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36 Cards in this Set
- Front
- Back
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3 SUB-SYSTEMS OF US HEALTHCARE DELIVERY
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managed care
military vulnerable populations |
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MANAGED CARE
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system of delivery that:
- seeks to achieve efficiency by integrating the basic functions of healthcare delivery - employs mechanisms to manage the utilizations of medical services -determines the price at which the services are purchased and how much providers get paid **most dominate healthcare system in USA and available to most insured americans ***employers and government are primary financiers of managed care |
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FUNCTIONS OF MANAGED CARE
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1- premium monthly payment
2- deductible ceiling (ex/ 3000) 3- claim premiums increase |
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FOUNDATIONS OF USA HEALTHCARE
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medical / biomedical model
*pre-supposes existing illness or disease -emphasizes clinical diagnosis and medical interventions to treat symptoms or disease, have clinical diagnosis and interventions |
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WHEN DOES OPTIMAL HEALTH EXIST?
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when a person is free of symptoms and doesnt require medical treatment
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MAJOR CHARACTERISTICS OF US HEALTHCARE DELIVERY
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USA has unique system; complex and massive
300 million americans included (187million have private insurance, 35 million medicare, 31 million medicaid) delivery can be different, but both usually refer to: 1) major components of the system 2) processes that enable people to receive healthcare 3) provision of health services to patients |
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OTHER COUNTRIES' HEALTHCARE SYSTEM IN CONTRAST TO USA HEALTH
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- most developed nations have national health insurance programs, aka universal access
- this provides basic and routine healthcare - ran by the government and financed through general taxes ***all americans are NOT entitled to basic and routing healthcare services |
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WHERE CAN HEALTH INSURANCE BE BOUGHT FROM?
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health insurance companies (10,000)
ex/ blue cross blue shield (over 70 plans available) |
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ORGANIZATIONS FROM MANAGED CARE SECTOR
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540 HMO's (health maintenance organizations)
925 PPO's (preferred provider oranizations) |
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WHY DO DOCTORS/HOSPITALS GIVE SO MUCH HEALTHCARE?
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lack of evidence as to which treatments are most effective
which drugs are efficacious "see for service"-- $ by # of patients. this means more money by the amount of health that they give, not by the accuracy of health administered |
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HOLISTIC HEALTH
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-treats the whole person
-incorporates complimentary therapies literature shows that religious and spiritual belief has positive impact over well-being -effects incidence, experience, and outcomes on common medical problems |
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HEALTHY PEOPLE 2010
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social and market justice approaches to improving the nations health
- production, distribution, and consumption of healthcare must be perceived as equitable ****no society has a perfectly equitable method to distribute limited resources * any method of resource distribution leaves some inequalities theory of justice--- needed to resolve allocation of healthcare |
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2 THEORIES OF EQUITABLE ACCESS TO HEALTHCARE DELIVERY
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market justice
social justice |
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MARKET JUSTICE
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the economic good
fair distribution of healthcare to the market forces in a free economy medical services distributed on the basis of peoples willingness and ability to pay |
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SOCIAL JUSTICE
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"the good society"
-theory at odds with capitalism and market justice |
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USA VS CANADIAN HEALTHCARE
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USA PROS-
# of facilities and doctors -speed of treatment USA CONS-- -cost - DR's are overworked - sick-care system CANADA PROS -universal access -more time spent on caring for people -for the citizens, $ isnt an issue -well care, proactive approach CANADIAN CONS - wait very long time for care |
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EQUITABLE DISTRIBUTION
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part of social justice, its the societies' responsibility
- best when a central agency is responsible for the production and distribution of healthcare -healthcare is a social good; should be collectively financed and available to every citizen -based upon need rather than cost |
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SHARED RESPONSIBILITY OF HEALTH
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factors outside a persons control might have brought on the condition
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OBLIGATION TO THE COLLECTIVE GOOD
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the well-being of community is superior to that of the individual
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PLANNED RATIONING
SUPPLY-SIDE RATIONING NON-PRICE RATIONING |
government limits the supply of healthcare services, particularly those beyond the basic level of care
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COMPLIMENTARY AND ALTERNATIVE MEDICINE
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group of diverse medical and healthcare systems, practices, and products that arent considered to be part of conventional medicine
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RESEARCH SUPPORT ON CAM
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key questions that are yet to be answered through well-designed scientific studies
*(whether or not these therapies are considered safe) *whether they work for the diseases or medical conditions for which they are used |
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COMPLIMENTARY VS ALTERNATIVE MEDICINE
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complimentary is used with conventional medicine
alternative is used in place of conventional medicine |
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D.O.
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doctor of osteopathic medicine
think more hollistically, can still prescribe medicine |
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D.C.
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doctor of chiropractic medicine
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INTEGRATIVE MEDICINE
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combines mainstream medical therapies and CAM therapies for which there is some high quality scientific evidence of safety and effectiveness
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MAJOR TYPES OF CAM
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alternative medical systems
mind-body interventions biologically based therapies manipulative and body-based methods energy therapies |
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ALTERNATIVE MEDICAL SYSTEMS; AURVEDIC MEDICINE
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based in India; includes yoga, medicine, and diet
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TRADITIONAL CHINESE MEDICINE
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well-care, chi
Maximize health; thoughts and emotions shape health taoism - balance techniques |
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MIND-BODY INTERVENTIONS
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music making you happy by increased cortisol levels, ex/ art and dance
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BIOLOGICALLY BASED THEORIES
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vitamin care
special diets |
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MANIPULATIVE AND BODY-BASED METHODS
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massage therapy
chiropractics |
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ENERGY THERAPIES
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reiki therapy
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STRESS RESPONSE IN THE BODY
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increased level of cortisol in the blood
inhibits SiGH (immune hormone) decreases risk for oppurtunistic infections |
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CAM STATISTICS IN THE USA
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-40% americans used some type of CAM in 2008
-visits to CAM practitioners rose 50% since 1990 - CAM expenses exceed out of pocket expenses from all hospitalizations in 2008 -most common therapy is non-vitamin, non-mineral natural products among adults -meditation, breathing, yoga therapies on the rise - most use CAM for musculoskeletal injuries like neck, back, or joint pain - CAM therapies for head/chest colds substantial increase from 2002-2007 |
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DEMOGRAPHICS OF CAM USE
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- cam higher among women than in men (49% - 38%)
- lower in blacks than any other racial group - higher in 35-49 age group than in older or younger - higher in college educated than in non-college educated more common with those of an income higher than $50K a year than in lower income -used higher in the west than in the rest of the US |
