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130 Cards in this Set
- Front
- Back
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Why Will the Healthcare system continue to grow?
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Growth in population
Aging of the baby boomer population
Increased rates in cancer, diabetes, alzheimers
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Doctor of Osteopathic Medicine |
emphasises Hollistic Health approaches like diet, nutrition, spinal manipulation, and alternative therapies
Most are generalists
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Medical Doctorate (MD) |
Emphasize Allopathic medicine
Medical model
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Generalists |
Primary Care Physicians |
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What are Generalists usually trained in |
Family Medicine/general practice
Internal Medicine
General Pediactrics |
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Specialists |
Seek certification in a certain medical specialty that includes a separate residency and board exam |
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Primary Care |
Longitudinal
Focuses on Whole person
Students are trained in outpatient settings |
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Longitudinal care |
Regular visit basis |
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Specialty Care |
Only for certain organ or disease
Follows primary care, and usually needs a referral
Students trained in hospital settings |
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Episodic Care |
Patients only go as needed |
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Geographic Maldistribution |
Surplus of Physicians, but shortages in certain parts of the country |
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Why do most Physicians opt to concentrate in a Metropolitan area |
More patients=More money
More insured people
More accessible technology |
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Specialty Maldistribution |
slowed growth in primary care and rapid growth in specialty care |
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Why is there a Specialty Maldistribution? |
Medical Technology
Higher Income and Prestige
More predictable work hours
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Why go in to Primary care?
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Less schooling
Always needed
Get to know patients
In demand
Not the same thing everyday |
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Dentists |
Diagnose and treat problems related to teeth, gums, and tissue of the mouth
Usually work in private practices |
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Dental Specialties |
Orthodontics, endodontics, oral surgery |
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What kind of Degree do Dentists need?
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Doctor of Dental Surgery (DDS)
Doctor of Dental Medicine (DMD) |
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Why Are Dentists in Demand? |
Emergence of Dental Insurance
Populations with high dental needs
Greater Public awareness of dental care
Appeal of cosmetic dentistry |
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What is the population most in need for Dental care? |
Elderly |
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Pharmicists |
Dispense medicines and provide consultations on use of medcines
Most have a PharmD Degree and work in community rite aids |
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What can Pharmicists specialize in? |
Nutrition
Nuclear pharmacy |
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Optomitrists |
Specializes in eyes
Doctor of Optometry (OD) |
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Psychologists |
Doctor of Philosophy (PhD) or Doctor of Psychology (PsyD) |
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Podiatrists |
Specialize in feet and usually have a Doctor of Podiatric Medicine |
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Chiropractors |
Focus on Muskuloskeletal system and spinal manipulation
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Nurses |
Largest group of health care professionals
Work in variety of settings |
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Associates Degree in Nursing (ADN) |
2 year degree, Sit for state liscensure |
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Bachelor of Science in Nursing (BSN) |
More common Sit for state licensure Most major hospitals only hire these |
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Licensed Practical Nurses |
One year program at a technical college complete with state licensure and examination. Assists and are overseen by Nurses |
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Certified Nurse Midwives |
Perform vaginal deliveries Prenatal care CANNOT Do C-sections |
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NonPhysician Practitioners (NPPs) |
Clinical professionals who practice medicine an many areas but do not have an MD or DO
Less training than a physician but more than a nurse |
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Physicians Assistants (PA) |
Assist physicians in the provision of care and perform medical procedures under supervision of physicians
Work in primary or specialty care |
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Nurse Practitioners |
RNs with expanded role including patient education and prescribing medications |
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VAlue of NPP Services |
provide high quality and cost effective medical care
Greater personal interest in patients, better communication |
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Barriers NPPs face |
Legal restrictions of practice
Reimbursement may be indirect
Sometimes challenging relationship with Physician |
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Allied Health Professionals |
other professionals who serve as compliment to doctors and nurses by being trained in technology and specialized interventions |
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Technicians and Assistants |
Receive a <2 year degree
under supervision of technologists/therapists |
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Technologists and Therapists |
More advanced training in order to evaluate, diagnose, and treat
Teach Technicians and Assistants |
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Health Services Adminitrators |
Employed at top, middle and entry levels of various organizations that deliver health services
Responsible for the operational, clinical, and financial outcomes of the entire organization |
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The effect of the Affordable Care Act |
Emphasis on preventive care and coordination of services
Funding given to increase academic training in primary care
Funding some loan forgiveness programs |
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Medical Technology |
The practical application of the scientific body of knowledge to improve health and create efficiencies in the delivery of health care
Benefits from research in chemistry, physics, engineering |
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Types of Medical Technology |
