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53 Cards in this Set

  • Front
  • Back

Rural Hospitals exist where?

Outside city of more than 50,000 or metro area of 100,000 ppl

Rural Hospital Probs

Threat of closure


No money if less than 50 beds


Quality of care may be poor


Hard to attract health professionals

Solutions to probs

Introduce ambulatory care/long term services


Expand technology capabilities


Telemedicine

What has large influence on the development of mental health?

Politics

Colonial times (mental health)

Mentally ill kept at home/wandered from town to town. Jailed sometimes.

Early 1800's (mental health)

Quakers and Physicians treated

1841 (Mental Health)

Dorthea Dix-reform to build special hospitals

Late 1800's (Mental Health)

Overcrowded poor hospital conditions

20th century (mental health)

Thousands of men rejected from WWI


- psychoneuroses


- war neuroses


- Situation stress cause

1910 and WWII

Little help for schizophrenia

1930's

Insulin come, drug induced compulsive treatments

WWII

1.75 million men rejected


many returned with mental illness


1946 national mental health act and national institute of mental health

Mid 1950's

New drugs-live in halfway houses


Joint commission on mental illness and health 1955


Emphasized community mental health care

1965

Medicare and Medicaid

ADL's vs, IADL

ADL: Measure of dependence on others for assistance with core functions



IADL: Measure of ability to perform household and social tasks

Mental Health Summary

1800s - kept at home
1841 - Dorthea Dix reform
1930s - physical "cures"
1946 - Act to treat vets
1955 - Opened Act to public
1965 - Medicaid
1977 - Mental Health System Act
1980 - Reagan shoots down Act
1992 - Clinton includes mental health reform

ADL examples

Eating, bathing, walking, going to bathroom

IADL examples

Shopping, cooking, managing money, paying bills, traveling to and from ones home

Long term care

Range of supportive, rehabilitative, nursing, and palliative services provided to people young and old who's capacity to perform daily activities is restricted due to chronic disease or disability

Medicare Financing (what does it finance?)

ONLY the SKILLED part of long term care


- skilled nursing facilities


-short term rehabilitation care related to hospital stay or outpatient procedure


(Covers care for 100 days following stay of at least 3 days)


- pays for skilled home care

Medicaid Financing (what does it finance?)

Pays MOST of CUSTODIAL long-term care

Discuss use of prescription drugs in US

In US, we use a lot of prescription drugs


-Nat'l expenditure since 1990 has tripled


-40% unnecessary

Factors making use a problem

higher price for drugs


Increasing # of prescriptions


New higher price replacing older low priced drugs

How many ppl will pay $1000 out of pocket for medications in 2001

27%

How does cost of drugs in US compare to other countries?

Much higher in US


-33% than Canada


-60% higher than united kingdom

What % of pop. does medicare cover?

14%

Tax Rate for pharmaceuticals vs tax rate for other industry

16.2% vs. 27.3%


- tax rate is much lower and profit is much higher for pharmaceuticals vs. other companies in other industries

Formularies and tiered pricing

Formularies: lists of medications


-function is to specify which meds are approved to be prescribed under contracts


-Physicians are against this... Believe they should pick medications


-Generic are least expensive ($5)


-Off formulary are most ($30)

Define Hospice Care

Focus on comfort and managing pain of dying patients


Care may be provided in home of patient or at a facility designed for patients who are dying

Define terminal illness

An illness form which there is little or no home of recovery and that will most likely cause death in the near future

Where did hospice care come from?

Came from Canada and England

Main goals in hospice care is what?

To control pain


Create comfortable environment


Allow patient to be close to family and loved ones during dying process


Give relief to at home care givers


offer counseling to patient and family

What happened in 1983 to medicare?

Medicare added hospice care to decrease hospital costs


-80% in home


Problems of health care in rural areas?

