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55 Cards in this Set

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What are the 3 major US health system goals?
Access
Cost
Quality
How do the 3 major US health system goals conflict with one another?
It is difficult to satisfy one or two goals without dissatisfying another goal.
What are some efforts to achieve the 3 major US health system goals?
Some efforts include: programs for aged and poor; price quality regulations; and government reform.
What are some barriers to access health care in the US?
Some current barriers include: determining who pays, programs that do not allow cost shifting, and a decline in individual health insurance coverage.
What does the Social Security Act of 1935 help provide?
The Social Security Act of 1935 helps provide the following: federal aid to states for public health, welfare, child/maternal health, and crippled children; and a legislative basis for most health welfare programs including Medicare, Medicaid, and SCHIP.
What are the three amendments to the 1935 Social Security Act?
Medicare
Medicaid
SCHIP
Explain Medicare (Title XIX).
Established in 1965, Medicare is the national health insurance program in the US for persons aged 65 and over and the disabled.
Explain Medicaid (Title XVIII).
Established in 1965, Medicaid is the national health insurance program in the US for low-income persons.
Explain SCHIP (XXI).
Created in 1997, the State Children's Health Insurance Program (SCHIP) is designed for families who earn too much money to qualify for Medicaid, but afford to buy private insurance.
What are the two types of government grant programs?
Block Grants
Categorical Grants
Explain Block Grants.
Block grants are a large sume of money granted by the national government to a regional government with only general provisions as to the way it is to be spent.
Explain Categorical Grants.
Categorical grants are grants where the federal government determines exactly how money should be used.
Explain Patient Bill of Rights.
Adopted in 1995, the Patient Bill of Rights is provided to every patients. It ensures Patient rights are protected under the US Constitution, state laws, and regulation.
What is Patient Bill of Rights Responsible for?
Accurate Information
Respect Providers
Respect Other Patients
Financial Obligation
What is ambulatory care?
Ambulatory care is medical care not requiring overnight hospitalization.
Where can ambulatory care be delivered?
Private Medical Office
Non-Physician Practioners
Hospital-Based (ED)
Free-Standing Facilities
Community Health Centers
Voluntary Agencies
Who can provide ambulatory care?
Nurses
Dentists
Nurse Practicioners
Pharmacists
Physical Therapists
List the most common practice sites for the following health care professionals:
Physicians
Nurses
Dentists
Nurse Practioners
Pharmacists
Physical Therapists
Private Group Practice
Hospitals
Private Practive
Managed Care Organizations
Drug Store Chains
Hospitals
How does the government regulate health care professionals?
The government regulates health care professionals through federal, state, and certificate requirements. This is done to eliminate phony doctors.
What are six healthcare cost growth drivers?
New Technology and Drugs
Complx Needs of Aging Pop.
Specialization
Labor Intensity
Reimbursement Incentives
Increased Uninsured
Approximately how many people in the US population are uninsured?
About 45 million or 16%.
How does managed care work?
A managed care organization links provision and payment for service; premium charged and financial risk shared with providers.
What are two organizational types of managed care organizations?
HMO
PPO
Explain HMO.
A health maintenance organization (HMO) is a legally organized entity responsible rsponsible for both provision and financing of comprehensive services to a defined population for a pre-paid fee.
Explain PPO.
Preferred provider organization (PPO) are formed by hospitals and MDs to serve purchased with discounted rates.
Explain Carve-Out.
One or more services that a managed care organization is not obligated to apply under its managed care contract.
What are two managed care organization carve-outs?
Menal Health
California Children Services
What is a quality assurance mechanism?
Accreditation
What are two quality assurance organizations?
NCQA
HEDIS
Explain HEDIS.
Health Plan Employer and Data Set (HEDIS) is designed to allow consumers to compare
health plan performance to other plans or national or regional benchmarks.
Explain NCQA.
Established in 1990, the National Committee for Quality Assurance (NCQA) is designed to improve health care quality.
What are the three major health maintenance organization models?
Staff/Group
Independent Practice Assn.
Hybrids
Explain Staff/Group Models.
MD employees provide care in HMO-owned facilities (Kaiser).
Explain Independent Practice Association Models.
Community-based MDs serve members on a pre-paid, fee-for-service, contractual basis (Pacificare, Health Net).
Explain Hybrid Models.
Hybrid models are a group practice network with direct contracts.
What are the key features of a managed care organization?
The key features of health maintenance organizations include: link health service delivery to payment; population based reimbursement; capitation; reverses provider incentived for utilization; utilization management controls; and a restricted provider network.
Explain the Mental Retardation Facilities and Community Construction Act?
Developed in the 1960s and 1970s, the Mental Retardation Facilities and Community Construction Act provides federal support for community mental health services.
Explain Deinstitutionalization.
Deinstitutionalization is the process of moving people from mental institutions into community-based or family-based environments.
What are the four classes of mental health organizations?
The four classes of mental health institutions include: the specialty mental health sector; the general medical/primary care sector; the human services sector; and voluntary support networks.
What are four costs associated with mental illness?
Medical Care
Disability Payments
Lost Productivity
Relationships
Explain the MH Parity Act of 1997.
The MH Parity Act of 1997 includes the following provisions: gives general lifetime limits, annual limits to medical care; 1999 24 states passed parity laws; and in 2002 the Mental Health Equitable Treatment Act to expand coverages was abandonned by Congress.
What are the public health objectives?
The public health objectives include: focus on primary prevention; protection from infection and toxins; response to natural and human disasters; health education; outreach to at-risk populations; diagnostic labs to monitor; and collect data on instiutional outcomes.
What are the two Healthy People 2010 objectives?
The two Helathy People 2010 objectives are to increase years and quality of health life and to eliminate health disparities.
Explain the VA health care system.
The VA health care system is a seperate federal system originally established for Civil War veterans. It is one of the worlds largest delivery systems with 173 hospitals, 105 medical school affiliations, nursing home units, and outpatient services.
What are the three types of epidemiological research?
Population Research
Observation Studies
Experimental Studies
Explain Evidence-Based Medicine.
Evidence-based medicine is a systematic applicatoin of the best available evidence to evaluate options and decisions in clinical practice and management.
How have health service research impacted health care policy?
Health service research have contributed to health policy in the following manner: prospective hospital payment based on DRGs and cost, qualitym, and access research on HMOs and managed care.
What are the challenges of chronic illness?
The challenges of chronic illness include: agining population burdens compel expansion of creative long-term facilities and services; needs of aging population will increase awareness of system deficiencies; and a monumental challenge to create chronic care system for social and medical needs.
What are the factors influencing the future of the US health care system?
-Growing Number of Uninsured
-Demand for Greater Clinical and Fiscal Accountability
-Technological Innovation
-Professional Labor Supply Inbalance
-Globalization of Economy
-Consolidation and Mergers: Vertical and Horizontal
-Information Management and Technology
Explain GIS.
Graphic Information Systems (GIS) are being used to better understand geographic relationships that affect health outcomes, public health risks, disease trainsmission, access to health care, and other public health concerns.
What are some forms of regulation in long-term care?
-State Nursing Home and Home Care Licensure
-Medicare and Medicaid Certification
-Laws for Elder Abuse Reporting
-Regulations on Restraints
-Ombudsman Progams
Who are the payers in long-term care?
Public 61%
Personal Out-of-Pocket 27%
Private Third Party 12%
What are some long-term care programs?
Skilled-Nursing Facilities
Assisted Living Facilities
Home Care
Hospice
Respite
Adult Day Care
Who are long-term programs for?
Children through adults meeting diverse needs.
What is a regulation for long-term care?
Licensing in 38 states.