U.S healthcare exam 3 Flashcards
for Germany
- what is mandatory
- is the health insurance public or private
- does the government mandate insurance, does employment provide it
how much does each employee get?
Mandatory sickness funds
Predominantly private
Government-mandated, employment-based private insurance
7.3% is employer responsibility; 7.3% withheld from pay; equals 14.6% for each employee
2009-government run health fund distributes health funds based on risk adjustment
Not allowed to exclude, or raise rates according to age or medical condition- which would be experiential rating
Remain in fund if ill, retired, lose job
Higher income can select private insurance
Germany
what kinds of appointments are common
how can you see a specialist?
how many generalists are there
what is there little coordination between
the patient receives no bill for what
Appointments with Primary Care is common
Allowed to make appointments with specialists without a referral
Over 40% of physicians are generalists
Little coordination between hospitalists and generalists
Appointments, labs, prescriptions, hospitalization=No bill to the patient
Germany
who. does a primary physician bill
how often are physicians reviewed?
how often are hospitalists billed
Primary physician Bills regional Association of Physicians
1986- began to cap spending- Rationing
Physicians are reviewed quarterly, with each quarter affecting the following quarter
Hospitalists are billed upon Episode- Based funding or Bundle payment
Germany cost control
what are the parts of concerted action?
what does it control
despite the best healthcare effort, what still continues to rise
Concerted Action
- Guideline Fees
- Hospital Rates
- Pharmaceuticals
Controls physician fees, capping physician fees
Throughout time still Germany has Gross Domestic Product (GDP) that has been rising since 1990
Canada
to get health insurance what must you show
for the Hospital Insurance Act who is and who is not covered
when was universal medical insurance made available
how is health care system financed
is it attached to employment
how does everyone contribute to health care
who gets no bill
what does private insurance allow for
Health insurance: show provincial government card
Hospital Insurance Act: Hospital coverage but no MD coverage
Universal medical insurance 1966
Tax financed, public, single-payer health care system
Funded with provincial and federal tax revenues
Not attached to employment at all
Everyone contributes through taxes-everyone benefits
No bill if part of provincial health service
Private insurance allowed for gaps: some pharmaceutical coverage or private hospital rooms
Canada
who refers to a specialist?
what happens to specialists who receive a referral
what is waiting like for elective procedures
what happens per capita
what still remains despite everyone being covered
Family physician referral to specialist
Specialists get paid best if referred
Longer waiting for elective procedures
Less services per capita than US for example: MRIs and surgery
Despite everyone being covered, inequities still happen
Canada
who does physician bill
how are they paid in full
who can the physician not bill and what must they agree with
what kinds of methods are used
what is the rate of the hospital services and hwy
what di hospitals not need to do
Physician bills provincial government
Paid in full according to fee schedule
Physicians must agree with payment, cannot bill patient
methods:
- Blended models
- Fee-for-service
- Capitation
Hospital services slow - not enough money to pay extra
Hospitals do not need to prepare itemized bills
Approval process for capital projects of hospitals
Regulation of pharmaceutical prices
what is the difference between Canada vs. US
Canada vs. US
Less administrative costs
Less expensive high tech costs
Lower pharmaceutical prices
Caps on payment (Similar to Germany)
Changes in 2010 due to lack of confidence
UK
what entitles you to healthcare
what is the NHS
what can compete with NHS
how many buy health insurance
who can pay for private hospitals
Being on the “soil” entitled to receive tax supported medical care through NHS –National Health Service
Private health insurance can compete with NHS
11% buy private health insurance
Private insurance can pay for care of private hospitals not NHS facilities
Britain
what do you need to see a specialist
what must you have
what does your GP act as
where are the GPs
how is home health care
NHS – need referral to specialist
Must have general practitioner
GP is primary care, local hospital is secondary care, regional/national hospitals is tertiary care
GPs not in hospitals, but with social services
Home care is highly developed in UK, doctors home visits
UK
what does home health care warrant
how does a doctor see their patient
what do consultants equal
what is awarded
Capitation for MD & Preventive care fee for service
Home visits, nights and weekends, fee for service
Consultants = Specialists
Quality is awarded
UK
what is lengthened
what is limited
what are there fewer of
how do they view technology?
