Pharm 706 Exam 1

Front 1

Define health

Back 1

"state of physical mental and social wellbeing and not merely the absence of the disease or infirmity"

Front 2

Define heath

Back 2

"state of optimum capacity for effective performance of valued task"

Front 3

Disease

Back 3

An object diagnosis by a health care worker.

Front 4

Illness

Back 4

A subjective feeling by patient.

Front 5

Determinants of health

Biological

Back 5

genetic endowment of the individual

Front 6

Determinants of health

environmental

Back 6

physical surrounding
social factors
personal lifestyle

Front 7

Determinants of health

psychological

Back 7

derangements in psychic functioning have been shown to cause physical health problems, including death.

Front 8

Determinants of health

social

Back 8

Goes beyond the individual to society as a whole.
May have to do with race, social class, nationality, and occupation

Front 9

health care service catagories

Personal

Back 9

Services that deal directly with individuals for the maintenance of health or the control/cure of illness.

Front 10

health care service catagories

Community

Back 10

Directed toward population groups and include services such as provision of pure drinking water, food inspection

Front 11

health care service catagories

combined

Back 11

Health care services hace aspects of body personal and community health services.

ie, immunization, and TB case finding and treatment programs

Front 12

qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

simple number or demographic characteristics

Back 12

age, sex marital status, icome

Front 13

qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

number

Back 13

count of conditions, events, individual

Front 14

qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

rate

Back 14

contains numerator and denominator, customary to give rate as applying during a particular time periode.

Front 15

qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

health status

Back 15

morbility (disease) and mortality (death)

Front 16

utilization of health services

Back 16

who, where, and what kind of health services

Front 17

quantifying that nature, health status, and health utilization patterns of the population

description

Back 17

describes the numbers and characteristics of the population being served.

Front 18

quantifying that nature, health status, and health utilization patterns of the population

Program planning

Back 18

descriptive data can reveal extence of poblems, data can be used to design solutions, evaluation after new programs are implemented.

Front 19

crude death rate

Back 19

what people are dying from

Front 20

cause specific mortality

Back 20

death due to a spacific cause

Front 21

infant mortality

Back 21

number of deaths under the age of one year amoung children born alive

Front 22

life expectancy

Back 22

age to which the average individual can be expected to live, given that the the person has reached a specified age.

Front 23

incidence

Back 23

number of new cause of the diseasee in question occuring during a particular time periode time periode, usually a year.

Front 24

Prevalence

Back 24

totaal number of case existing in a population during a time period, or at one point in time.

Front 25

Explain why utillization of health care services date may be incomplete.

Back 25

Doesn't get reports from alternative therapy providers.

Front 26

Kerr-mills act

Back 26

sought to eliminate some of the economic barriers to medical care for elderly medically indigents.

Front 27

TIttle XVIII medicare

Back 27

a program that provides finacing of medical care for elderly indigents.

Front 28

Title XIX medicaid

Back 28

provides financing for the poor

Front 29

Private sectors of the US health care delivery system

Back 29

Only serves regulary employed, middle and high income families.
offers individual choice.

Front 30

Who the medical governemnt provides medical care for.

Back 30

indian natives the indian health services
underserved rural areas
the old andthe poor
active military
veterans

Front 31

public health care systems in the US

Back 31

the public sector has to meet special eligibility requirements established by the government.

Front 32

private health care system in the US

Back 32

private patients have the freedom of choice of provider and facilites.
the public patient usually doesn't have that option.

Front 33

Diagnostic related group (DRG) payment mechanism has played in the relation to the present provision of the hospital and ambulatory care services.

Back 33

DRGs have created incentives contrary to fee for servce, hospitals are motivated to perform fewe procedures and discharge patients as quickly as possible. B/c of this hospital occupancy rates have decreaased, and hospital have begun to unbundled services to bill seperately.

Front 34

Horizontal integration of hospital

Back 34

hospital have begun to form affiliations with one anothe to improve efficiency and to secure better opportunities for purchasing equipment. Hospital combine to get more coverage in a city.

Front 35

Vertical integration of hospital

Back 35

a provision of a continum of services. One hospital has everything a person would need for his entire life. This helped integrate the health care delivery system.

Front 36

classifications used to differentiate hospital types.

Back 36

acute care- 30 days or less

long term care- 30 day or more

Front 37

Types of services

general hospital

Back 37

provide a variety of services, general medical and surgical services.

Front 38

Types of services

specialty hospital

Back 38

concentrated on one disease process such as psychiatric or cancer.

