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96 Cards in this Set
- Front
- Back
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issues of concern for how consumers obtain health care
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-access
-quality -cost |
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Limited Availability & Accessibility of Services
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Lack of health insurance
Inadequate insurance Poverty |
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U.S. Health Care Coverage
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44 million Americans uninsured/underinsured
Lack primary care access |
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paying for health care (pre-obamacare)
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U.S. $4,100 per capita per year
more than any other nation (by almost 50%) sources of payment: Consumers (19.6%) Third-party payments private insurance companies (33.1%) Public/governmental insurance (43.6%) Other private funds (3.7%) We (insured people) are basically a 1st and 3rd party payer (we pay copays straight to doctors) |
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cafeteria plan (CSU)
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pick your plan (green, gold, ram) and each has a different premium and deductible
-then you have the coinsurance and copayment |
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fee-for-service
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means that the patient (1st party) either pays the physician, another health care professional, or pays the facility (2nd party) for services rendered
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Prepaid health care
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capitation system
co-payments |
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health insurance
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-Risk and cost spreading
-System of 3rd party payments in which a fee for service is paid by a 3rd party ~an insurance company or government agency, which has collected the funds as insurance premiums or taxes -Children’s Health Insurance Program |
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premium
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regular periodic payment
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deductible
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amount of money that the beneficiary must pay before the insurance company begins to pay for covered services ($500/1500)
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Copayment or coinsurance
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the portion or % of insurance company’s approved amounts for covered services that the beneficiary is responsible for paying (10%)
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fixed indemnity
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maximum amount an insurer will pay for a certain service ($250,000)
-per year - or per process (ex. pregnancy) - can have multiple indemnities at the same time (ex. have a broken arm and got a stab wound) |
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Exclusion
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a specified health condition is excluded from coverage (n/a).
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preexisting condition
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a medical condition that carries a higher-than-average risk; a health problem you had before becoming insured (cancer, CHO).
- obama wants this gone - something that is high risk |
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types of health insurance coverage
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*Hospitalization
includes room, care, supplies & medications Surgical surgeons’ fees Regular medical/Preventative nonsurgical service provided by health care providers. Often has set amounts ($1000). Long-term care array of supportive services *Major medical large medical expenses usually not covered by regular medical or dental coverage |
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trends in insurance coverage
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More complex plans/cafeteria plans
Increasing diversity of products Delivery of care through networks *Shifting financial structures and incentives: incentivizing health care *Managing utilization: make sure our supply doesn't get outweighed by demand |
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cost of health insurance
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Cost of insurance mirrors cost of care
Two major factors: -risk of the group -amount of coverage provided -Self-Insured organizations control cost of insurance |
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government health insurance
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Medicare:
65 years of age & older disabled persons who entitled to Social Security benefits administered by Health Care Financing Administration Actuary: figures out the risk that someone will cost for insurance Controlling costs: -prospective pricing system ~diagnosis-related groups Medicare + Choice: -Medicare Managed Car Plan -Medicare Private Fee-for-Service plan Medicaid: -policy for the poor Eligibility: -for the programs is determined by each State -no age requirements |
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Supplemental Health Insurance
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Medigap:
-is a supplemental insurance program specifically designed for those on Medicare -10 standardized plans -Federal government mandates a standardized policy Other Supplemental Insurance: -often disease specific -fixed indemnity policies (AFLAC) -long-term care insurance |
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Managed Care
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Preferred Provider Organizations
Exclusive Provider Organizations: go to a doctor that is in your network, instead of picking from 500 random doctors (same as HMO and PPO) Health Maintenance Organizations -Staff model HMOs -Independent practice association model Point-of-Service Option Physician-Hospital Organization Medicare + Choice Medicaid and Managed Care |
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national health insurance
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Canadian Health Care System:
-public financed, privately delivered -each provincial and territorial authority is responsible -combination of taxes -fee-for-service provided; government only payer (unless you want to pay and go to a private doctor) Strengths: -no one is without health insurance -equity across income groups |
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reproductive, infant and
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child health
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Maternal, infant, and child health are important to a community health:
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1. Important indicators of the effectiveness of health promotion and disease prevention services
2. Many risk factors can be reduced or prevented with intervention or education services for women, infants, and children. 3. WHO: infant mortality is the MOST important factor in judging national health--->infant mortality is a good indicator of how well we take care of our people. 4. HP2020: minorities and infant mortality |
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why is the infant mortality rate in the US so high for NH blacks?