Queues lengthened
Capitation and salary for physicians
Limited consultant slots- controls supply of personnel and facilities
Fewer surgeons
Fewer meds
Fewer x-rays
More skeptical of new technology than US
Japan
what must large companies provide
what health insurance do smaller companies have
what health insurance do self employed and retirees have
what health insurance do government workers have
what do they all have
what is the insurance a mix of
Large companies- required to operate self-insured plan for employees and dependents
Smaller companies-single national health insurance plan
Self-employed workers and Retirees- National Health Insurance or Citizen’s Health Insurance
Government workers- society managed insurance
All have standard comprehensive coverage
Mix of employment-based insurance, social insurance, universal insurance
Japan
are there pre-authorizations
are there restrictions
are there more hospitalizations
is there more surgery
how long are their hospital stays
No pre-authorizations
No restrictions
Less hospitalizations
Less surgery
Longer hospital stays
Japan
what is the basis
how are hospitals paid in 2003
what does government strictly regulate
what volume do physicians see their patients
what is the average amount of physician visits
who many times have physicians see their patients
what can physicians do for meds
what do patients also see physicians for
Fee-for service was the basis
2003 hospitals paid per diagnosis, physicians still paid fee-for-service
Government strictly regulates physician fees, hospital payments, medication pricing, number of expensive services
Physicians have high volume of seeing patients
Average physician visits: 13 per capita in Japan versus 4 per capita in US
Physicians may see 60 patients in a day
Physicians can dispense medications and profit from medications dispensed
Some patients see physicians just for refills
Japan
how is the GDP looking
what does health care system rely on
what is problematic for this structure
are the elderly decreasing and at what rate
how about for the U.S how is the elderly pop. looking
how are costs contained
GDP increasing 7.7% in 2000 to 10.3% in 2012
Healthcare system relies greatly on employer taxes
Low birth rate and longer life expectancy is problematic for this structure
Japan estimated 65 and older population is projected to increase from 12% 1990 to 39% in 2050
US 65 and older population also growing but not as quickly from 13% in 1990 to 21% in 2050
Costs are contained with strict fee schedules but may not be able to sustain
with older facilities and potential underfunding of the healthcare system
Benefit Package:
the additional perks and benefits a company provides to its employees in addition to the employee’s base wage or salary
Patient Cost Sharing:
The share of costs covered by your insurance that you pay out of your own pocket.
Effects on existing health care coverage
Cost Containment:
a process of judiciously reducing costs in a business or limiting them to a constant level
Reform Health Care Delivery:
a process of change involving the what, who, and how of health sector action
which label is best for patients and why
second one is better for reading and understanding
Spacing, information being available, name is easily found, directions is higher up
what do patients like and don’t like
like:
color, bolding, large font
white space
what drug is for
The most important info on top
name of medicine
prescriber name
don’t like
info for pharmacists
confusing dates
addresses
clutter
unclear directions (twice daily)
all capital letters
Health Literacy
Word Choice
What info they can use to understand their own health
Things related to them to help them decide their health
Numeracy is saying, I’m going away and how much do I need, when is my next refill
Take medicine is different than. Give, give for giving to child so parent should not take It
Take once in morning and at night is different than Twice a day so that the first one is better
Can be very important
Can be difficult for people to understand
Health Literacy and Numeracy
From 2013
Majority of people are below the proficient level of understanding their health and health brochures
Try to get convo. To 5th grade level, fewer syllables is better
Break things down for folks
Patient Literacy Assessment Tools
Zone in one this
Use to assess someone’s ability to understand material
Look at these tests
How many grams of total carbs are in ½ cups: 13g
Have to teach people these things cause not everyone can do these word problems
Things to know to counsel patient
Health literacy tools
make sure student can say these words and you will see how literate they are based on the words they say
Is kidney more associated to urine or fever?
