Term
| What is the relationship between physicians and hospitals? |
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Definition
| Both the hospital and physician are in a business to earn money by seeing patients. The physicians were the dominant power in the hospital because they admit the patients, and hospitals without patients have no income. |
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Term
| Who provides health care services? |
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Definition
Three major forms:
1. Fee-for-service reimbursement with utilization review
(traditional type, a 3rd party payer authorizes or denies payment for expensive medical interventions)
2. Preferred Provider Organizations (PPOs)
(insurers contract with a limited number of physicians and hospitals)
3. Health Maintenance Organizations (HMOs)
(patients are required to receive their care from providers w/in that HMO) |
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Term
What is fee-for-service?
What is capitation?
What is salary? |
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Definition
Fee-for-service: doctors get paid by each patient they see. Thus the more visits the more money creating a tendency to over diagnose.
Capitation: getting paid "by the head" aka by how many patients you have by a check each month. Does not matter how many times the patient is seen. So they get a bonus for doing nothing, less quality work and minimal amount of work.
Salary: doctors belonging to organizations are paid by this. Best method of payment because their is no incentive to over/under treat. |
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Term
| What does "Payment Per Episode" mean? (In regards to the physician) |
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Definition
1. Per Episode: Bundles together payments. Results in incentive to give less postoperative visits and more incentive to preform more surgeries.
EX:) surgeons receive a single payment for postoperative care and the surgery itself. |
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Term
| What does "Payment Per Diem" mean? (In regards to the hospital) |
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Definition
| Hospital receives a lump sum for EACH DAY a patient is in the hospital and is paid by their HMO. Hospital has less incentive to do expensive studies because they don't get extra money. |
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Term
| What does "Payment Per Episode of Hospitalization: Diagnosis-Related Groups" mean? |
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Definition
| Medicare pays a lump sum FOR ALL services performed by the hospital with the size of payment depending on patient's diagnosis. Long stays = financial loss to hospital, Short stays = profit |
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Term
| What does it mean when an institution is paid by a "Global Budget"? |
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Definition
| An HMO pays its hospitals a fixed payment for one year. The hospital must then find a way to stay within that budget for the entire year. |
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Term
| Explain how capitation can shift the risk to a provider. |
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Definition
| With capitation payment hospitals are at a risk for admissions, length of stay, and resources used because they get a set amount of payment per patient and that patient may remain healthy and never step foot in the hospital - OR they may contract a serious/lengthy illness that costs the hospital way more then they are getting for that particular patient. |
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Term
| Who are the three major payers for healthcare in the US? |
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Definition
1. Patients: out of pocket
2. Insurance: HMO, Indemnity
3. Government: VA, IHS, Military |
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Term
| What are the government insurance programs? |
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Definition
1. Indian Healthcare Services
2. Military
3. Government employees (teachers, politicians, etc.)
4. ANHC |
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Term
| What are the eligibility requirements and benefits of Medicaid? |
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Definition
Requirements: Your income must be under a certain amount designated by the state because Medicaid is state run.
Benefits: There are no premiums or co-payments. |
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Term
What is the difference between Medicare Part A and Medicare Part B?
How is Medicare A financed? Medicare B? |
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Definition
Part A pays hospitals and Part B pays doctors.
Medicare A is financed through the Social Security system. Medicare B is financed by monthly premiums of $66 and general federal revenues. |
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Term
| What is Primary Health Care? |
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Definition
Your average medical care that involves common health problems; it includes:
Internal Medicine
Pediatrician
Family Practice (only true primary)
Gynecologist/Obstetrician |
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Term
| What are the eligibility requirements and benefits of Medicare? |
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Definition
| Eligibility Requirements: You have to be 65+ years and have been paying in the Social Security system for 10 years OR people who are permanently disabled and have been receiving disability benefits for 2 years. Benefits include: Cheap and does not change by location. |
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Term
| What is a community rating? |
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Definition
| How health insurance premiums are set by how many people had insurance in the community. |
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Term
| What is an experience rating? |
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Definition
| Health insurance is based on what type of health experience an individual or company has had. (Think Ben Stiller's job in "Along Came Polly") |
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Term
| What is meant by regressive mode of financing? |
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Definition
| A falling percentage of income is taken out of pocket as income increases. So if I make an income of $10,000 and have a health care bill of $1,000 I'm paying 10% of my income but if someone with an income of $100,000 has the same bill they only pay %1 of their income. |
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Term
| How does HMO health insurance work? |
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Definition
| No payment at time of service because you have been paying premiums to the company. There is a designated staff and a gate keeper (primary care physician who will tell you if you need to see a specialist or not). |
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Term
| What agency has the goal to improve the health of the world's population? |
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Definition
| World Health Organization |
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Term
| What are the four causes of famine in the world? |
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Definition
1. Desertification/Flooding
2. Warfare
3. Poverty
4. Production of non-edible crops (tobacco, cotton, etc.) |
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Term
What is Germany's Health Care system like?