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poverty
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infant mortality worldwide
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singapore is the best (least infant deaths)
US is #30-->behavioral or environmental issues. why? we don't do what we are supposed to do-preventative care. |
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what does the surgeon general say about infant mortality and maternal mortality?
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Infant and maternal mortality is a “national disgrace” and is “a great representation of our failure in preventative care.”
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New focus (HP 2000) is on
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child health
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stats about babies
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A baby dies every 18 minutes
A LBW baby born every minute A premature baby born every 2 minutes A mother dies of pregnancy every 12 hours |
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teenage births
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3.98 million per year
11-20% of all of 15 -19 year old females become pregnant annually (22-40% by some calculations – 50% spontaneous termination) |
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teen pregnancy=greater health risks
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more likely to divorce early
less likely to receive an adequate education greater incidence of infant low birth weight & prematurity, & higher mortality rates more likely to engage in child abuse and neglect mothers under 20 are less likely to get 1st trimester care, more likely to smoke, more likely to have a preterm birth and have a low birthweight baby |
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unplanned pregnancy
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56% of all pregnancies
80% of teenage pregnancies =unintended 57% of these were not using contraceptives |
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contraceptives
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Temporary
>Condoms, natural Reversible >Pills, implants, injections, inserts, emergency Permanent >Sterilization Barrier, hormonal, natural, surgical |
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Process of determining the preferred number and spacing of children in one’s family and choosing the appropriate means to achieve this preference.
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Non Government
>Planned Parenthood Federation of America, Inc. Government >Title X >broad range of acceptable family planning methods >contraception ONLY – no abortion support >encourage family participation >give priority to low income families |
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roe v wade
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number of deaths from illegal abortion has declined
number of legal abortion has been stable since late 1970s >1.2 million/year |
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maternal health
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>The health of women in the childbearing years.
>Maternal mortality - the death of a woman while pregnant or within 6 weeks of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. ~Drugs, ectopic pregnancies, PID, abortions ~8.1 for white, 32.3 for AA (per 100K) |
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infant's health depends upon many factors
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maternal, medical, environmental
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infant death=child under 1 year of age
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#1 cause is genetic factors
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infant mortality rate
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death of children under 1 yr/1000 live births
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LBW
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under 5lbs
average=7lbs |
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premature
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less than 37 weeks
normal=38-40 weeks |
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infancy development
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birth process factors:
279 days+/- 2 week gestation period |
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obstetrical meds
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labor inducers, anxiolytics, analgesics, sedatives
help us have an easier child birth |
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obstetrical processes
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forceps: clips to put on babies head and pull it out (dont do this anymore)
breech birth procedures: anything other than head first, now with ultra sounds we can wait until baby has turned c-sections: none vaginal birth. we use these more now for convenience. 25% we do based on babies health, 25% based on maternal health, 50% based on $ and convenience and insurance |
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causes of infant mortality
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1.Birth defects
2.Accidents (car, dropping,etc) 3.Sudden Infant Death Syndrome (SIDS) 3rd leading cause of death of infants defined as sudden unanticipated death of an infant in whom, after examination, exhibit no recognized cause of death usually occurs in infants between ages of 2 & 4 months |
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health problems: Prenatal development
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-Genetic inheritance (IQ, cancer genes, etc) of the fetus will define the upper and lower limits of development
-medical conditions, environmental exposure, substance abuse, genetic history critical period: stage in life where sever changes happen= #1 infancy- when you need most help. SG says this is the most important part of health |
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Substance Abuse
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many over-the-counter drugs can influence fetal development
Fetal Alcohol Syndrome >leading cause of birth defects in the US Smoking, alcohol |
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health problems: genetic factors (we cant fix these)
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chromosomal alterations
Down syndrome Physical dysformities Blood problems (toxoplasmosis) |
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health problems: environmental factors (we can fix these)
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Pollutants (second-hand smoke)
nutrition >malnutrition, undernutrition, breastfeeding |
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improving infant health
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Majority of birth defects attributed to environmental hazards and unhealthy behaviors of the mother during pregnancy.