Health Literacy Readability Assessment Tools
SMOG (“Simple Measure of Gobbledygook”) Readability Test
Fry Readability Test
Flesch-Kincaid Grade Level Readability Formula
SAM (Suitability Assessment of Materials)
SMOG Conversion Chart
For looking at a booklet
Take 30 sentences and see how many words have 3 or syllables
Put hand on chin, every time your jaw drops then it is a syllable
Fry Graph
what does it show you
how does it do it
what do you want on in a pamphlet
more syllables equals what
what do we want for sentences
Average # of sentences and average # of syllables per 100 words
Section 100 words and how many sentences are made for 100 words
Least amount of sentences
More syllables = more difficult for person to read
Want short sentences and fewer syllables
how to do Flesch-Kinaid assessment
word
file
options
show readability stats
Making a Difference
how can you fix the label
where do we need to improve labeling
Label is not easy to see
Patient centered labelling
We need to improve labelling of OTC
Health Literacy and drug coverage
what do people not tend to understand
can a lot of people figure out cost of hospitalization
what must we make sure a patient knows
what can “take 1 tablet every day” mean
when is the best time to take statin
what must pharmacists be in order for there to be better outcomes
Rx label instructions
Ppl did not understand their health insurance
Only 11% of people could figure out the cost of hospitalization
Make sure that we know if the patient understands the med
Take 1 tablet every day- can take it anytime
Best time to take statin - at night time because cholesterol is made at night so you take at night to reduce how much is made in the body
Tell them when to take it
Be more specific for better outcomes
Based on Rx directions, effects health outcomes
Four Major Actors in Conflicts, Change, Tensions, and Challenges
who are they
how do they relate to each other
Purchasers supply the funds
Insurers receive the funds, pay providers
Providers provide the care, all health care providers
Suppliers provide the treatments and supplies to providers
who makes up the healthcare industry
what was this like in the past
what is it like now and is there a discrepancy
Insurers, providers, and suppliers make up the healthcare industry.
Previously:
- Gain for health industry Thought of as an investment in economics of the nation
Now:
- Too much to pay, purchasers want to reduce the amount spent while health care wants the number to increase
Provider-Insurance Pact 1945-1970
who formed the alliance of insurers and providers and was their competition
who decided on payment provisions of medicare & medicare
who had the upper hand in negotiating generous payments
who paid without much question
who paid for insurance and recieved tax benefits
were there complaints
what was growing and was profitable
who is able to pay for benefits
who was charged for new facilities and construction?
who is benefitting
Alliance of insurers and providers
Many independent hospitals
Lack of competition
Hospitals and insurers decided payment provisions of Medicare and Medicaid
Providers had the “upper hand” in negotiating generous payments
Insurers paid without much question
Employers paying for insurance and receiving tax benefits; no real complaints of increased costs
Businesses growing and profitable
Able to pay for benefits
Hospitals even charged for facilities and new construction
who benefits: purchasers, insurers, providers, suppliers
Perception of 1970s
what decreases
what does this result in
what becomes a rising concern in healthcare
what is the result
when does regulation begin
what is the result
who begins utilization reviews
who benefits
US share of world industrial production decreasing from 60% in 1950 to 30% in 1980
- Lower profits
- Purchase cash flow decreased
- Inflation and unemployment on the rise
New economic reality of less money for individuals and companies, becomes increased concern for the rising costs of health care
- Hospitals being regulated for new construction
- Government begins health planning agencies
Regulation begins after Blue Cross increase of premiums 25% to 50% in a single year
Utilization reviews begin by insurers
- Provider-insurer tensions rise
- Insurance-provider pact unravels-Blue Cross separates from the AHA
insurers benefits
purchasers and suppliers do not benefit
providers benefit only half way
Coverage Landscape Changes-1990’s
what does the plan become specific to
what do employers shop around for
what do providers lose and why
what power do purchasers have and what was the result
who benefts
Plan become very specific as to where and from whom care can be provided and covered
Employers shop around more for insurers
