Health Policy And Management Chapter 3

Front 1

Almshouse

Back 1

Precursor to hospitals in the United States, but functioned more like a poor house. Existed in cities and run by the local government. Provided food and shelter to the destitute and poor; unspecialized institutions

Front 2

Balance bill

Back 2

Refers to the billing of the leftover sum by the provider to the patient after insurance has only partially paid the chare initially billed.

Front 3

Capitation

Back 3

A set amount (or a flat rate) to cover a person’s medical care for a specified period. The sum is generally paid monthly.

Front 4

Cost-shifting

Back 4

Shifting of costs from one entity to another. A way of making up losses in one area by charging more or by expanding services in other areas

Front 5

Cross-subsidization

Back 5

see cost-shifting

Front 6

Cultural authority

Back 6

The general acceptance of and reliance on the judgment of members of a profession

Front 7

Fee for service

Back 7

Payment of separate fees to physicians for each service performed, such as examination, administering a test, hospital visit. The physician sets the fees

Front 8

Gatekeeping

Back 8

The use of primary care physicians to coordinate health care services needed by an enrollee in a manage care plan

Front 9

Means test

Back 9

A test that confined eligibility to people below a predetermined income level for specific programs

Front 10

Medicaid

Back 10

A joint federal program of health insurance for the poor

Front 11

Medicare

Back 11

A federal program of health insurance for the elderly and some disabled persons

Front 12

Organized Medicine

Back 12

Concerted activities of physicians, mainly to protect their own interests, through such association as the American Medical Association (AMA)

Front 13

Title XVIII Part A

Back 13

Forand's initial bill stated the administration's proposal to finance hospital insurance for the elderly through social security to provide hospital care and limited nursing home coverage

Front 14

Title XVIII Part B

Back 14

The Byrnes proposal to cover physicians' bills through government-subsidized insurance

Front 15

Pesthouse

Back 15

Operated by the local government to quarantine people who had contracted a contagious disease such as cholera, small pox, typhoid or yellow fever

Front 16

Primary Care

Back 16

Basic and routine health care that is provided in an office or clinic by a provider (physician, nurse, etc) who takes responsibility for coordination of all aspects of a patient's health care needs. It is the patient's first contact with the health care delivery system

Front 17

Title XVIII

Back 17

Part A and Part B of Medicare--this title was a part of the social security amendment of 1965 to provide publicly financed health insurance to the elderly

Front 18

Title XIX

Back 18

A title of the Social Security Amendment of 1965--it became Medicaid; It was an extension of the Kerr-Mills program of federal matching funds to the states based on each state's financial needs.

Front 19

Why did the professionalism of medicine start later in the US than in some Western European nations?

Back 19

-American medicine LAGGED BEHIND THE ADVANCES in medical science, experimental research, and medical education.
-Americans had a tendency to neglect research in basic science and place more EMPHASIS ON APPLIED SCIENCE
-American attitudes towards medicine placed a strong emphasis on natural history and CONSERVATIVE COMMON SENSE

Front 20

Why did medicine have a domestic rather than a professional character in the preindustrial era? How did urbanization change this?

Back 20

-Medical services, when deemed appropriate by the consumer, were purchased out of one's own private funds because there was no health insurance.
-The health care market was characterized by competition among providers.
-The CONSUMER WAS SOVEREIGN.
-Urbanization: created increased reliance on the specialized skills of paid professionals.
1. Distanced people from their families and neighborhoods where FAMILY BASED CARE was traditionally given (women began to work)
2. PHYSICIANS BECAME LESS EXPENSIVE to consult (phones, cares, paved roads, NO TRAVEL COSTS)
3. More and more Americans move to growing towns and cities--no more house calls
4. GPs COULD SEE MORE PATIENTS in a given amount of time

Front 21

Which factors explain why demand for the services of a professional physician was inadequate in the preidustrial era? How did scientific medicine and technology change that?

Back 21

-Medical practice was in DISARRAY. (Market proved who would be successful/no rigorous course of study)
-Medical procedures were PRIMITIVE. (No anesthesia; bleeding, use of emetics, purging with enemas).
-An institutional core was unstable. (No hospitals, lack of sanitation and ventilation in preexisting social welfare institutions)
-DEMAND WAS UNSTABLE. (Most competent physicians in urban centers; cost of transportation expensive, opportunity cost)
-Medical EDUCATION was unorganized. (4 Med Schools by 1797, 1 year=3 or 4 months, fears that higher standards would drive enrollments down, no need for HS diploma)
-Scientific medicine and tech: Judgment of physicians was used to control the everyday lives of patients/fitness for employment, ASSESS DISABILITY in workers' comp. cases, when an individual can return to work, peoples lives governed by decisions of physicians

Front 22

How did the emergence of general hospitals strengthen the professional sovereignty of physicians?

Back 22

-The HOSPITAL BECAME THE CORE around which the delivery of medicine was organized
-Demand for hospital services, physicians growing PRESTIGE, professionalization of medical practice
-HOSPITALS NEEDED DOCTORS to keep their beds filled; thus the hospitals needed to keep the docs happy

Front 23

Discuss the relationship of dependency within the context of the medical profession's cultural and legitimized authority. What role did medical education reform play in galvanizing professional authority?

Back 23

-REFORM OF MEDICAL EDUCATION started around 1870 with the affiliation of medical schools with universities.
-The creation of medical schools was partly to enhance one's professional status and prestige, and partly to enhance one's income.
-Doctor of Medicine degree became the standard of competence
-Changed from 2 years to 3 and became a graduate training course requiring a college degree, not a high school diploma
-The Association of American Medical Colleges was founded in 1876 by 22 medical schools
1. Se minimum standards for medical education, including a 4 year curriculum
-Advanced medical training was made necessary by scientific progress
-Once advanced graduate education became an integral part of medical training, it helped legitimize the profession's authority and galvanize its sovereignty

Front 24

How did the organized medical profession manage to remain free of control by business firms, insurance companies, and hospitals until the latter part of the 20th century?

Back 24

-For a long, physicians' abilities to remain free of control from hospitals and insurance companies remained a prominent feature of American medicine.
-Individual physicians who took up practice in a corporate setting were castigated by the medical profession and pressured into abandoning such practices
-Independence from corporate control enhance PRIVATE ENTREPRENEURSHIP and put American physicians in an enviable STRATEGIC position in relation to orgnizations such as hospitals and insurance companies

Front 25

Discuss the key factors that were instrumental in the growth of voluntary health insurance?

Back 25

-Voluntary health insurance=private health insurance
-Caused by converging technological, social, and economic developments
1.Technological-Medicine offered new and better treatments
2.Social-Medical care was regarded as socially desirable and the value placed on medical services by individuals and society created a growing demand for medical services
3.Economic-People could predict neither their future needs for medical care nor the costs, both of which had been gradually increasing
-Scientific and technological advances made health care more desirable but less affordable
-The AMA endorsed voluntary health insurance but made it clear that private health insurance plans should include only hospital care
-From the medical profession’s point of view, voluntary health insurance in conjunction with private fee-for-service practice by physicians was regarded as a desirable feature of the evolving health system