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Exam 1 HLTH-2030
HLTH-2030 Clemson University
| Question | Answer |
|---|---|
| maldistribution | the unequal distribution of healthcare workers across populations, specialties, geographic areas,etc. |
| Types of Maldistributions: geographic | metro f suburban concentration (new/better tech). causing Shortages in rural tinner-city areas |
| Types of Maldistributions: specialty | 47.7% generalists 52.3% specialists. More people choose specialty for higher pay rather than family medicine. |
| Reasons for Maldistribution: economic | higher salary f financial incentives in urban areas. better opportunities for private practice. |
| Reasons for Maldistribution: professional factors | advanced tech and specialized facilities, more opportunity for career development, education research |
| Reasons for Maldistribution: social and work conditions | heavier workloads in underserved areas, burnout. better housing, schools, ad entertainment in metropolitan areas |
| Other Reasons for Maldistribution | migration aging population expansion of health insurance with ACA |
| DO | considering whole person, not just physical symptoms of disease. Addresses physical, emotional, mental, social and spiritual aspects (holistic) |
| MD | focus on diagnosing, treating, and preventing disease using scientifically tested methods (allopathic) |
| PA | worths under physician; can perform medical procedures under supervision of physician. evaluates ,monitors ,counsels, and refers; can prescribe medicine in most states |
| NP | health assessment/physical exams diagnose fats patients; prescribe medicine autonomously, oriented around health promotion education |
| Primary Care | -first point of contact in healthcare system, -focus on general health, prevention, diagnoses, etc. |
| Secondary Care | Specialized medical care provided by health care professionals who usually receive referrals from primary care providers |
| Types of Nurses: LPN | licensed practical nurse) 1 year |
| Types of Nurses: RN | (registered nurse) 2-3 years |
| Types of Nurses: BSN | (bachelor science of nursing) 4 years |
| Types of Nurses: APN | (advanced practice nurse) NP, clinical nurse specialist, certified nurse midwives ,CRNA |
| Types of Medical Specialists: Allergist | treat conditions and illness caused by allergies. |
| Types of Medical Specialists: Anesthesiologists | use drugs and gases to render patients' unconscious during surgery |
| Types of Medical Specialists: Cardiologists | treat heart diseases |
| Types of Medical Specialists: Dermatologists | treat infections, growths and injuries related to skin |
| Types of Medical Specialists: Emergency Medicine | in emergency departments treating acute illnesses and emergency situations |
| Types of Medical Specialists: Family physician | Are prepared to handle most types of illnesses and care for the patient as a whole |
| Types of Medical Specialists: General practitioners | Similar to family physicians—examine patients or order tests and have X-rays done to diagnose illness and treat the patient |
| Types of Medical Specialists: Geriatricians | Specialize in problems and diseases that accompany aging |
| Types of Medical Specialists: Gynecologists | Specialize in the care of the reproductive system of women |
| Types of Medical Specialists: internists | Treat diseases related to the internal organs of the body—for example, conditions of the lungs, blood, kidneys, and heart |
| Types of Medical Specialists: Neurologists | Treat disorders of the central nervous system and order tests necessary to detect diseases |
| Types of Medical Specialists: Obstetricians | Work with women throughout their pregnancy, deliver infants, and care for the mother after the delivery |
| Types of Medical Specialists: Oncologists | Specialize in the diagnosis and treatment of cancers and tumors |
| Types of Medical Specialists: Opthalmologists | Treat diseases and injuries of the eye |
| Types of Medical Specialists: Otolaryngologists | Specialize in the treatment of conditions or diseases of the ear, nose, and throat |
| Types of Medical Specialists: Pathologists | Study the characteristics, causes, and progression of diseases |
| Types of Medical Specialists: Pediatricians | Provide care for children from birth to adolescence |
| Types of Medical Specialists: Preventative Medicine | Includes occupational medicine, public health, and general preventive treatments |
| Types of Medical Specialists: Psychiatrists | Help patients recover from mental illness and regain their mental health |
| Types of Medical Specialists: Radiologists | Perform diagnosis and treatment by the use of X-rays and radioactive materials |
| Types of Medical Specialists: Surgeons | Operate on patients to treat disease, repair injury, correct deformities, and improve health |
| Types of Medical Specialists: General Surgeons | Perform many different types of surgery, usually of relatively low difficulty |
| Types of Medical Specialists: Neurologic Surgeons | Specialize in surgery of the brain, spinal cord, and nervous system |
| Types of Medical Specialists: Orthopedic Surgeons | Specialize in the repair of bones and joints |
| Types of Medical Specialists: Thoracic Surgeon | Perform surgery in the chest cavity—for example, lung and heart surgery |
| Types of Medical Specialists: Urologists | Specialize in conditions of the urinary tract in both sexes and of the sexual/reproductive system in males |
| Job of Health Administrators | - provide leadership - strategic direction - responsible for operational, clinical, and financial outcomes of organization |
| ambulatory care | outpatient service, services rendered to patients who come to physicians' offices or et to receive core |
| allopathic | view of medical treatment as active intervention to counteract the effects of disc through medical and surgical procedures that produce opposite effects of disease |