Providers would lose contracts due to poor rates and unwillingness of insurers to negotiate
Purchasers had some negotiating power with HMOs and saw a drop in premium growth in the earlier 1990’s
providers do not benefit
purchasers benefit
insurers benefit only 50%
suppliers remain steady
1980’s Purchasers Pay Attention
what result did the Costs increase for employer-sponsored health plans result in
what did the Business more attentive to costs and health care issues result in
what rose and who was droped from plans
what did the Selective contracting of purchasers = In-network and Out-of-Network result in
what is tighter controlled
who benefits
Costs increase for employer-sponsored health plans
By 1989 =20.4% of business expenses (it was a fraction of the cost from1945-1970)
Almost a double increase (from 5% to 9%) of payroll spent on health care benefits
Business more attentive to costs and health care issues
Large companies start self-insurance
More companies use managed care options such as HMOs as cost-control
Individuals and labor unions see shift of costs to them; complain of health care costs
Rising premiums and policy cancellations for those with chronic illnesses become media headlines
Selective contracting of purchasers = In-network and Out-of-Network
Insurers choose providers to contract with (those that provide cost containment)
Shift from fee for service to capitated reimbursement-causes providers to cost-control as well
Medicare payments are tighter controlled and Medicaid is scaled back
insurers, purchasers and suppliers dod not benefit at all but suppliers remain steady
what did the Counter-revolution by providers/Consolidation in health care market result in
what did the Growing power of specialists and specialty services
result in
who benefits
Counter-revolution by providers/Consolidation in health care market
Provider and insurance negotiations are intense
Costs accelerate especially for the individual employee-Premiums and deductibles rise 34%
Large HMOs emerge due to buy-outs and consolidation
Growing power of specialists and specialty services
For-profit services, physician owned imaging facilities
Specialist physician groups grow and negotiate for higher payment rates from insurers
Ambulatory centers for day surgery and clinics grew and are physician owned
Hospitalists are a growing specialty
purchasers and insurers benefit
providers and suppliers do not benefit
Pharmaceutical industry criticisms
in 1988, how much of the national health expenses was Rx vs how much in 2009
what happens after that and what did the insurances challenge the pharmaceutical companies to begin
how much did Most profitable companies earn
were there regulations to regulate prices
what tactics were used to continue market share and what act was this
what were the generic manufacturers doing
what was evergreened
what is Pharmacy Benefit Managers (PBM) part of and responsible for what
who benefits
Pharmaceutical industry criticisms
- 1988 Rx was 5.5% of national health expenses versus in 2009 10.1
- Shift of insurance coverage of Rxs occur; Insurances take notice and begin to challenge pharmaceutical costs; Tiers begin
- Most profitable companies: earning 20% of revenues compared to other Fortune 500 companies that earn 5% of revenues
- No regulations by the government to regulate prices
- Brand to generic tactics to continue market share-Hatch-Waxman Act
- Generic manufacturers are consolidating driving up generic costs
- “Evergreening”- Immediate release vs extended release – Rx to OTC
Pharmacy Benefit Managers (PBM)
–Part of the supply chain and responsible for formularies
suppliers benefit
Primary Care Shifts
what method of payment do primary care practices look for
what is payment for
patient-oriented care, is it rising or declining
what is forming
Primary care practices looking at capitation versus fee-for-service
Choosing Wisely campaign spotlights overuse of health care
http://www.choosingwisely.org/patient-resources/
Payment for value versus volume
Patient-Oriented care on the rise
Primary care teams are forming
Suppliers The Perfect Health Care System
is it realistic
what are the important factors of health care systems
Noble aspirations but most likely impossible to attain 100%
Important factors of health care system:
Improve health
Control costs
Prioritize allocation of resources
Enhance quality of care
Distribute services fairly
Blurring of the Actors
Insurers acquiring Providers: UnitedHealthcare acquired DaVita Medical Group
Providers acquiring Insurers: CVS merging with Aetna
Providers acquiring Suppliers: CVS merging with Caremark
Insurers acquiring Suppliers: Cigna merging with ExpressScripts
Companies moving into health care: Amazon
Many conditions have increased during the pandemic.