Physicians paid by:
Financed by:
Required to have health insurance? |
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Definition
Physicians are paid by fee for service.
Health Care is financed by sickness funds.
Everyone is required to have health insurance. |
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Term
How is health care structured in England?
Physicians paid by:
How are prices set?
Financed by: |
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Definition
Physicians are paid by capitation and salary.
Prices are set nationally.
Health care is financed by National Health Insurance. |
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Term
How is health care structured in Canada?
Physicians Paid by:
Financed by:
Prices set by: |
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Definition
Physicians are paid mostly by fee for service but some are paid by salary.
Financed by: Provincial government taxes
Prices set by the provincial government. |
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Term
How is health care structured in Japan?
Physicians paid by:
Financed by:
Prices set by: |
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Definition
Physicians paid by: Fee for service
Financed by: 3 insurance companies
Prices are government regulated. |
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Term
| What is the United States ranking among nations in infant mortality rate? |
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Definition
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Term
| What is Secondary Health Care? |
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Definition
Specialists that can charge whatever they want (because you don't "shop" around for doctors. Also, no competition between doctors. Includes:
Surgeons
Orthopedics
Dermatologists
ENT (ear, nose, throat) |
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Term
| What is Tertiary Health Care? |
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Definition
| Tertiary Care is the most rare of all health care types and are teams of physicians. For example: heart transplant teams, burn center specialists, neonatology. |
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Term
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Definition
| Health care designed to maintain good health. Some examples are: early diagnosis, exercise/diet to prevent obesity, etc. |
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Term
| What is a financial barrier to health care? |
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Definition
| No insurance coverage (due to illness, to expensive, unemployed, etc.) |
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Term
| What are some non-financial barriers to health care? |
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Definition
- Transportation
- Language
- Fear of diagnosis
- Cultural
- Location
- Lack of Education
- Illiterate |
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Term
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Definition
| A gatekeeper refers you to a specialist if the problem can't be solved at a primary health care institution (for example Family Medicine). |
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Term
| Why is our health care system so expensive? |
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Definition
| Doctors set the prices for health care and tell you what you need. |
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Term
| What is epidemiology and how does it affect health care? |
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Definition
Epidemiology is the study of FACTORS affecting the health and illness of populations.
It is the "backbone" of public health because by knowing how disease is spread we can prevent. |
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Term
| What is the epidemiology triangle? |
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Definition
The study of diseases as they affect the population.
HOST
/ \
/ \
/ \
/ \
AGENT_________ ENVIRONMENT |
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Term
| What is the PREVALENCE of a disease? |
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Definition
| The number of people with a particular disease. (Snapshot of a population) |
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Term
| What is the INCIDENCE of a disease? |
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Definition
| Number of new cases of a particular disease OVER A PERIOD OF TIME. |
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Term
| What factors are driving up the cost of health care? |
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Definition
1. Price inflation: recently, physician incomes increased much more rapidly than those of other workers (but this increase is not the only contributer to price inflation).
2. Unnecessary Surgeries: get more health "bang" for the health "buck"
3. Lack of adequate insurance and access to care.
4. Administrative Waste: to much money is spent toward the administrative overhead in the health care system.
5. Ineffective/Inappropriate Care: services provided by highly paid physicians can just as well be provided by their assistants, nurses, or nurse practitioners. |
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Term
| Who pays for health care in Alaska? |
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Definition
| The federal government pays for IHS. Employers and individuals pay for their own. |
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Term
| How do large numbers of uninsured people affect health care costs? |
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Definition
| Basically the healthy pay for the ill who can not pay. Health insurance premiums are upped to compensate those who are receiving free care. |
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Term
| What is the difference between the two cost control strategies: financing and reimbursement. |
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Definition
| Financing is the flow of dollars (by premiums or taxes) from individuals and employers to the health insurance plan (private health insurance or govt. programs) while Reimbursement is the flow of dollars from insurance plans to physicians, hospitals and other providers. |
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Term
| What are the components of high quality health care? |
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Definition
-access to care
-adequate scientific knowledge
-competent health care providers
-separation of financial and clinical decisions
-organization of institutions to maximize quality |
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Term
| How does understaffing affect health care? |
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Definition
| Understaffed = risk for a serious error is increased |
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Term
| What two factors drive up the cost of health care? |
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Definition
PRICE AND QUANTITY...
