Health Care Midterm I

Front 1

How did Darwin's work on genetics, Pasteur and Lister on micro-organisms and disease, and John Snow and Jane Addams work in public health, lead to the evolution of the modern health care system? (3)

Back 1

1. micro organisms/genetics vs demonic spirits

2. John Snow/cholera outbreaks/better understanding of germs and disease

3. Jane Addams/check environment/healing homes

Front 2

What was the contribution of the Flexnor report in adding to the expense of health care and the arguably over-reductionist approach to research and medicine? (2)

Back 2

1. Flexnor = professionalization of medicine/ +research and the biomedical model/shift from patient care to the development of treatments + scientific process

2. Flexnor led to "more is better"/expensive tech w/out justification/ex overuse of MRI (+radiation -benefits)

Front 3

Describe the historical events that led to the development of Employer-Sponsored insurance as the predominant model in the US health care system. (8)

Back 3

1. 1930s = better care in hospitals but $$$

2. then hospitals offer Blue Cross

3. Blue Shield created by state medical societies to help with med costs during Great Depression

4. idea of paying small amounts now to cover future services spread

5. WWII creates a need for goods, increases labor forces

6. fed gov't caps wages but not fringe benefits like insurance

7. employers attract employees by offering health insurance

8. unions further/continue trend - negotiating for HI as part of contracts

Front 4

In what ways do taxpayers currently subsidize the health care system (medical education, hospital infrastructure, and ESI [employer-sponsored insurance])? (5)

Back 4

1. pay into Soc Sec/Medicare thru tax

2. Medicaid thru tax

3. Medicare pays hospitals subsidies for medical education; taxes subsidize residency training (even more than state schools) via Medicare

4. taxes subsidize state med schools

5. gov't subsidizes ESI - excludes employer-provided tax benefits from income and payroll taxes

Front 5

Describe parts A, B, C, and D of the Medicare program. Who pays for Medicare? Who is eligible for the program? (6)

Back 5

1. A: Hospital Insurance: hospitalization, SNF, home health, hospice; free if you've worked 10+ years; premium if not

2. B: Medical Insurance: doc visits, prevent care, durable med equipment, outpt services, lab tests, x-rays, mental health, some home health and ambulance; costs a monthly premium

3. C: Not a benefit: part of the policy that says private HI companies can provide Medicare benefits; "Medicare Advantage Plans"

4. D: Rx drugs; not direct thru gov't, thru private companies

5. pays? tax payers, employers, consumers pay

6. is eligible? 65+, spouses, dependent parents of dead child; under 65 who are on disability for 2+ years; under 65 on dialysis

Front 6

Who is currently eligible for Medicaid? Who pays for Medicaid? How did the Affordable Care Act change Medicaid and what are the implications of the Supreme Court decision in 2012? (4)

Back 6

1. eligible: depending on the state, ppl under 65 with incomes up to 133% below the federal poverty guideline

2. pays: fed gov't and the state

3. change Medicaid: said it's expansion is legal if states have a choice BUT fed gov't has the right to remove state's Medicaid funds if it chooses not to accept expansion

4. implications: ACA is constitutional; "shared responsibility placement" - 2.5% of income or $695; means for the first time states can give Medicaid to low income ppl under 65 w/out a waiver

Front 7

Along with Medicaid and Medicare, what other coverage or safety-net programs exist for people who are not currently covered by employer-sponsored insurance? (7)

Back 7

1. Federally Qualified Health Centers

2. Migrant Health Centers

3. Public Housing Primary Care Programs

4. Three Share Programs (premiums split between 3+ ppl)

5. Volunteer Clinics

6. Community Service Agencies

7. Project Access Now (connects needy with volunteers who can help

Front 8

What does EMTALA stand for and why does it exist? 1 (a-c), 2

Back 8

1. EMTALA: The Emergency Medical Treatment and Active Labor Act

a. only hospitals that participate in Medicare are included (98%) and they must perform a screening to ensure an ED need exists

b. if EMC exists hospital staff must either stabilize the condition or transfer patient to another hospital with appropriate capabilities

c. hospitals w/ specialized capabilities are required to accept transfers of patients in need of specialized services if they have the capacity to treat

2. why: to ensure public access to emergency services regardless of $$$

Front 9

Why were so few people covered by individual private insurance? How did the Affordable Care Act change the individual market?

Back 9

???

Front 10

What is guaranteed issue? (2)

Back 10

1. GI: as long as someone is a citizen s/he can't be denied HI for any reason including pre-existing conditions

2. IM: requires all citizens and legal res. to have health insurance; if those who don't qualify for Medi/Medi or Veteran's Health Benifits do not enroll they get a tax penalty

Front 11

20. What are the 6 quality aims as defined by the Institute of Medicine in the seminal book “Crossing the Quality Chasm: A New Healthy System for the 21st Century”? (6)

Back 11

SEPTEE

1) safe: avoid injuries/mistakes

2) effective: EBP to those who benefit, refrain from administering to those who wouldn't

3) patient-centered: patient values guide clinical experience

4) timely: reducing waits and harmful delays

5) efficient: avoid waste: equipment, supplies, ideas, energy

6) equitable: gender, SES ethnicity geographic location don't affect care

Front 12

19. Give three examples of approaches to lower systemic health care costs (3)

Back 12

1. Price Controls: various ways/Medicare/Medical negotiate w/ service providers for a set cost to the consumer or to receive a set reimbursement from the insurer/government program; hospitals engage in "competitive bidding" where they compete for Medicare contracts and agree to perform services for a lower cost than they would otherwise

2. Unit of Payment Change

-largely changed from "fee for service" to "episode of care" payments

3. Patient Cost-Sharing: typically done with a deductible/pt. pays a portion of their healthcare in addition to the premium/made @ time of service in the form of a copay, rest covered by insurance/once co-pays cover deductible, pts are clear of out-of-pocket payments until the end of the calendar year/lowers pt demand for procedures

Front 13

18. What is the difference between implicit and explicit rationing in health care? Give examples.

Back 13

Implicit Rationing: discretionary decisions made by providers within a fixed allowance

-care limited/neither the decisions nor the rationale behind them iclearly expressed

-it is built into the system but not necessarily suggested

-ie the VA waitlist or a provider's waitlist

Explicit Rationing: administrative authority makes decisions as far as who receives what services when and how

-care is limited and decisions are clear, as is the reasoning behind said decisions

-ie chemotherapy or other specialty treatments might be denied if they haven't been proven effective/ACA does not always cover dental and vision care