in life expectancy at birth for
males and 12th in life expectancy at birth for females
How high is the US ranked for infant mortality rate in the world?
In 2004, U.S. infant mortality rate was the HIGHEST OMG
In 2006, how many people DID NOT have health insurance?
41.6 million
What does the Affordable Care Act (PPACA) do about insurers denying coverage?
Prevents health insurers from denying coverage to
people for any reason, including health status,
charging higher premiums based on health status
and gender, and imposing a lifetime limit on
insurance coverage
How old can a child be covered under the affordable care act?
26
When do most individuals required to have health insurance under the PPACA?
2014
How does the PPACA expand medicaid coverage?
Expands Medicaid coverage to 138% of the federal
poverty level ($15,415 for an individual and $31,809
for a family of four in 2012) for individuals under age
65 to insure more low income people
How does the PPACA close the donut hole of medicare part D?
coverage gap when enrollees
hit a specified amount of spending and until a larger
specified amount is reached
omelette
du fromage