Front 39

Types of services

ownership
federal government

Back 39

veterans, military, native american

Front 40

Types of services

ownership
nonfederal government

Back 40

owned by city, county, or state

Front 41

Types of services

ownership.
non-government

Back 41

not-profit or for-profit

Front 42

Board of trustees

Back 42

composed of members of the community who determine the goals of the hospitals daily operation

Front 43

hospital administration

Back 43

This is typical management structure that is responsible for hospital daily operation.

Front 44

Medical staff

Back 44

composed of staff and physicians with hospital privileges but responsible for the quality of medical serviced provided to patients.

Front 45

Describe the role and importance of than national accreditation body.

Back 45

The joint commission is the body that accreditis hospital. They set standards and accredit hospitals based on those standards. They also accredit LTC facilities, psychiatric hospital, hospices, etc. Accreditstion id critical for fulfilling state license requirments and for receiving reimbursement in the medicare and mediciad programs

Front 46

Private practice/fee for service

Back 46

CAre provided on a fee for service basis. Patient or the patient's services other than the physician and pays the physician fee directly. Can bee a solo practice or a group practive of physicians.

Front 47

Managed care

Back 47

A structured network of providers formed to offer cost effective services, with a emphasis on preventive care. Managed care is bult on the foundation of the primary care provider or "gatekeeper." May be seen as an HMO-which is a prepaid health plan in which enrollees pay fix fee fro designated health services, or it may be a PPO-Preferred provider organization where the organization contracts to provide health services for set fee through the use of selected physicians.

Front 48

Explain the growth of and interest in hospital related ambulatory services from the hospital perspectives.

Back 48

Ambulatory services help to expand a hospital's patient base for inpatient services. It improves access to understand population. It is cheaper than being in the hospital.

Front 49

Active daily living
ADL

Back 49

bathing, dressing

Front 50

Instrumental activities of daily living
IADL

Back 50

shopping, cooking for self

Front 51

List and describe the factors contributong to the growth of the long term care in the US.

Back 51

Increaseing elderly population, changing family structure, nature of modern chronic disease, advert of cost containment in health care.

Front 52

Long term service

Institutional services

Back 52

Nursing facilities (nursing homes), psychiatric hospitals, correctional facilities, specialized institutional care

Front 53

Long term services

Hospice care

Back 53

goal therapy is maintaing the quality of a patient's life rather than curing tha patient's disease. It is usually an in home service.

Front 54

Long term services

Community facility services

Back 54

adult day care andassisted living facilities.

Front 55

What specific role does the "aging of America" roles play on need fro future LTC services?

Back 55

There is a rapid increase in the number of elderly. The fastest growing segment in the population are thos 85 yr's and above.

Front 56

What specific role does the "women's changing" roles play on need fro future LTC services?

Back 56

Much of the care giving in the home is provided by women so now women have to balance a job, kids, and their parents. This is known as sandwhich generation

Front 57

Explain four reasons for the growth in home health care.

Back 57

1.medicare prospective payment system.
2. Due to DRGs hospitals want patients out faster but they must not be all betterso home healthcare is the solution.
3. The increase in technology have allowed patients to do things at home that didn't used to be pssible (IV and telecommunication). Home health care is what most people want.
4. It has been found that people heal better at home.

Front 58

Explain the pharmacist's role in the prevision of home care services.

Back 58

Pharmacists help with home infusion therapy. This includes things like cancer drugs, pain management, nutrition, anti-infectives and more. Pharmacists play a crucial role in the management of these home infusions.

Front 59

Mental care

preventive

Back 59

aims at promoting goog mental health and preventing specific mental dissorders.

Front 60

Mental care

Therapeutic

Back 60

psychotherapies, hypnosis, drug terapy, etc

Front 61

Mental health care

Rehabilitative

Back 61

occupational training, socail skill training etc.

Front 62

Explain how the delivary of mental health care is beset by many difficulties.

Back 62

Access to mental healthcare can be difficult in some areas. It also carries a social stigma. The mental health care delivery system is poorly coordinated with other programs like general medicine, education, et. Since many mental disorders are life long, long term management ia required.

Front 63

Descride some of the priliminary evidence related to the impact of managed care on the provision of mental health services

Back 63

Managed care organizations have become more active in their expansion of mental health service to the public ae well as to the employed population.

The downside is that therapists are working for multiple people, there has been a reduction in services, there my be fewer referrals when patient is in a HMO, and there is a bias towards medication only.

