Week 1 Flashcards
Rests on the values or beliefs accepted by a particular society or group without systematic reflection or an attempt at justification
Morality
Focuses on the reasons why an action is considered right or wrong. It requires the rational justification of positions and beliefs.
Ethics
Semi-autonomous group of skilled individuals who posses similar credentials, standers of behavior, and motivation to serve. (3 rules of membership)
Profession
Describes the extent to which members of a profession maintain a level of conduct equal or above an ethical threshold determined by the profession and accepted by society
Professionalism
5 Essential attributes of a professional
Equanimity, Accountability, Self-Assurance, Respect, Impartiality
Describes how an individual perceives their own please within the ranks of a profession and publicizes this perception to the outside world
Professional identity
Requirements for formulating an ethical question
Clear, focused, specific, forward-looking, and action-oriented
Formula for ethical question
Given the conflict between consideration 1 and consideration 2, is it ethically permissible to decision or action?
3 categories of ethical action
Obligatory, permissible, prohibited
Problem representation (one sentence) description of a case to guide diagnostic reasoning. Will evolve with additional information.
Problem representation
Principles of health care ethics
Beneficence, respect for autonomy, non-maleficence, justice
Freedom to live according to one’s values
Autonomy
Acting to promote another’s best interest
Beneficence
One ought not to inflict evil or harm
Non-maleficence
Protect patients from discrimination and exploitation
Justice
Two ways population health is being see
Public health perspective, delivery system perspective
Componentes of Three-Legged Stool
Access, cost, and quality
US hospital beds per 1000
2.8
Physicians per 1000
2.6
Primary care physicians in US
43%
GDP spent on healthcare
17.8%
Spending per capita
$9,403
MRIs per 1000 people
118
Spending per person on pharma
$1,143
Amount spent on administration
8%
Average GP salary
$218,000
Life expectancy
78.8
Infant deaths per 1000
5.8
Maternal deaths per 100k
26.4
Smoking rate
11.4%
Obese or overweight percentage
70.1%
Type of US health insurance system
Voluntary, private, employer-based and individual based
Healthcare system in which Government is payer and provider
National Healthcare system
Similar to national healthcare systems but less centralized
Regionally Administered universal Health insurance program
Highly regulated multiple payer healthcare system
Statutory mandatory health insurance systems
Triple aim
Improve population health, improve experience of care, decrease per capital cost
4 aim of quadruple aim
Care team well being
Control knobs of healthcare system
Financing, payment, organization, regulation, behavior
All money that pays for the healthcare system
Financing
Describes how funds collected through the healthcare system pay healthcare providers for the delivery of healthcare service
Payment
Reimbursing a provider a set fee for delivering a specific procedure or service
Free for service
Paying a flat per member per month amount to cover the full cost of care for a patient, no matter what services are provided
Capitation
The mix of providers within a given healthcare market, including their structures, roles, and functions
Organization
Where is care provided?
Inpatient, outpatient, long-term services and support, rehabilitation
Levels of care
Primary, secondary, tertiary
First point of contact between a patient and the healthcare system
Primary care
Provided at request of PCP for more in-depth investigation of a specific concern
Secondary care
Often via referral from primary or specialty vare for complex, high intensity, and serious illness
Tertiary care
How state and federal governments oversee of different actors within the healthcare system
Regulation
How we think about changing the way actors within the healthcare system behave-often providers and patients
Behavior
Having an insurance cared which helped cover the cost of care when using services
Access to health insurance
Timely use of personal health services to achieve the best health outcomes
Access to healthcare services
Services covered trough your plan. Plan explains coverage for each type of service, whether it is subject to deductible, as well as copayment and coinsurance amounts
Benefits
Amount paid monthly to have health insurance
Premium
Beneficiary pays a flat fee per service or visit, at the point of service
Copayment
Beneficiary pays a fixed percentage of medical bills. Often billed after care is provided
Coinsurance
Amount the beneficiary pays before coverage kicks in.
Deductible
Eligible individuals are entitled to defined set of benefits. States are entitled to federal matching funds
Medicaid entitlement
ACÁ Medicaid expansion population
People living 138% below FPL
Medicaid: Feds pay at least 50% of costs (can be as high as 74%). Formula is based on state per capital income
Federal Matching Assistance Percentage
Expanded coverage to low-income children above Medicaid Eligibility Levels
CHIP
1) Develop separate children’s health insurance program
2) Expand Medicaid Coverage
3) Combine these options
CHIP adoption in states
CHIP Financing
Block grant, not an entitlement
Medicare Part A
Hospital
Medicare Part B
Doctor
Medicare Part C
Medicare Advantage
Medicare Part D
Prescription
Services not covered by Medicare
Long term services and support, dental services, eyeglasses, hearing aids
Insured all year but experienced one of the following:
1) Out of pocket expenses equaled 10% or more of income
2) Out of pocket expenses equaled 5% or more of income if low income
3) deductibles equaled %% or more of income
Underinsurance
A structural or functional change in the body that is harmful to the organism. It occurs when the cellular environment changes to such a degree that tissues are no longer able to perform their functions optimally. (Non-experiential)
Disease
A condition in which a person perceives that their usual state of health is compromised. This change in health is described in terms of symptoms or functional loss.
Illness
Environment during fetal development can influence Epi genetic health circumstances later in life. Can cause a match or mismatch.
Developmental origins hypothesis
When anatomically modern humans appeared in Africa
200k years ago
Humans migrated out of Africa
60k-70k years ago
Humans developed agriculture
12k years ago
Ways inherited genomes contribute to disease
Chromosomal aneuploidy, single gene mutations, poly genetic SNPs
Found that we were spending a lot of money in care but not getting desired improvements in population health.
Surgeon General’s Report 1979
We tend to be blind to the influence of the environment because we are in equilibrium with it.
Variation within populations vs. variation external to the population
When a physician attributes differences between patients they see to individual patients rather than to the environment, they may be likely to make a diagnostic error
Nominator/denomintor confusion
Disease that involves many genes (ex. Type 2 Diabetes)
Thrifty genome hypothesis
Near (physiologic) causes of disease
Proximal causes
Underlying causes of disease
Distal causes
Allows organisms to enhance their fitness by adjusting to different environmental circumstances
Developmental plasticity
If sources of stress are constant (poverty, racism, or social isolation), they become maladaptive and induce permanent changes in the biology of multiple organ systems, many of which promote the development of chronic disease
Stress model of chronic disease
According to 1979 Surgeon General Report, individual behavior is estimated to account ___ of the differences in mortality seen between groups stratified by socio-economic status.
20%
4 categories determinants of health can be divided into
Genetic, developmental, behavioral, societal
Social determinants can be further divided into these categories
Physical exposure and social position
Refers to a condition in which an organism has successfully adapted to an environment over time
Allostasis