1/2 as mant physicians


less likely to have employer provided health care


2x more likely to die of motor vehicle accident


Pooper


Older


Alcohol and smokeless tobacco big problem


less likely to have routine dental care


fewer mental health professionals


suicide rate higher in men


greater transportation difficulties in reaching health care providers

Changes in FDA

-1897 Harvey Wiley wrote the ladies home journal article


-1905 Upton Sinclair wrote the jungle discussing meat packing industry


-1906 Pure food and drugs act


-1938 food, drug, and cosmetic act


-1962 Drug amendment act (got rid of thalidomide that caused birth defects)


-1997 FDA modernization act (brings new drugs for AIDS, Alzheimer's, and cancer)

Things to remember about FDA

Public has made most changes to FDA over the years


FDA does not have authority over the market


To let FDA have authority, congress must pass a law

History of hospitals

1873: most care done by family at home due to lack of hospitals


1870-1910: First period of growth... Nurses and new surgical techniques administered


1910-1945: First period of consolidation... not a lot happened because of world wars and great depression; fewer hospital built now in this time period than any other time due to shortage of money.


1945-1980: Second period of rapid growth... This was a time of rapid growth!


1965: Medicare/Medicaid/BlueCross developed during this period

What is primary care?

Provision of integrated, accessible care services by clinicians who are accountable for addressing a majority of the person health care needs, developing a sustained partnership with patients, and practicing in the contact of family and community

Emergency Room Care

Nonurgent: does not require emergency room; disorder is non acute, minor in severity


Urgent: Requires med attention w/i a few hrs; disorder is acute but not severe


Emergent: Condition required immediate med attention; disorder is acute and is life threatening

Bottom line desire for direct to consumer prescription drug advertising is ______________?

profit


- In the US only

Why are prescription drugs so expensive?

- Patent protection


- Advertised on TV, high cost substitutes for lower priced equally effective generic drugs


- 25 of most heavily advertised drugs accounted for 41% of the increase in drug spending


Utilization of prescription drugs

We use a lot of prescription drugs


-9 in 10 americans take them


-54% on regular basis

Pharmacist training and supply

increase in demand for pharmacy service


decrease in pharmacy school applications


increase in prescription filled


Why is there a pharmacy shortage?

Competition among retail pharmacies


Expansion in pharmacist roles


Greater number of women pharmacists-shorter work patterns


Increased access to healthcare/number of providers


Eligibility rules for medicare

Medicare (Part A) Social Security


- Eligibility


- ppl 65 years of age and older


- ppl who earn $3000/year or more for 10 yrs


- ppl who pay a monthly premium


Medicare is for elderly ppl


Medicare is for the skilled part of hospital care


It is paid by tax and that is why it needs social security

***Just a side note***

Eligibility rules for medicare Cont.

Medicare (Part B) Physician Stuff


- Eligibility


- ppl who are eligible for medicare part A who elect to pay for part B


- Part C covers other health stuff

Eligibility rules for Medicare Cont.

Medicare (Part D) Prescription drugs


- need to pay premium

Medicaid

Eligibility


- most ppl over 65, blind, totally disabled


- important to remember for low income elderly, has an income level


- there are federal required services, and states can add what they want to add but must provide required medicaid services


-medicaid is financed by STATES, medicare is financed by FEDERAL

Progressive vs. regressive financing

Progressive: pay an increasing percent of income as income increases (its like income tax) higher income means you pay more



Regressive: Pay same amnt. no matter what income level (its like sales tax) same % pay, different % income

Community vs. experience rating

Community: in a given area, cost of insurance policy is the same for everyone regardless of health status or age (healthy pay for sick)



Total cost of health care in area/ number of subscribers = cost of premium



Experience: For same insurance plan, different premium rates determine by utilization services (age and health status) Increased price to sick and elderly

Reason for growth of private health insurance

There was a push for national health insurance but public refuses to have a national plan


- Increased private insurance to stop national plan


Two methods of rationing of health care

- Limit physical capacity


-Limit by price and ability to pay