Diagnostic equipment Pharmaceuticals Equipment and devices to render treatment Medical procedures: surgeries Facilities and organizational systems |
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Information Technologies |
Manages information used in patient care |
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Clinical Information System |
Electronic Health records Dr. can send prescription directly to pharmacy |
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Administrative information systems |
Automated system |
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Decision support system |
Administrators that make managerial decisions and track quality outcome trend data
Also Bill to Medicare and Medicaid |
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Health Informatics |
The application of information science to improve efficacy, accuracy and reliability of health services
goes beyond IT by focusing on improvement |
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Electronic Health Records |
Electronically stored information pertaining to individual [atients to deliver health care services |
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Four key Concepts of Electronic Health records |
1. Collection of storage of Health info 2. Immediate access by authorized users 3. Decision support 4. Improved Efficacy |
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HITECH Act |
$19 billion to promote use of EHRs
2011-2014 |
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HIPAA 1996 |
Confidentiality of the patient
Use only for health care delivery, operations, reimbursement
Established patient right to inspect and obtain copies and to restrict use of information |
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E-health |
all forms of electronic health care delivered over the internet |
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Telemedicine |
Distance medicine that uses telecommunications for diagnosis and patient care |
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Telemedicine Barriers |
Licensure across state lines Legal Liabilities Lack of Reimbursement Unsubstainted Cost effectiveness |
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Technological Diffusion |
Spread of technology into society |
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Technological Imperative |
Desire to have the latest and greatest despite the cost |
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Factors that Drive Innovation and Diffusion |
Cultural beliefs and Values Medical Training and Practice Payment for Service Competition among providers |
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Role of Government in Medical Technology |
Federal legislation aimed at addressing issues of cost, safety, benefits, and risk |
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FDA |
responsible for ensuring medical devices are safe and effective |
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FDA Modernization Act of 1997 |
Allows fast approval for life-saving drugs or devices that are significantly better than those currently available |
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FDA Regulation of Devices Class I |
Branding -Gloves, bandages, bedpans -registered, labeled, and branded |
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FDA Regulation of Devices Class II |
Subject to performance Standard |
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FDA Regulation of Devices Class III |
Most stringent requirement for safety and effectiveness
i.e. surgical equipment |
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Quality of Care |
The degree to which health care services increase the likelihood of desired health outcomes |
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Quality of Life |
Faster recover times Overcoming limitations Ability to manage chronic conditions Relief from pain and suffering |
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Bioethics |
Concern for ethical and moral dilemmas in health care |
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Medical Technology Assessment determines... |
Efficacy Safety Cost-effectiveness |
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Efficacy |
did it do what it was supposed to do? |
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Objective of Medical Technology Assessment |
to establish the appropriateness of medical technology for widespread use |
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Health Services Financing |
Any mechanism that gives people the ability to pay for health care services |
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Sources of Financing |
1. Private 2. Public Insurance 3. Uninsured |
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What will the ACA do for financing? |
Increase public insurance and decrease Uninsured |
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Moral Hazard of Health Insurance Financing |
higher utilization of health care since services covered by insurance |
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Provider-induced demand |
provider's ability to create demand for services based on reimbursement |
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Cost Sharing |
shared cost between Insurance company and Insured patient |
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Premiums |
The amount charged for insurance coverage
Usually paid monthly |
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Deductible |
The amount that the insured has to first pay before any benefits are paid by the plan
Paid on annual basis |
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Copayment |
Amount the insured has to pay out of pocket each time health services are received
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Stop-loss Provision |
Maximum amount out-of-pocket liability an insured would incur in a year |
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Group Insurance |
Offered through an em[ployer, union, or professional organization
Risk & Cost shared equally among insured |
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Self Insurance |
Used for employers with 5,000+ employees
Assume risk and pay all claims, which gives employers greater degree of control |
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Individual Private Insurance |
For those who do not have group insurance
Self employed, retired, part time, small business |
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Managed Care Plans |
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs)
Assume risk in exchange for insurance premium and contract with network providers |
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High-Deductable Health Plans (HDHP) |
Low cost premiums
Linked with Personal savings account used to reimburse the insured for qualified medical expenses |
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Private Insurance and the ACA |
Cover Young adults Cover pre-existing conditions No lifetime limits minimum essential coverage all employers and individuals required to have insurance or pay fee |
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Health Insurance Exchanges |
created to help individuals purchase competitive coverage |
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Medicare |