| osteopathic | holistic approach, use traditional medical practice advocating treatment that involves correction of the position of joints or fissures emphasizes diet environmental factors |
| allied health professional | someone who has received a certificate or degree related to health care or health delivery |
| generalists | physicians in family practice, general internal medicine, or general pediatrics |
| hospitalists | physicians who specialize in the care of patients who are hospitalized |
| four sources of funding for medical school | -tuition - Medicare -ACA - federal scholarship program |
| Mid-level provider | healthcare professional who evaluates, diagnoses, treats, and manages patients while working independently or in collaboration with physicians to provide high-quality medical care |
| Reasons for trend in Mid-level providers | -cost effectiveness -growing healthcare demand -improved access -shorter educational route |
| Quad function model: Financing | -paying for health care services - collecting money through taxes, health insurance, out of pocket, employers - example: Medicare, Medicaid |
| Quad function model: Insurance | -protects individuals from high costs examples: blue cross blue shield or Aetna or etc. |
| Quad function model: Delivery | -provision of health care services to patients examples: hospitals, physician's offices, or clinics |
| Quad function model: Payment | -reimbursing providers for services delivered -determines how doctors, hospitals, and providers are compensated. example: salary, fee for service or etc. |
| Medicare | program for elderly and certain individuals with certain disabilities administered by federal government |
| Medicaid | program for underserved jointly administered by state and federal government |
| managed care | - seeks to achieve efficiency by integrating the four functions of health care delivery -employs mechanisms to control utilization of medical services -determines the price of services and how much providers are paid |
| What explains the four functions of health care delivery? | quad function model |
| Reasons why US does not pass as free market | - government programs pay for large share of healthcare - extensive government regulation - third party payment system - lack of pricing transparency |
| Continuum healthcare services: preventative care | Public health programs Community programs Personal lifestyles Primary care settings |
| Continuum healthcare services: primary care | Physician’s office or clinic Community health centers Self-care Alternative medicine |
| Continuum healthcare services: specialized care | Specialist provider clinics |
| Continuum healthcare services: chronic care | Primary care settings Specialist provider clinics Home health Long-term care facilities Self-care Alternative medicine |
| Continuum healthcare services: long term care | Long-term care facilities Home health |
| Continuum healthcare services: subacute care | Special subacute units (hospitals, long-term care facilities) Home health Outpatient surgical centers |
| Continuum healthcare services: acute care | hospitals |
| Continuum healthcare services: rehabilitative care | Rehabilitation departments (hospitals, long-term care facilities) Home health Outpatient rehabilitation centers |
| Continuum healthcare services: end of life care | Hospice services provided in a variety of settings |
| 3 primary objectives for acceptable health care system | - access - quality - cost |
| US leads in 4 areas | - technology - training - research - sophisticated institutions |
| premium cost sharing | Employers’ requirement that their employees pay a portion of the health insurance cost. |
| third party | An intermediary between patients and providers, which carries out the functions of insurance and payment for healthcare delivery. |
| access | The ability of a person to obtain healthcare services when needed |
| moral hazard | Consumer behavior that leads to a higher utilization of healthcare services because people are covered by insurance. |
| national health insurance(NHI) | A tax-supported national healthcare program in which services are financed by the government but are rendered by private providers |
| national health system (NHS) | A tax-supported national healthcare program in which the government finances and also controls the service infrastructure |
| socialized health insurance (SHI) | Health care that is financed through government-mandated contributions by employers and employees and delivered by private providers |
| defensive medicine | Excessive medical tests and procedures performed as a protection against malpractice lawsuits, and otherwise regarded as unnecessary. |
| medical model | Delivery of health care that places its primary emphasis on the treatment of disease and relief of symptoms instead of prevention of disease and promotion of optimum health. |
| holistic model | treats person as a whole (mind, body, spirit) focusing on balance and prevention |
| epidemiological triangle | - hospitable environment (environment) - agent infectivity (agent) - host susceptibility (host) |
| hospitable environment (environment) | - temperature - moisture -light -surface |
| agent infectivity (agent) | - virulence - ability to breach body defenses - unique pathogen characteristics |
| host susceptibility (host) | - genetics - diet - age |
| primary prevention | the prevention of disease—for example, health education, immunization, and environmental control measures. |
| secondary prevention | Efforts to detect disease in early stages so as to provide a more effective treatment—for example, screening and periodic health examinations. |
| tertiary prevention | Interventions to prevent complications from chronic conditions and avoid further illness, injury, or disability. |
| utilization | consumption of healthcare services and the extent these healthcare services are used |
| Measures of utilization... | ...can determine which individuals in a population group do or do not receive certain types of medical services |