COST = PRICE X QUANTITY |
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Term
| What is continuous quality improvement? |
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Definition
| An ongoing effort to reduce waste, rework, and complexity in an organization. |
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Term
| How is quality measured in health care? |
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Definition
| By Processes (following guidelines & meeting requirements) and by Outcomes (morbidity and mortality). |
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Term
| In regards to medical care, what is rationing? |
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Definition
| A conscious policy of equally distributing needed resources that are in limited supply. |
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Term
| What are the four principals of medical ethics? |
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Definition
1. Beneficence: a health care providers obligation to help those who are in need.
2. Nonmaleficence: Duty of a health care provider to not harm the patient.
3. Autonomy: the right of a person to decide and follow their own plan of life and action.
4. Justice: treating everyone fairly. |
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Term
| How is medical care rationed in national health systems? |
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Definition
| The more costly procedures are rationed to people who meet a certain quota (age, health history, etc.). Surgery is rationed by limiting the number of physicians and/or putting people on wait lists. |
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Term
| How is medical care rationed in the U.S.? |
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Definition
| Rationed by MONEY. If you got the $, you'll receive the treatment. |
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Term
| Uninsured people are discriminated against in these health care components: |
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Definition
-Probably won't receive preventive care
-Surgery will take longer
-Rehabilitation/Physical Therapy/Nursing Home, etc. will all not be funded or received. |
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Term
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Definition
| A positive stress that presents oppurtunities for personal growth. Can be just as distressful as "distress". |
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Term
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Definition
| Negative form of stress which results from extreme anxiety, sorrow, or pain. |
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Term
| What are 3 techniques to managing stress? |
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Definition
1. exercise
2. massage/spa
3. relax (read, watch T.V.) |
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Term
| What are 4 treatable mental illnesses? |
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Definition
1. Schizophrenia
2. Depression
3. Post traumatic stress disorder
4. Bipolar |
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Term
| Back before the 1970's people were ___1___ away because people didn't know that mental illness is a ____2___. After the 1970's there was a change in attitude toward mental institutions because of new _____3_____ on the market which led to ___4_____. |
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Definition
1. locked
2. disease
3. medications
4. treatment |
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Term
| When a mentally ill person is deinstitutionalized, what are the social effects on that person? |
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Definition
| They may become homeless, have to survive for their life, or they'll wind up in a mental health clinic. |
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Term
| What are the three stages that occur in our general adaptation syndrome to stress? |
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Definition
| Alarm, resistance, and exhaustion. |
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Term
| How does mental illness affect your ability to get health insurance? |
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Definition
| If you are mentally ill your chances for getting health insurance are significantly low. |
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Term
| Identify the four signs of addiction? |
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Definition
1. Obsession
2. Loss of Control
3. Negative Consequences
4. Denial |
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Term
| What kind of effects does alcohol have on the developing brain? |
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Definition
-Interferes with connections the brain is making.
-Mental retardation
-Intellectual impairment
-Physical/Mental impairment
-FAS/FAE |
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Term
| What does "enabling" mean? |
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Definition
| Enabling is helping/protecting a person from the negative consequences of their behavior in an addiction. |
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Term
| What kind of impact does tobacco have on health? |
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Definition
Causes:
-Cancer
-Heart strokes
-Chronic Obstructive Pulmonary Disease
-Emphysema
-Chronic Bronchitis
-Cardiovascular Disease |
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Term
| List 5 ways drugs are administrated into the body: |
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Definition
1. INJECTION
2. ORAL INGESTION
3. INHALATION
4. INTRAVENOUS INJECTION
5. ABSORPTION THROUGH SKIN (INJUNCTION) |
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Term
What are the social/health effects of:
Cocaine:
Meth:
Opiates:
Marijuana: |
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Definition
Cocaine: increased heart rate and blood pressure, loss of appetite, convulsions, muscle twitching, decreased fatigue, alertness, talkativeness
Meth: elevates heart rate, decreased appetite, increased physical activity, alertness, high state of irritability and agitation
Opiates: relieves pain, lowers heart rate, respiration and blood pressure lowered, hallucinations
Marijuana: blood shot eyes, cotton mouth, increased thirst and appetite, lowered blood pressure, drooping eyelids, anxiety, panic, hallucinations, magnified color, sounds & speed of which things move. |
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Term
| What does YPLLs stand for and what is it? |
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Definition
| Years of Potential Life Lost: it is a measurement of the impact of a specific disease or societal event/condition on a given population. |
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Term
| What is the leading cause of death of people between 15 and 45? |
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Definition
INJURIES.
::Intentional:: ::Unintentional::
-Homicide -Auto Accidents
-Suicide -Drownings
-Bicycle Accidents
-Falls |
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Term
| What are three evidence based measures that can reduce mortality and morbidity from Motor Vehicle Injuries? |
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Definition
1. Reduced Speed
2. Reduced Alcohol Limit
3. Children's Car Seats |
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Term
| What is the difference between ACTIVE INTERVENTIONS and PASSIVE INTERVENTIONS for injury prevention? |
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Definition
| Active Intervention is something YOU have to initiate (seat belts, bike helmet, etc.) while Passive Intervention is something automatic for your safety (Guardrails, smoke alarms, air bags, etc.). |
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