what are Additional Barriers to Care
Travel costs and arrangements
Childcare
Time off work
Therapy costs and insurance coverage
HEALTHCARE IS CHANGING
what have patients adopted
where is the center of health
do providers meet patients now
Patients have adopted a consumer mentality towards engaging in their health seeking to meet their needs on demand.
Home as the center of health is a quickly growing area of focus in medicine including the ‘Hospital at Home’ model
Meeting patients where they are at is a growing healthcare business structure across multiple care modalities.
Why Digitalize Healthcare?
what issues can they help address the following issues:
Digital tools are giving providers a more holistic view of patient health through access to data and giving patients more control over their health. Digital health offers real opportunities to improve medical outcomes and enhance efficiency.
Reduce inefficiencies
Improve access
Reduce costs
Increase quality
Make medicine more personalized for patients.
how many physicians and federal acute care hospitals (96%) adopted a certfied EHR
As of 2021, nearly 4 in 5 office-based physicians (78%) and nearly all non-federal acute care hospitals (96%) adopted a certified EHR. This marks substantial 10-year progress since 2011 when 28% of hospitals and 34% of physicians had adopted an EHR.
what can you do during. TELEHEALTH
talk to who
message who
Telehealth — sometimes called telemedicine — lets your health care provider care for you without an in-person office visit. Telehealth is done primarily online with internet access on your computer, tablet, or smartphone.
Talk to your health care provider live over the phone or video chat.
Send and receive messages from your health care provider using secure messaging, email, and secure file exchange.
Majority of payers cover telehealth services for members
Expansion of services available pre-pandemic
Mental and psychological health over state lines
Remote Patient Monitoring (RPM)
what do devices monitor
what does CPT do
what can RPM be used for
what do some patients need
what are some disease states that it monitors
Devices monitor physiological data from patients
CPT codes for setting up and monitoring data available from CMS
RPM can be used for many conditions that require physiological data indicative of disease management
Some patients will need in-person testing, diagnostics, or monitoring. This depends on their condition, Internet capabilities, or personal preferences and abilities.
But there are many ways that remote patient monitoring can help with chronic conditions, pregnancy complications, and short-term illness.
High blood pressure
Diabetes
Weight loss or gain
Heart conditions
Chronic obstructive pulmonary disease
Sleep apnea
Asthma
what is Remote Therapeutic Monitoring (RTM)
what does it cover
Combination of technology like RPM devices and disease management for therapeutic outcomes
This can include medication adherence and physiological data
Interventions can include education and coaching
Currently, CMS covers pulmonary and musculoskeletal conditions
CPT code 98976 - RTM (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days.
DIGITALIZATION OF DEVICES
what does the Integration of health devices do
what is also integrated
what are the ongoing issues
Integration of health devices into the ‘Internet of Things (IoT) landscape
approaches include:
Integration of Bluetooth to tether to an external device (e.g., smartphone or peripheral)
Mobile app integration for data collection and user engagement
Enabled the movement towards:
Remote Patient Monitoring (RPM)
Remote Therapeutic Monitoring (RTM)
Ongoing Issues:
Accuracy, data interoperability, coverage, patient education, user adherence
RISE OF CGM
what does it result in fewer of
what is the accepted use for
what are the limitations
Increased desire amongst PwD to utilize CGM over other BGM interventions due to fewer finger pricks and convenience
Visually impaired patients have benefited from easier BGM
Digital affinity closely related towards acceptance of the use of CGM technologies
- This is likely to increase over time with digital natives
Increased recommendation of CGM use in clinical practice guidelines influencing clinician behavior
Limitations still present:
Cost barriers
Clinician and patient buy-in
Technology barriers
what is the center of healthcare or the ____ at ____ model
hospital at-home model
home is the center of care
ER/provoder identificaton of patient identification of valid patient
conditions of defined treatment protocols
- HF, COPD, CAP, cellulitis
patient home is within hospital range to provide emergent care
home must have space and fit patient needs - food, heat/cooling, water
health staff visit patients in the home (ex. respiratory therapist, nursing)- kinda like UK!
