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HSA3111 Test 1


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How much was spent on healthcare in 1996?
1.3 trillion, 14% of gross domestic healthcare
How many Americans don't have health insurance?
42 million; 10 million are children;
How does the U.S. rank in rate of infant mortality?
17th in the world
What percentage of for-profit HMO's control health care industry/managed care?
25% & growing/60%
What percentage of Americans are dissatisfied with the health care system?
For each .5% point increase in unemployment, how many people lost health insurance?
one million
health insurance coverage declines in a downturn or recession because small firms may drop coverage to maintain salaries or simply to stay in business
What percent did health insurance premium rise in 2000 & 2001?
2001: 8% 2002: 11%
Is the US Health Care System a system?
What is the US Health Care System?
a kaliedoscope of financing, insurance, delivery, and payment mechanisms that remain unstandardized and loosely coordinated
What is a major part of the health care system controlled by?
private hands
invites the participation of numerous private entities to serve functions such as payment mechanisms, insurance, financing, delivery
What does the blend of public & private involvement in delivery of health care services result in?
diff. financial arrangement to enable individuals to receive health care services; numerous insurance agencies employing various mechanisms for insuring against risk; multiple payers that make own determinations regarding how much to pay for each type of service; large array of settings where medical services are delivered; numberous consulting firms offering their expertise in planning, cost containment, quality, and restructuring of resources;
Massive Delivery System
Order of amount: nurses, doctors, dentists, pharmacists, osteopathic doctors
Vast array of institutions
Order of amount: facilities for the mentally retarded, home health agencies, nursing homes, hospitals, mental institutions, and primary care programs
Health Profs. training facilities
order of amount: nursing programs, medical & osteopathic schools, dental schools
How did the baby boomers impact the health care system?
won't mirror previous middle-age generations nor continue habits of their youthful behavior; want to keep their options flexible; desire to look & feel young; need for long term health care, every 8secs a baby boomer turns 50
How will the baby boomers be impacted by the health care system?
parent-child relationships will become complex as individuals live longer & needs for support increase; businesses that offer services & products to help generations cope with the dilemma of aging parents and growing children & grandchildren will be in high demad
Has immigration accelerated or deccelerated in the last decade?
Of the 50 million added to our population next 25 years how many will immigrant's children account for?
7 US health care values
1) pluralism and choice; 2) individual accountability; 3) ambivalence toward gov't; 4) progress, innovation, and new technology; 5) volunteerism and communitarianism; 6)paranoia about monopoly; 7) competition;
What are 3 value disagreements we have with the world?
health care as a right, equity, public administration
What are 7 global health care values diff. from us?
universality, equity, acceptance of the role of gov't, skepticism about markets and competition, global budgets, rationing, technology assessment and innovation control
What are national health care characteristics?
defined sets of benefits that every citizen i entitled to receive; use global budget to determine health care expenditures and allocate resources; gov't controls proliferation of health care services, esp high cost technology; universal access;
Canadian Health Care System
single-payer system(we are multi-payer); predominantly publicly financed; 13 interlocking provincial & territorial health plans; linked thru adherence to national principles set at federal level;
Canadian nat'l Policy on Health Care
all elgible residents have reasonable access to medically necessary insured services, prepaid basis, no direct charges at point of service; 10% of federal budget, 1/3 of provincial budgets;
Principles of the Canada Health Act
1)Public administration non-profit governed by public authority subject to audit of finances 2)comprehensiveness: health plans must insure all medically necessary health services; 3)universality: all insured persons in the provinces/territory must be entitled to public health insurance on uniform terms and conditions; 4)portability:residents moving fromone province to another must be entitled to public health insurance coverage on uniform terms and conditions; 5)accessibility: reasonable access by insured persons to medically necessary hospital and physician must be unimpeded by financial or other barriers;
What is Florida's ranking in uninsured populations?
4th, number of uninsured is increasing;
In 1997, how many of Florida's children were uninsured?
What percentage of 21-24yr olds don't have insurance?
What is the ranking of ethnicities without health insurance?
hispanic-32, blacks-31, whites-19
What percentage of Florida's uninsured are employed?