Federal program to help insure: -65+ -Disabled individuals receiving social security -People with end-stage renal disease
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Why does Medicare Pose the greatest future challenge of all programs? |
Declining workforce and wages will cause more difficulties to pay
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How is Medicare financed? |
Payroll taxes (1.45% x2): split between you and employer
Beneficiary deductibles, premiums, coinsurance
General taxes |
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Medicare Part A |
-Hospital Inpatient: first 60 days after deductible -Skilled Nursing Facility: Fully paid for first 20 days -Home Health: Up to 100 visits following hospital without deductible or copay -Hospice: fully paid for and also offers respite care |
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Medicare Part B |
Unlimited physician care Outpatient services Ambulance and ER Limited Home Health --> Requires beneficiaries to pay monthly premium ($104/month f earn more than $85,000) --Coinsurance for 20% covered services |
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Medicare Part C (Medicare Advantage) |
Optional program that operates under a managed care plan
May offer extra benefits and lower out of pocket costs
Privitized Medicare |
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Medicare Part D |
Prescription drug benefit (2006)
"Doughnut hole" coverage
turns over money to private plans |
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What are Medicare limitations |
Eye care Hearing aids Dental Care Experimental treatments Long term care |
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Medicare Costs |
Older adults pay 4x as mucg No out of pocket limit |
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Medigap |
Private insurance covers remainder of medical bills
Only about 30% of beneficiaries have it |
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Medicare and the ACA |
"Doughnut Hole" slowly eliminated
Preventive care vegins to increase cost
Reductions in payment in Part C plans |
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Medicaid |
Provides health care services for the indigent and other needy groups
Federal requirement, but administered by States -Jointly financed |
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Medicaid and Health Reform |
Payments to primary care doctors increased
Some states expanded to 138% of poverty level covered |
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Children's Health Insurance Program (CHIP) |
offers additional funds to states to expand Medicaid eligibility for children whos families may not qualify |
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Reimbusement |
Payment made by third-party payers to providers |
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Best payers for Reimbursement |
1. Private Insurance 2. Medicare 3. Medicaid |
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Fee for Service |
Services billed separately as a set of identifiable units of service |
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Managed Care Reimbursement PPOs |
establish fee schedules based on discounts negotiated with providers |
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Managed Care Reimbursement HMOs |
pay doctors a salary or use capitation |
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Capitation |
Provider is paid a set monthly fee per enrollee, regardless of how often enrollee sees provider |
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Retrospective Reimbursement |
Payment based off of what was paid in past years |
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Prospective Reimbursment |
pre-established criteria to determine in advance the amount of reimbursement |
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National Health Expenditures |
Estimate of the amount spent for all health services, supplies, research, and construction activities in a year |
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What is Outpatient Care? |
Any health care services that do not require an overnight stay in a hospital or long-term care facility |
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Ambulatory care |
"walking" of a patient, where patient is able to leave in same day of procedure/service |
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Scope of Outpatient Care |
More than Primary care services Most diagnostic testing and surgeries Growth of non-hospital services intensified competition |
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Use of Outpatient Care
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Increased volume of services in new settings Americans average 3 visits per year |
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Outpatient reimbursement |
Costs far less than an inpatient care |
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Utilization Control |
Inpatients stays strongly discouraged by payers |
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Why use Outpatient instead of Inpatient? |
Technology Utilization Control Social factors |
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Private Practice in Physicians Office |
majority of outpatient centers
Most visits are short
Group practices, some partnered with hospital |
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Hospitals |
expanded outpatient care to be key source of profits |
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Freestanding facilities |
primary to urgent care, routine services for acute conditions, outpatient surgery centers |
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Mobile facilities |
Health care services that are transported to patients
Provides rural areas with access to advanced services
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Telephone Triage |
expert advice given to patient over the phone |
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Home Health Care |
services brought to patients in their own home |
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Hospice |
Provides palliative care to terminally ill |
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Community Health Centers |
Required by law to be located in medically underserviced areas and to provide care to anyone regardless of the ability to pay
Funded by federal and state governments |
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Free Clinics |
Primarily serves poor and uninsured
Services provided at low or normal costs
Charity organizations that rely on donations or grants
Mainly volunteer staff |
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Primary Care |
Basic and routine care that is provided by a physician or NPP who takes responsibility for coordination of all aspects of patients health |
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Secondary Care |
Health services that are short term and more complex, usually involving consultation from a specialist |
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Tertiary Care |
Most complex level of care, needed for conditions that are relatively uncommon |
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Complementary and Alternative Medicines |
All health care resources other than those instrinsic to biomedicine |