tests conducted in the patient home and therapy (ex. medications) given as well
RPM will play a significant role
Why is PH Controversial?
19th century public health closely tied to social reform movements: campaigns for improved housing, trade unions, abolition of child labor, child and maternal health
Public Health viewed as a broad social movement
Winslow’s 80 yr old definition: the role of PH is the development of the social machinery to ensure every individual in the community a standard of living adequate for maintenance of health.
Why is PH Controversial?
Contrasting views that direct the production and equitable distribution of scarce health care resources
Distribution of benefits/burdens and responsibilities within a society
Free market vs government responsible for allocation and delivery of resources
Health care access a right vs ability to pay
Health care an individual vs collective responsibility
Role of PH in society, broad and expansive vs restrictive
Social Justice in PH
Health is a collective responsibility
Emphasizes community well-being
Views health care as a social resource
Allocation and delivery of health care resources governed by need
Minimum levels of income, housing, employment, education and health care are fundamental rights
PH closely tied to social reform movements (public hygiene, improved housing, abolition of child labor, maternal and child health, trade unions
Social Justice in PH
what two things does it emphasize
what is it a strong obligation to
is access to healthcare universal or limited
what does it propose
Emphasizes collective responsibility for health
Emphasized community well-being
Strong obligation to the collective good
Access to health care universal
Proposes public solutions to social problems (drug abuse, homelessness, violence)
Market Justice. in PH
Health is an individual responsibility
Emphasis on individual well-being
Views health care as an economic good
Allocation and delivery of health care resources governed by demand
Powerful forces of environment, heredity, social structure prevent equitable distribution of the burdens and benefits of PH
Market Justice in PH
what does PH aim to control
who encourages it
what does it limit
how is medical care distributed
PH is an enterprise focused on controlling communicable disease or as a safety net that provides medical care to the indigent
Encouraged by MD’s
Limits federal health funding to programs run by local health departments
Medical care distribution based on the ability to pay
Market Justice access to medical care
how is access to medical care viewed
what is the role of the government and public health
Access to medical care is viewed as an economic reward for personal effort and achievement
Role of government and public health
- Restricted, narrow
- Limited to a technical enterprise
Sources of Controversy
Economic impact
Individual liberty
Moral and religious concerns/values
Political interference with science
Economic Impact in PH
PH measures may have negative impact on segment of population or industry
Those paying for PH measures may not benefit from those measures
Costs are measurable/benefits are often not
Costs may be short-term while benefits may not be immediately seen
Example of a PH initiative with significant economic impact? Discuss in groups of 3 to 4.
Economic Impact industries
Tobacco industry: product labeling, bans on smoking in public places, restaurants
Lumber industry: regulations cost jobs to preserve a long term stable climate
Standing orders for Narcan in community pharmacies: high cost to insurance companies
Mandatory immunizations
Individual Liberty in PH
what is the role of the gov’t in this
what are restrictions on
what may the restrictions benefit
To what extent can and should the government restrict
individual freedom for the purpose of improving the community’s health
Restrictions on behaviors that may cause direct or indirect harm to others
Restrictions may benefit the individual or the community
Example of PH initiative affecting individual liberty?