Why are people losing health care insurance?
when health care costs rise faster than wages rise; cost of health insurance premiums is the PRIMARY reason ppl don't have insurance, employers are shifting more of the cost to employees; when premiums increase employers switch from conventional coverage to managed care plans, restrict health plan eligibility, & increase cost-sharing; some employers are eliminating coverage for dependents or shifting the entire cost to the employee; more employers are using part-time or temp employees who are not eligible for coverage; welfare reform is moving ppl off welfare & into jobs, usually end up making too much income to qualify for medicare but jobs don't always offer insurance
What are the implications of being uninsured?
most people who lack health care coverage receive lil or no preventative care-less likely to fill a prescription or return for follow-up care; emergency room becomes source of primary care; health conditions that go unmanaged can result in serious conditions requiring hospitalization; emergency room care represents 7% of all patients admitted to Florida hospitals;
recognized by a person's own perceptions and evaluations of how he or she feels
the presence of disease is based on professional evaluation
an infectious disease cannot occur without the presence of at least one factor ie the agent
the host is the organism that becomes sick
environment is external to the host, it includes the physical, social, cultural, and economic aspects of the environment
attributes that increase the liklihood of developing a particular disease or negative health condition at some time in the future
the model emphasizes efforts and programs geared toward prevention of disease and maintenance of an optimum state of well-being (US follows medical model-as problems arise fix)
Primary Prevention
refers to activities undertaken to reduce the probability that a disease will subsequently develop
Secondary Prevention
refers to early diagnosis and the treatment of disease
Tertiary Prevention
refers to rehabilitation activities and the monitoring of treatments to preven complications
What is the number 1 killer in the US?
Heart Disease
What is the number one cause of accidental deaths?
motor vehicle accidents
What are the number one cancer killers?
founded on advances in science and technology; fueled growth in medical science & technology innovation, US has been leading the world in medical breakthroughs
Implications of Development of New Medical Breakthroughs
increase demand for latest treatment & raise patients expectations of finding a cure; alternative methods have been deemphasized; health care profs focus on physical symptoms; few attempts to be made to integrate diagnosis & treatment with education & disease prevention; concern with lack of health has pushed health & well-being behind; medical specialists who use latest tech are held in higher esteem; hospitals desirability are often evaluated by advanced tech;
Implications of Medical Model
Biomedicine has taken center stage & therefore mental health is lesser; isolated the social & spiritual elements of health;
What is "healthy people 2010"?
a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats; builds on initiatives pursued over the past 2 decades;
What are the 2 goals for healthy people 2010?
increase quality of years of healthy life; eliminate health disparities
What are determinants of health?
biology, behaviors, social environment, physical environment, policies & intervention,and health status
What happened in 1798?
the first marine hospital, a forerunner of today's public health service, was established to care for seafarers
What happened in 1935?
congress passed the social security act
What happened in 1946?
the communicable disease center was established, forerunner of the centers for disease control and prevention
What happened in 1955?
licensing of salk polio vaccine
What happened in 1965?
the medicare and medicaid programs were created, making comprehensive health available to millions of Americans
What happened in 1981?
identification of acquired immune deficiency syndrome, AIDS, in 1984, the HIV virus was identified by PHS and French scientists, in 1985, a blood test to detect HIV was licensed
What happened in 1990?
human genome project established; nutrition labeling and education act was signed into law; Ryan White comprehensive AIDS resource emergency act began in 1990 to provide support for communities to help people with AIDS
What happened in 1995?
social security administration became an independent agency
What happened in 1996?
regulations were published providing for FDA regulation of tobacco products to prevent use of tobacco by minors
What is the department of Health and Human Services?
United State's gov't principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves
What are the 6 divisions of the department of Health and Human Services?
national institutes of health; food and drug administration; centers for disease control and prevention; agency for toxic substances and disease registry; indian health service; centers for medicare and medicaid services;
What are the 8 objectives to Human Health and Human services?
increase the percentage of the nation's children and adults who have health insurance coverage; eliminate disparities in health access and outcomes; increase the availability of primary health care services for under-served populations; protect and improve the health and satisfaction of beneficiaries in medicare and medicaid; improve the health status of American Indians and Alaska natives; increase the availability and effectiveness of services for the treatment and management of HIV/AIDS; increase the availability and effectiveness of mental health care services; increase the availability and effectiveness of health services for children with special health care needs; increase the availability and effectiveness of health services for children with special health care needs;
Who is Medicare for?
people 65 year or older; some ppl with disabilities, under 65 yrs.; ppl with end-stage renal disease (permanent kidney failure requiring dialysis or transplant);
What is part A of medicare?