Low birth weight >40 times more likely to die in first year of life than healthy babies >Smoking >Alcohol and other drugs >Breastfeeding |
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child (1-14) health
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Mortality:
unintentional injuries (#1 cause, all the way up until you are 45yrs) >motor vehicles homicide rates suicide rates Morbidity: unintentional injuries child abuse and neglect infectious diseases |
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community programs
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>35 health programs in 16 agencies to serve the needs of our Nation’s children.
>Maternal and Child Health Bureau: -Maternal and Child Health Service Block Grant Program -Immunizations -The Healthy Start Initiative -The Emergency Medical Services for Children Program -The Abstinence Education Program WIC-provides moms with everything they need but maybe cant get. FMLA: your job has to give you off time to take care of your family with no penalty |
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child survival
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Growth monitoring
Hydration Immunization Breastfeeding Supplements |
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Providing Health Insurance
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Medicaid
Children’s Health Insurance Program (CHIP) |
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advocates for children
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Children Defense Fund
United Nations Children’s Fund American Academy of Pediatrics |
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adolescent and
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adult health
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Understanding age group health risks and problems
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Detect risks for specific target populations
Propose specific reduction programs: biggest cause of death= car accidents= biggest reason you get in a car accident is driving impaired (cell phones, drinking, drugs)--->when adolescents get in accidents they are more likely to have more people in the car=more deaths |
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adolescents and young adults
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>Fall into the 15- to 24-year-old range
>Critical time periods ~physical, emotional, and educational changes >Changing ethnicity ~Currently, about 58% NHW ~By 2050, this will be 38% |
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demography
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Living arrangements: have a lot of stress from moving. on average moves 9 times and 6 different jobs.
Employment status Independence: you find how independent you are. |
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employment status
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>Proportion of overall labor force has remained constant since 1980’s
>Unemployment rates vary significantly by race and ethnicity >Access to health care affected by employment status >Obama-care … age 26? get your parents insurance no matter what, unless you get married |
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health profile adolescents and young adults
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Mortality:
Medical advances have reduced death rate dramatically Physical threat comes primarily from behavioral activities war is a big factor (in war=more deaths) right now we are at an all time low Causes: Motor vehicle crashes Other unintentional injuries Homicides Suicides biggest threat = behavorial choices because of "illusion of inviscinability" SG |
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suicide
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2nd highest time for suicide (1st is old people)
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causes of morbidity
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Communicable diseases
Measles Sexually transmitted diseases CDC says 22% have STD |
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Health Behaviors and Lifestyle Choices of High School Students
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>Behaviors that contribute to unintentional injury
>Behaviors that contribute to intentional injury >Tobacco use ~Increased use of smokeless tobacco among teenage males >Alcohol and other drugs (highest ) >Sexual behavior ~Age at first intercourse gets lower every time we survey – currently 15.4/16.1 years (15.1/15.5=AA) |
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Strategies for Improving the Health of Adolescents
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Community Based
>Involving stakeholders Comprehensive Collaborative Multifaceted involve the people who are doing it; not just the mom's families talk to every body who is an important factor in your life and get everyone on the same page |
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Health of College Students
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Accidents
Violence Tobacco & Alcohol >25% / 64% of college students Drug Use >21% of college students |
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adults
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25-64 years old
represents about half the US population |
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health profile of adults
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Mortality:
Overall death rate improving (going down) >Improved health behavior and lifestyles Cancer Cardiovascular Disease Chronic Disease Accidents |
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death rates 24-44
45-64 |
main cause of death is accidents
2nd 1/2 of adulthood the 3 "C" are more deadly |
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Health Profile Adults
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Health Behaviors and Lifestyle Choices
>Smoking -Responsible for one in every six deaths >Lack of Exercise >Alcohol Consumption >Weight |
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Risk Factors for Chronic Disease
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Smoking
Lack of exercise Alcohol consumption Body weight |
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risk factors for personal injury
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safety belt use
drinking and driving -effects other people that is why it is the law (flying projectile) a huge part in promoting adult health is education. you may make better decisions |
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awareness and screening
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hypertension
diabetes cholesterol |
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Strategies for Improving the Health of Adults
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>Primary Prevention programs (edu. and programming to prevent these)
Exercise Nutrition >Secondary Prevention (surgery:bypass, blood thinners.) up 300% from 20 years ago Clinical Screening >Tertiary Prevention Medication Compliance (meds to help you live longer) |
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aged
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state of being old
old = 65+ Young-old = 65-75 Old-old = 75-85 Oldest-old = 85+ |
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aging
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changes that occur as living things grow older
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gerontology
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study of aging
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geriatrics
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medical practice specializing in treatment of the aged
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myth of aging: After age 65, life goes steadily downhill.