Individual Liberty
what do people have a say in
Seat belts
Bike helmets
Extra large soft drinks
Removal of vending machines in public areas
Additional driving tests for elderly
Mandatory health screenings
Mandatory immunizations
Moral and Religious Concerns in PH
what do some PH initiatives do
are discussion of PH issues always comfortable to have
how may some religions react to PH initiatives
Some PH initiatives provoke moral or religious objection
Discussion of some PH issues are offensive or
embarrassing to discuss (sex and reproduction, alcohol and drug addiction, suicide and end of life decisions)
Can the government determine and enforce moral behavior?
Some religions may prohibit some common PH initiatives (birth control, immunizations)
Politics vs. Science
Presidential administrations criticized for misrepresenting and/or distorting scientific information and evidence to support its policies and political agenda
Examples:
Bush admin pressured CDC to promote abstinence only programs for preventing teen pregnancy
Promoted condom failure rates rather than place in prevention of spread of AIDS and other STD’s
Prevented publication of research on agriculture affect on antibiotic drug resistance
Handling of the AIDS crisis
Handling of drug/alcohol addiction crisis
Health Statistics in PH
how do PH workers monitor health of a community
what does health statistics deal with
Public health workers monitor the health of a community by collecting and analyzing health data
Health statistics
- Identify special risk groups
- Detect new health threats
- Determine success of disease state management
- Help plan and evaluate success of public health programs
- Are considered when preparing government budgets
Health Statistics for research
Provide raw data for research on
Epidemiology
Environmental health
Social and behavioral factors in health
The health care system
Essential for the Assessment Function in public health
NCHS
what does it stand for
what does it do
what is it a part of
how many ways does it collect data and what does it do
National Center for Health Statistics
Primary agency that collects, analyzes and reports data on the health of Americans
Part of the CDC
Collects data in two ways
- States and local agencies periodically transmit data they have compiled from local records: vital stats, births and deaths
- Conducts periodic surveys of representative samples of the population on health status, lifestyle, health-related behaviors, onset and diagnosis of illness and disability, use of health care resources
Vital Statistics
Births and deaths are the most basic and reliable and complete data set
Causes of death subject to uncertainties
Utilize birth and death certificates
Vital Statistics also include information on marriage, divorce, spontaneous fetal deaths and abortions
The state health department is generally responsible for collecting these reports and transmitting them periodically to the NCHS
Birth Certificates
who supplies info about baby
who supplies medical and health info
Mother supplies information about the baby’s family (names, address, ages, race, ethnicity, education level)
Medical and health information supplied by hospital, doctor, birth attendant (prenatal care, birth weight, medical risk factors, complications during delivery, OB procedures, abnormalities in the newborn)
The Census
what is the # of people in society important
what is used as a numerator and what is used as a denominator
how do you calculate age adjusted or age specific rates
The number of people in the population is necessary in order to convert the data collected through vital statistic systems into rates per number of people
The number of people in the population serves as the denominator when a vital statistic is used as the numerator.
To calculate age-adjusted or age-specific rates it is necessary to know how many people are in each age group
The Census what does it determine
how often does the constitution require that the population of the U.S be counted to determine the state representatives
what are the two controversial issues presented
To determine sex-specific or race-specific rates, we need to know how many males and females there are in a population as well as the breakdown of races within the population
The Constitution requires that the population of the United States be counted every 10 years to determine each state’s representation in the House of Representatives
2 controversial issues
- How race is determined
- Ability to accurately count every individual household
The Census.