Hospital insurance; ppl don't have to pay for part A; social security; pays for hospitals, skilled nursing facilities, hospice, and some home health care; no premium if medicare taxes were paid while working; orgs. who administer medicare part A are called "Fiscal Intermediaries"
What is part B of medicare?
medical insurance; most ppl pay monthly for part B; helps pay for dr's, outpatient hospital care, some other medical services; occasional contributions from fed. gov't, interest earned on part B trust fund; orgs which administer part B are called "carriers"
What is part C of medicare?
managed care; HMOs pay; created by balanced budget act of 1997; choices include HMO, POS, PSO, PPO
What is Medicaid
a health insurance program for certain low-income ppl; its funded and administered thru a state-federal partnership; states design programs;
Who qualifies for Medicaid?
on any given day about 33 million ppl are eligible for medicaid; low-income families w/ children; blind or disabled ppl; low income pregnant women and children; ppl w/ very high medical bills;
What does the department of veteran's affairs do?
provide federal benefits to veterans and their dependents; its a huge agency;
What year was the dept. of Veteran's affairs established?
March 15, 1989, succeeded veteran's administration
What is the dept. of Veterans Affair's vision?
the dept will continue to honor, care for, and compensate veterans in recognition of their sacrifices for America
Who is eligible for VA benefits and services?
almost 1/3 of the nation's pop (70 million ppl) who are veterans, dependents, or survivors of deceased veterans
What is the VA's mission statement?
to serve the needs of America's veterans by providing primary care, specialized care, and related medical and social support services;
VA/defense department
serves as a backup to the defense department during nat'l security contingencies for VA internal emergencies and as a federal support organization for major catastrophic disasters;
VA research
become a world leader in such research areas as aging, women veteran's health concerns, AIDS, and post traumatic stress disorder and other mental health issues
What are the 9 planning assumptions of the VA?
the US won't become involved in major global conflict that would place large numbers of troops in jeopardy or require significant increases in troop strength resulting in a large unexpected increase in claims for benefits and services; role of federal gov't in american society will continue to be evaluated and competition for federal funding will become even more intense than its today; recent balanced budget agreement will constrain resources & will continue to put pressure on agencies to reengineer work processes to make them more efficient; scrutiny of the outcomes & impact of VA programs & demands for account ability by the executive branch, congress, and American taxpayer will increase; customer expectations of accurate, timely, and courteous service will increase; technology will provide opportunities to improve customer service areas, accuracy and timeliness, and the delivery of benefits and services; by the end of the 1st session of the 101st congress, legislation will be passed to restrict benefit payments for tobacco related conditions; managed care within integrated delivery systems will become the most common mode of health care delivery in the US; the aging veteran population will increase demand for some benefits and services such as long-term care and burial services;
What percent of Veterans using VA system have no private or medigap insurance? no health care coverage?
59.3%; 21%
What is physicians role?
evaluating a patient's health condition, diagnosing abnormalities, and prescribing treatment;
What are a growing number of physicians involved in?
Prevention of illness
Do all states require physicians to be licensed to practice?
What are the requirements to get your doctoral?
graduation from an accredited medical school that awards either an MD or DO, successful completion of a licensing exam and completetion of a supervised internship/residency program;
What is a doctor of osteopathic medicine (DO)?
emphasizes the musculoskeletal system of the body, such as joints & tissues; stress diet and enviro as factors that influence natural resistance;
What is a doctor of medicine (MD)?
view medical treatment as active intervention to produce a counteracting reaction in an attempt to neutralize the effects of disease;
What are Primary Care physicians?
physicians trained in family medicine/general practice, general internal medicine, and general pediatrics;
What are physicians in non-primary care specialities?
What do primary care physicians serve as in managed care?
What do gatekeepers do?
serve an important role in controlling cost, utilization, and the rational allocation of resources;
Where do primary care students spend a significant amount of their time?
in ambulatory care settings
Is there a physician shortage or surplus?
Is there a nursing shortage or surplus?
What are factors affecting the supply of nurses?
overall decline in nursing school applicants, turnover, part-time workers, and declining age and activity of working nurses; other career choices for women...both in the med field, business, & education; overall funding from the fed gov't to support nursing edu has been sharply reduced; job burnout and dissatisfaction are driving nurses to leave the profession; changing demographics signal a need for more nurses to care for our aging pop;
What is the nurse practitioner?
a registered nurse who has advanced education and clinical training in a health care speciality area
Who do nurse practitioners work with?
ppl of all ages and their families providing information ppl need to make informed decisions about their health care and lifestyle choices
What do nurse practitioners do?
obtain medical histories and perform physical exams; diagnose and treat acute health probs. such as infections and injuries; diagnose, treat, and monitor chronic diseases such as diabetes and high blood pressure; order X-rays, prescribe medications;
What do PA's do?
physician assistants are health care professionals licensed to practice medicine w/ medical supervision; PA's conduct physical exams, diagnose and treat illness, order and interpret tests, counsel on preventative health care, and in some states write prescriptions;
What do physical therapists do?