Front 64

Describe national expenditures for health trends related to % of GDP, per capita spending and growth of spending

Back 64

15.3% of the GDP was spent for health purpose in 2003. This was an average spending of $5,670 per person. Spending is still growing every year but a a lower rate in 2003 versus 2002.

Front 65

Describe private payment mechanism (total, insurance and out of pocket) trends in relation to total national health expenditures.

Back 65

in 2003, 54% of health care was paid either out of the pocket or through insurance. The government did not pay it. Out of this private sector, 14% is directly by the consumer and insurance covers the rest. Insurance is the contribution by individuals to a fund for the prupose of providing protection against finacial losses following relatively unlikely but damaging effects.

Front 66

Blue cross/ blue shield

Back 66

paid providers on a fee for service basis. The beginning of health insurance.

Front 67

Commercial insurance

Back 67

Usually provided to groups through employee fringe benefits packages, but can also be purchased individually

Front 68

Managed care

Back 68

system that integrates the financing and delivary of appropriate medical care. It contracts with selected physicians and hospitals and pay them a monthly premium whether you use the service or not.

Front 69

Community rating

Back 69

sets premium based on health services utilization and cost projections for an entire community.

Front 70

Experience rating.

Back 70

based on anticipated use and cost for specified groups. With experiance rating, elderly lose out compared to younger healthier people.

Front 71

Fee for service

Back 71

Simple system in which the physician sets a price for each type of service delivered, then the patient or insurer pays the price.

Front 72

Capitation

Back 72

They physicians receives a capitated annul payment for each patient who use that physician as a primary privider. The doctor gets the money whether tha patient uses the services or not.

Front 73

Salary

Back 73

Managed care just provides the physician a salary per year. This makes things simple for the administration and keeps the physician's income protected from sudden fluctuation.

Front 74

Advantages: related to DRG related prospective payment of hospitals for medicare patient.

Back 74

THe basis of payment is the case treated rather than the ancillary or routine inputs to hospital care. So the company is paying only for the service and not any other crap. It saves money.

Front 75

Disadvantage: related to DRG related prospective payment of hospitals for medicare patient.

Back 75

Not sure that what cost DRG assigns to procedure will actually cover the real cost of the procedure. Using DRGs cause hosptials to want to hip expensive patients to other hospitals b/c they will not profit. Also b/c of DRGs, there has been a large increase in the use of post hospital service.

Front 76

Identify characteristics used to differentiate b/w managed care and fee-for-service health care delivery system.

Back 76

The key defining feature of managed care versus fee-foe-service is the use of provider networks. A network is a group of providers who are linked through contractual arrangements are supply a full range of primary and acute care services.

Front 77

Risk bearing

Back 77

The amount of risk borne by providers (ranges to full risk of getting to no risk-HMO provides all Patients)

Front 78

Relationship exclusivity

Back 78

Addresses whether physician provides care to patients from one MCO only or to patients from multiple MCOs

Front 79

Out of network coverage

Back 79

Addresses whether care received from a provider who is not in the MCOs network is a covered benfit.

Front 80

Physician type:

Back 80

Relationship b/w managed care organization and physicians

Front 81

List and describe two characteristichey

Back 81

Place providers at financial risk; capitation is one of the most common risk arrangements-where the costs for a given population are first estimated.

Most HMOs provide no coverage for car received out of network.

Gatekeeper-a central components of most HMOs. They are primary care physicians or PA's etc who cordinate and authorize all medical services, including lab, specialty referals, and hospilization.

Front 82

Staff-model HMOs

Back 82

contract exclusively with large capitated medical group who are not considered employees of the HMO.

Front 83

IPA

Back 83

Independent practice association
contracts nonexclusively with solo physicians or small physicians groups. This provides more freedom for doctors.

Front 84

Explain why PPOs have become a popular managed care choice.

Back 84

they are perceived by patients to be similar to traditional indemnity insurance. They do not capitate physicians in their network. The physicians accept discounted fee-for-service but they get many more patients and quick payment turnaround.

Front 85

Provide pro and anti managed care arguments related to the four ethical issues in managed care.

Back 85

sancity of physician-patient relationship

ethics of medicine-finacial above a person's life

Quality of care- reduced to make a profit.

freedom of choice for patient and provider

Front 86

Describe the role report cards, NCQA and HEDIS play in reguard to measuring quality in managed care organization (MCO)

Back 86

Report cards are used to release info on the quality of MCOs. They includ info on both cost and qualitut thay are self-report cards