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There is no magic age that defines the boundary between healthy middle age and total decrepitude.
why do we believe this? it all started with SS, retirement was 65 and death age was much younger |
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myth: old people are all alike
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There are more differences among seniors than any other segment of the U.S. population.
(george blair 85 and ripped!) |
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myth: old people are lonely and ignored by their families
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Seniors are the least likely to be lonely of any age group; and those who live alone are likely to be in close contact, either in person or by telephone, with close friends and/or their children
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myth: old people are senile
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Senility is the result of disease and only affects about 5% of seniors living in noninstitutional settings
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myth: Old people have a good life
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Though seniors do gain certain advantages when they retire and when their children leave home, they still face a number of concerns such as loss of loved ones, loss of health, and loss of value in society (agism)
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myth: most old people are sickly
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Most older people do have at least one chronic health problem, but the majority of seniors are able to live active life-styles.
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myth: old people no longer have sexual interest or ability
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Sexual interest does not diminish with age, but there is a slight alteration in sexual response. Nonetheless, many seniors in reasonably good health have active and satisfying sex lives.
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myth: most old people end up in nursing homes
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Only approximately 6% of those above the age of 65 live in nursing homes. While that % jumps to 25% for the oldest old, (85 & over) it is still well below half.
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myth: old people are unproductive
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There is no consistent pattern to show superior productivity in any age group. productive in a different way
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demography of aging
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Size & growth
>2010: 19% of Americans are 65+ (baby boomers) >2025: est. 26% will be 65+ (we wont be able to pay for it!) Factors which affect population size & age: fertility rates mortality rates migration |
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demography of aging (all very similar, different in health)
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Marital status & other variables
Living arrangements Racial and ethnic composition (whites live longer) Geographic distribution (warm areas) Economic status- live comfortably |
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income source of seniors
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38% SS
21% earnings 19% assets 19% pensions 3% other |
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housing needs of seniors
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older homes
homes of lower value in need of repair less likely to have central heating and air conditioning less likely to have a telephone |
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morbidity of aging
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Chronic conditions
Long-term impairments >Environment >Lifestyle choices |
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mortality of aging
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Top causes of death:
Heart disease Cancer Stroke CLRD Alzheimer’s Disease Diabetes is rising quickly |
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health behaviors
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Less likely to:
consume large amounts of alcohol smoke cigarettes overweight or obese When compared to younger counterparts neglect and abuse: become more and more like a kid. by law they are like kids so it is illegal to neglect and abuse old people (older americans act 1965) |
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instrumental needs of elders
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Income
Housing Personal Care Health Care |
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transportation concerns of seniors
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Important to remain independent (their primary goal)
Solutions to transportation problems Fare reductions Subsidies to mass transit Subsidies for taxis Funds to assist centers in purchasing equipped vehicles |
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community facilities and services
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Meal service
>programs such as meals-on-wheels & congregate meals Homemaker service >enables elderly to remain in their own homes Chore & home maintenance service Visitor service Adult day care >provides care for seniors left alone all day Respite care Home health care Senior centers Other services |