physical therapist provides services aimed at preventing the onset and/or slowing the progression of conditions resulting from injury, disease and other causes;
What does an occupational therapist do?
concentrate on activities of daily living, the ability to cook, clean, and manage safely in a home environment;
What is the definition of medical technology?
medical technology is the practical application of the scientific body of knowledge produced by biomedical research;
What are the 5 types of medical technologies?
diagnostic(CT scan); survival(life saving, ICU, transplants); illness management(renal dialysis, pacemaker); prevention(implantable automatic carioverter-defibrillator, vaccines); systems management(telemedicine);
What is telehealth?
involves the use of modern information technology, computers, and telemetry, to deliver health services to remote patients and to facilitate info exchange between primary care physicians, specialists, and patients;
What are the potential benefits of telehealth?
expand access to health care and rehabilitation services; improve quality of care; more frequent visitations; provide more access to rural areas; convenience for both patient and provider; vast number of expanded services provided; encourage patients to become active in their health care; allow physicians to work collaboratively w/ their colleagues from distant locations; physicians can discuss new and latest advances in care, seek opinions, conduct research, etc;
What are the shortcomings of telehealth?
privacy of patient information in questioned; high cost of technology; due to immense amount of info. creditability of sources is questionable; insurance coverage-how to specify charges for services provided on-line;
What is telemedicine?
the use of medical information exchanged from one site to another via electronic communications for health and education of the patient or healthcare provided and for the purpose of improving patient care
Are there any authorities overseeing the operation of diagnosis and treatment websites?
What should clinical consultations over the web to protect the patient include?
informed consent; info security & privacy protection measures; documentation of the clinical encounter;
Two main points of health care spending are:
the largest percentage of $ spent on health care goes to hospital care (34%) and the health care spending is consistently rising, up from 1.3 trillion in 200)!!
When did Medicare begin?
1966 thru the federal social security act
What is Fraud?
knowingly and willfully executing, or attempting to execute, a scheme or artiface to defraud any health care benefit program or to obtain by means of false and fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program;
What is abuse?
directly or indirectly result in unnecessary costs to the medicare or medicaid program, improper payment, or payment for services which fail to meet professionally recognized standards of care, or that are medically unnecssary
Welfare reform
led to many low-income ppl losing medicaid coverage; generally accepted that welfare reform has contributed to the growth in the number of Americans w/o health insurance;
Health Insurance
provides ppl with a way to protect themselves against financial catastrophe and to assure themselves and their families of access to the health care system
What are the 2 common types of coverage?
medical expense insurance; disability income insurance;
What are the 6 types of private health insurance?
hospital/medical insurance; major medical expense insurance; medicare supplemental policy; disability income insurance; dental expense insurance; long term care insurance;
What are the major objectives of HIPPA?
streamline industry inefficiencies, detect and prosecute fraud, reduce paperwork, enable workersto change jobs even w/ pre-existing medical conditions; reduce healthcare fraud & abuse, enforce standards for health info, guarantee security and privacy of health information
Why were blue shield plans established?
to cover the physician's services
size or capacity of a hospital is determined by the number of beds set up and staffed for inpatient use
night spent in the hospital by a person admitted as an inpatient
cumulative number of patient days over a certain period of time
average number of hospital beds occupied per day
total number of patients discharged from a hospital's acute care beds during a given period of time
calculated by dividing the total number of inpatient days by the total discharges
dividing average daily census by the average number of beds during a given period of time, expressed as percentage
Acute Care Hospital
non-federal short-term medical/surgical hosp;
Federal Hospital
controlled by a dept. of federal gov't such as VA, US Navy, Army
owned and operated by a corporation or an individual that operates a for-profit basis
Long-term hospital
average length of stay exceeds 30days
Not for profit
general, acute care, non-taxable hosp, that operates on a not-for-profit basis under the ownership and control of a private corporation
provides diagnostic and treatment services to patients with emotional, mental, or substance abuse disorders
restorative services
non-metro area; not in medicare;
less than 30 days stay
Specialty hospital
if surg services provided can be acute care; 23 speciality areas;
varies from state to state, must be affiliated w/ accredited med school;
patient w/ same diagnosis, the same procedures, and w/ similar characteristics, such as age and presence of other sicknesses and complications. Medicare reimburses acute care hospitals by assigning specific payments to each DRG
NET patient revenue
what the hospital received
Gross patient revenue
Not what hospital received; amount charged to patients;
Gross Revenue
inpatient services charged

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