what is the major change
what is the American Community Survey (ACS)
was it different than the long form
who was it sent to
what was it designed for
A major change in the way the 2010 census was conducted was that only
- the most basic data was collected using a short form (included name, sex, race and ethnicity, and relationship of everyone living in the household)
American Community Survey (ACS) launched in 2005 by the Census Bureau
- Same information as long form
- Sent to 3 million households selected to be representative of the populations of local jurisdictions
- designed to help communities plan for transportation systems, zoning, schools, healthcare facilities, housing and social services
National Center for Health Statistics Surveys
In addition to collecting data from the states, NCHS actively conducts a number of surveys to gather additional information on the health of the American public
Two ongoing NCHS surveys
The National Heath and Nutrition Examination Survey (NHANES)
Designed to obtain detailed and accurate information
Doctors and nurses conduct physical and dental exams and lab tests on a carefully selected sample of the population
Data collected determines prevalence of chronic conditions and risk factors as well as nutritional status and its association with chronic disease
NCHS Surveys
what does the BRFCC do
Two ongoing NCHS surveys
The Behavioral Risk Factor Surveillance Survey (BRFSS)
- Largest telephone survey in the world
- Self reported data (may be less reliable)
- The only available source of timely, accurate data on health-related behaviors
- Conducted by the states which report their findings to the CDC
- Asks questions about health status, high risk behaviors, physical activity, preventive medical care
NCHS Surveys examples
National Youth Fitness Survey
National Survey on Family Growth
National Immunization Survey
National Asthma Survey in collaboration with the CDC National Center for Environmental Health
National Infant Feeding Practices Study
Other Governmental Surveys
EPA surveillance for health hazards in the environment
National Cancer Institute monitors long-term trends of cancer incidence and mortality through a program called Surveillance, Epidemiology, and End-Results (SEER)
The Centers for Medicare and Medicaid Services utilize billing records for research on utilization and outcomes of medical care
Is so much data necessary?
Data is critically important in making up the surveillance systems that form the basis of effective public health practice as well as the planning and evaluation efforts that are increasingly being used in public health programming
The success of intervention programs to confront a problem is evaluated based on whether they improve the statistics
Accuracy and Availability of Data
what is the process of data collection
health info. always relying on survery or voluntary reports are always what
is the census info. always reliable
The process of data collection is always imperfect
Health information relying on surveys or voluntary reports are often incomplete or subject to bias
Census information contains errors and there are political difficulties in attempting to correct these errors
Accuracy and Availability of Data errors
Errors exist in reporting cause of death on death certificates
Maternal deaths are suspected of being underreported because doctors fail to indicate the woman was pregnant on the death certificate
The data collection and reporting processes contain sources of inaccuracy and bias
Accuracy and Availability of Data
New information technology (public health informatics) has vastly improved accessibility of information to public health workers and the general public
Confidentiality of Data
All information collected from individuals by governments for whatever purpose is considered confidential and cannot be divulged without the consent of the individual
Information is generally entered into a database without any names, addresses or personal identifiers
Exception: when someone has been exposed to a communicable disease they must be notified
Data and PH Interventions
PH problems are identified in terms of statistics
Data is the basis of the statistics utilized in PH initiatives
Success of PH initiatives is evaluated based on improvement in statistics
Pharmacist Patient Care Process
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collection of the necessary subjective and objective info. about the patient to understand the relevant medical/medication history and clinical status of the patient
the pharmacist assesses the clinical effects of the patient’s therapy in the context of the patient’s overall health goals to identify and prioritize problems and achieve optimal care
develop a plan to combat the issue that is evidence-based and cost-effective
put a plan into place with other health care professionals and patient or caregivers
evaluate the effectiveness of the plan
Policy Development
what does it help to develop
what does it determine
what does it inform
what does it develop
what does it used to devise strategies
Development of the treatment plan
Determines what will be done
Informs, educates and empowers people about health issues
Mobilizes community partnerships to identify and solve health problems through DPH
Develops policies and plans that support individual and community health efforts
Uses scientific knowledge to devise strategic approaches to improve community health
Public Health
WHAT WE FOCUS ON
The role of the pharmacist
Public Health
what is it a measure of
what else does it measure in regards to bringing and maintaining
Measure of the general, overall state of health of a population or society
Measures that people take to bring about and maintain the health of a population or society
What is Public Health 1920 definition, Charles Edward A. Winslow
The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the:
Sanitation of the environment
Control of community infections
Education of individuals in principles of personal hygiene
Organization of medical and nursing services for early
diagnosis and prevention of disease
Development of social machinery which will ensure to every individual a standard of living adequate for the maintenance of health
