Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/86

Click to flip

86 Cards in this Set

  • Front
  • Back
Define health
"state of physical mental and social wellbeing and not merely the absence of the disease or infirmity"
Define heath
"state of optimum capacity for effective performance of valued task"
Disease
An object diagnosis by a health care worker.
Illness
A subjective feeling by patient.
Determinants of health

Biological
genetic endowment of the individual
Determinants of health

environmental
physical surrounding
social factors
personal lifestyle
Determinants of health

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

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

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

Community
Directed toward population groups and include services such as provision of pure drinking water, food inspection
health care service catagories

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

ie, immunization, and TB case finding and treatment programs
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
age, sex marital status, icome
qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

number
count of conditions, events, individual
qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

rate
contains numerator and denominator, customary to give rate as applying during a particular time periode.
qualitative perspectives on health and healthcare that may be used for understanding that nature and health status of the population.

health status
morbility (disease) and mortality (death)
utilization of health services
who, where, and what kind of health services
quantifying that nature, health status, and health utilization patterns of the population

description
describes the numbers and characteristics of the population being served.
quantifying that nature, health status, and health utilization patterns of the population

Program planning
descriptive data can reveal extence of poblems, data can be used to design solutions, evaluation after new programs are implemented.
crude death rate
what people are dying from
cause specific mortality
death due to a spacific cause
infant mortality
number of deaths under the age of one year amoung children born alive
life expectancy
age to which the average individual can be expected to live, given that the the person has reached a specified age.
incidence
number of new cause of the diseasee in question occuring during a particular time periode time periode, usually a year.
Prevalence
totaal number of case existing in a population during a time period, or at one point in time.
Explain why utillization of health care services date may be incomplete.
Doesn't get reports from alternative therapy providers.
Kerr-mills act
sought to eliminate some of the economic barriers to medical care for elderly medically indigents.
TIttle XVIII medicare
a program that provides finacing of medical care for elderly indigents.
Title XIX medicaid
provides financing for the poor
Private sectors of the US health care delivery system
Only serves regulary employed, middle and high income families.
offers individual choice.
Who the medical governemnt provides medical care for.
indian natives the indian health services
underserved rural areas
the old andthe poor
active military
veterans
public health care systems in the US
the public sector has to meet special eligibility requirements established by the government.
private health care system in the US
private patients have the freedom of choice of provider and facilites.
the public patient usually doesn't have that option.
Diagnostic related group (DRG) payment mechanism has played in the relation to the present provision of the hospital and ambulatory care services.
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.
Horizontal integration of hospital
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.
Vertical integration of hospital
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.
classifications used to differentiate hospital types.
acute care- 30 days or less

long term care- 30 day or more
Types of services

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

specialty hospital
concentrated on one disease process such as psychiatric or cancer.
Types of services

ownership
federal government
veterans, military, native american
Types of services

ownership
nonfederal government
owned by city, county, or state
Types of services

ownership.
non-government
not-profit or for-profit
Board of trustees
composed of members of the community who determine the goals of the hospitals daily operation
hospital administration
This is typical management structure that is responsible for hospital daily operation.
Medical staff
composed of staff and physicians with hospital privileges but responsible for the quality of medical serviced provided to patients.
Describe the role and importance of than national accreditation body.
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
Private practice/fee for service
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.
Managed care
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.
Explain the growth of and interest in hospital related ambulatory services from the hospital perspectives.
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.
Active daily living
ADL
bathing, dressing
Instrumental activities of daily living
IADL
shopping, cooking for self
List and describe the factors contributong to the growth of the long term care in the US.
Increaseing elderly population, changing family structure, nature of modern chronic disease, advert of cost containment in health care.
Long term service

Institutional services
Nursing facilities (nursing homes), psychiatric hospitals, correctional facilities, specialized institutional care
Long term services

Hospice care
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.
Long term services

Community facility services
adult day care andassisted living facilities.
What specific role does the "aging of America" roles play on need fro future LTC services?
There is a rapid increase in the number of elderly. The fastest growing segment in the population are thos 85 yr's and above.
What specific role does the "women's changing" roles play on need fro future LTC services?
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
Explain four reasons for the growth in home health care.
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.
Explain the pharmacist's role in the prevision of home care services.
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.
Mental care

preventive
aims at promoting goog mental health and preventing specific mental dissorders.
Mental care

Therapeutic
psychotherapies, hypnosis, drug terapy, etc
Mental health care

Rehabilitative
occupational training, socail skill training etc.
Explain how the delivary of mental health care is beset by many difficulties.
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.
Descride some of the priliminary evidence related to the impact of managed care on the provision of mental health services
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.
Describe national expenditures for health trends related to % of GDP, per capita spending and growth of spending
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.
Describe private payment mechanism (total, insurance and out of pocket) trends in relation to total national health expenditures.
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.
Blue cross/ blue shield
paid providers on a fee for service basis. The beginning of health insurance.
Commercial insurance
Usually provided to groups through employee fringe benefits packages, but can also be purchased individually
Managed care
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.
Community rating
sets premium based on health services utilization and cost projections for an entire community.
Experience rating.
based on anticipated use and cost for specified groups. With experiance rating, elderly lose out compared to younger healthier people.
Fee for service
Simple system in which the physician sets a price for each type of service delivered, then the patient or insurer pays the price.
Capitation
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.
Salary
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.
Advantages: related to DRG related prospective payment of hospitals for medicare patient.
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.
Disadvantage: related to DRG related prospective payment of hospitals for medicare patient.
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.
Identify characteristics used to differentiate b/w managed care and fee-for-service health care delivery system.
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.
Risk bearing
The amount of risk borne by providers (ranges to full risk of getting to no risk-HMO provides all Patients)
Relationship exclusivity
Addresses whether physician provides care to patients from one MCO only or to patients from multiple MCOs
Out of network coverage
Addresses whether care received from a provider who is not in the MCOs network is a covered benfit.
Physician type:
Relationship b/w managed care organization and physicians
List and describe two characteristichey
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.
Staff-model HMOs
contract exclusively with large capitated medical group who are not considered employees of the HMO.
IPA
Independent practice association
contracts nonexclusively with solo physicians or small physicians groups. This provides more freedom for doctors.
Explain why PPOs have become a popular managed care choice.
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.
Provide pro and anti managed care arguments related to the four ethical issues in managed care.
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
Describe the role report cards, NCQA and HEDIS play in reguard to measuring quality in managed care organization (MCO)
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