| social justice | the equitable distribution of health care is a societal responsibility, which is best achieved by letting the government take over the production and distribution of health care |
| market justice | the equitable distribution of health care is a societal responsibility, which is best achieved by letting the government take over the production and distribution of health care |
| simple social justice | healthcare is a right (collective responsibility) |
| simple market justice | healthcare is earned (individual responsibility) |
| health risk appraisal | The evaluation of risk factors associated with host, agent, and environment and their health consequences for individuals. |
| acute condition | The condition that is relatively severe, episodic (of short duration), and often treatable and subject to recovery |
| subacute condition | The condition that is a less severe phase of an acute illness. It can be a post-acute condition, requiring continuity of treatment after discharge from a hospital. Examples include ventilator and head trauma care. |
| chronic condition | A condition that persists over time and is not severe but is generally irreversible. |
| morbidity | sickness |
| mortality | death |
| life expectancy | Actuarial determination of how long, on average, a person of a given age is likely to live. |
| health life expectancy | |
| incidence | The number of new cases of a disease in a defined population within a specified period. |
| prevalence | The number of cases of a given disease in a given population at a certain point in time. |
| ADL | activities of daily living; The most commonly used measure of disability. whether an individual needs assistance to perform basic activities |
| preindustrial health care | Primitive care, few hospitals, little regulation, no insurance, low cost but poor quality. |
| industrial health care | Scientific medicine, hospitals and specialists, licensing and education reforms, private insurance and Medicare/Medicaid, higher quality but higher cost. |
| Year Medicare and Medicaid passed? Through what Act? | 1965; Social Security Amendments of 1965 |
| Medicare Part A | hospital insurance coverage for older |
| Medicare Part B | medical insurance cover physician bills |
| Medicare Part C | Medicare advantage bundles hospital, medical, and often prescription drug coverage |
| Medicare Part D | prescription drug coverage |
| Who qualifies for Medicare? | - 65+ - certain disabilities - ALS or end-stage renal disease (kidney disease) |
| Who funds Medicare? | Federal government through payroll taxes, premiums and federal revenues |
| Who administers Medicare? | Federal government through CMS |
| Who qualifies for Medicaid? | - low income - Eligible families, children, pregnant women, older adults, and people with disabilities - Eligibility varies somewhat by state |
| Who funds Medicaid? | jointly by federal and state government |
| who administers Medicaid? | administered by state under federal guidelines |
| Children's Health Insurance Program (CHIP) | A federal-state program that provides health insurance coverage to children from low- to moderate-income families who do not qualify for Medicaid. |
| Centers for Medicare and Medicaid Services | - manages Medicare - oversees Medicaid with states - set quality standards and regulations - administers payment systems and reimbursements |
| Workers' Compensation (1914) | The first broad health insurance program in the United States. It provided medical and wage-loss benefits for workers injured on the job and is considered a trial for government-sponsored health insurance. |
| The first insurance model created was created at Baylor University for who? | Blue Cross for teachers |
| First Hospital and Physician plan with Blue Shield | 1939, California Medical Association |
| When did Blue Cross and Blue shield merge | 1974 |
| Congress made employer-provided health coverage non-taxable in | 1954 |
| Why was the Kerr-Mills Act not successful? | Many states did not implement it, and it only covered low-income older adults, making it ineffective and limited in coverage. |
| Describe hospitals in preindustrial era | were few, unsanitary facilities that mainly cared for the poor and had very high mortality rates. |
| Describe almshouses in preindustrial era | were poorhouses that provided shelter and basic care for the poor, elderly, sick, and disabled. |
| Describe pesthouses in preindustrial era | were quarantine facilities used to isolate people with contagious diseases. |
| Describe dispensaries in preindustrial era | were free outpatient clinics that treated the poor and provided training opportunities for medical students and young physicians |
| The Corporatization Era is characterized by what 5 core elements? | 1. large healthcare corporations 2. managed care 3. integrated delivery systems 4. physician group practices/ hospital partnerships 5. focus on cost control and efficiency |
| means test | A program in which eligibility depends on income. |
| balance bill | The practice in which the provider bills the patient for the leftover sum after insurance has only partially paid the charge initially billed. |
| fee for service | Payment of separate fees to providers for each separate service, such as examination, administering a test, and hospitalization. |
| cost shifting (Cross-Subsidization) | Making up financial losses by charging some patients or payers more to cover the costs of others |
| gatekeeping | The use of primary-care physicians to coordinate healthcare services needed by enrollees in a managed care plan. |
| healthy people 2020 | national U.S. initiative that set science-based health objectives to improve the health of all Americans, reduce health disparities, and promote healthy behaviors and environments by the year 2020. |
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Philipdshay
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