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Healthcare Organization

The healthcare system is influenced by what external factors? Political climate,economic development, technological progress, and population characteristics.
Market justice vs. The principle places the responsibility for the fair distribution of health care on the market forces in a free economy; medical care and its benefits are distributed on the basis of people's willingness to pay.
Social justice vs. Emphasizes the well-being of the community over that of a lack of financial resources would be considered unjust.
Avedis Donabedian defines what three basic components of medical care? structure,process,outcome
Iron triangle Access, cost, quality
Types of hospitals and healthcare facilities. Voluntary not for profit, profit making corporation, public facilities, teaching and non teaching hospitals
Horizontal Integration ( Integrated delivery systems) Aggregations that produce the SAME goods or services.
Vertical integration (Integrated delivery systems) operates as a VARIETY of business entities, each of which is related to the other. Future hc systems will emphasize this.
3 legged stool: Three components of a hospital board,administration, and medical staff
Subacute care facilities A mix of rehabilitations and convalescents services that require 10-100 days of care.
Ambulatory care facilities Comprises health care services that do not require over night hospitalization. most common.
3 core functions of public health Assessment, policy development, quality assurance
What is the federal govt.s primary agency concerned w/ health protection, promotion, and provison of health services? Dept. of health and humans services (1979)
1850 Lemuel Shattuk Published the report of the sanitary commission, which argued for public health control by the govt.
The blus cross hospital insurance was modeled after what? Baylor Univrsity Hospital school teacher plan
One of the most significant social legislation passed by congress in the history of U.S? Social Security Act of 1935- Instrumental in providing PHS
Health Care Proxy Laws Enable an indivdual to appoitn an agent to: make health care decisions if individuals become incapacitated
The event that contributed most significantly to the decline of the charitable mission of voluntary hospitals was the? Passage of Medicaid and Medicare
The first medical school was in? Pennsylvania 1756
The first state to restrict medical licenser to graduates of medical schools was? Georgia 1821
Pubic Health the efforts made by communities to cope with the health problems that arise when people live in groups
1933 Federal Emergency Relief Act Passed to provide federal aid to states for public health needs
Dept. of health and human services Federal governmental agency concerned with health protection, promotion, and provision of health services to vulnerable populations
DHHS Administers the Medicare and Medicaid programs-Does medical and social science research -Administers infectious disease prevention and control - enforces child support - Improves maternal health an child health - provides services for older americans etc.
Epidemiology population research concerned with distribution and determinants of health, disease, and injuries inte human population
What are the types of epidemiology studies? Observational and experimental
Observational studies Studies that focus on collections of information about natural phenomena, the characteristics and behaviors of people, aspects of their location or environment, and their exposure to certain circumstances or events.
Experimental studies Studies in which the investigator actively intervenes by manipulating one variable to see what happens with the other.-Best test of cause and effect
Which two types of studies are considered observational studies? Descriptive and Analytical
Descriptive studies Information used to identify factors and conditions that determine the distribution of health and disease among populations. Look at patient records, interview studies, various databases,etc..They are fast and inexpensive.
Analytical studies Studies that try to explain biological phenomena by seeking statistical associations between factors may contribute to a subsequent occurrence and occurrence itself. Ex.Exp.Study
Preindustrial America (18th-19th century) Era: Med practice more of trade than profession- No health ins. -Any could practice medicine - Poor sanitation - Almshouses( fed) - penthouses (local govt) - quarantined - Apprenticeship - Med training.2 year. -Labs non existent -Surgery limited- socialwe
Post industrial America (late 19th century) Era: Physicians become cohesive prof. and gained prestige and power systems- med training was extended - ...
When was the American Medical Association founded? When was the American Nurses association founded? When was the American Hospital Association founded? 1847,1896,1898
Flexnor Report****** 1910- Illustrated the poor medical educations provided by many medical schools, which in turn greatly reduced the number of medical schools.
Social Security Act of 1935 Provided federal aid for public health and welfare assistance
Hill Burton Act of 1946 Increased the number and size of hc facilities
When was Medicare and Medicaid formed and under what act? 1965 Social Security Act under President Johnson Medicare- title 18 SSA Medicaid-title 19 SSA
When did OSHA pass? 1970
When was the HMO formed? Health Maintenance Org, Act 1973
What is an HMO? An organization responsible for the financing and delivery of comprehensive health services to an enrolled population for a prepaid fixed fee. Supposed to keep costs low.
What is ERISA? Employee Retirement and Income Security Act, which mandates minimum benefits or retired/retiring ee's 1974
When did DRGs become popular? 1980s- during the Reagan administration
Health Insurance Portability and Accountability Act (HIPPA) 1996- Intended to address growing number of uninsured. Required computerized medical records.
Health Plan Employer Data and Information Set (HEDIS) 1989- Created as a standarized method for managed care orgs. to collect, calcualte, and report information about their performance.
Stephen Shortell Came up w/ 7 steps to function effectively in the future: become part of an integrated health system -develop new mgmt structures - building the capacity for population-based needs create - re-engineer the clinical process - Improve TQM - focus on outomes
An independant community hospital is organized with three components? Administrations, medical staff, board
MDs Allopathic medicine, views medial treatment as active intervention to produce a counteracting reaction in attempt to neutralize the efffects of disease
DOs Osteopathic mdicine, emphasizes the musculoskeletal system of the body such as correction of joints or tissue
Which school extended training from 4-9 months and med edu. from 2-3? Harvard Med School 1871
What did John hopkins hospital do in 1893? Reformed med education. Graduate training rogram required a degree.
When and where was the first medical school established? 1756- the college of philadelphia- Pennsylvania
The first hospital to open in what was then known as the American colonies? Pennsylvania in 1751
What is the differemce between almshouses and pest houses? (18th century) one is for the needy-A Isolation (quarantine)-P
Define moral hazard? Is when consumer behavior leads to higher utlization of hc services when the services are covered by insurance.
What are the three types of cost sharing? Premium cost sharing, deductibles, and copayments
What are the four types of health insurance? Group insurance, self insurance, individual private insurance, and managed care
Group insurance Can be obtained through an entity such as an employer, a union,or a professional org. It anticipates that a substantial number of people in the group will participate in purchasing insurance through its sponsor.
Self insurance Employers can protect themselves against any potential risk of high losses by purchasing reinsurance from a private insurance companies.
Individual private insurance Private non-employer related health insurance. It determines premium price and eligibility based on the risk indicated by each individual's health status demographics.
SCHIP is in what act? Social security act- Title 21
Diagnostic related groups (DRG'S) Base hospital payments on established fee for services required to treat specific diagnoses. Groups 10,000+ ICD codes into 500 patient categories - Emphasis decresed length of stay
Medicare part A: hospital services
Medicare part B: Physician services
Medicare Part D: Drugs
***Joint Commission on Accreditation of Healthcare Organizations(JCAHO) Concerned with quality of care;looks at structure (physical facility), Process ( what was done;appropriateness(, Outcome
Leap frog group Is voluntary and provides quality assessment and practices through the National Quality Forum
Indicators that boards regularly review: Mortality rates be dept, hospital aquired infections, patient complaints, patient falls, adverse drud reactions, unplanned returns to surgery, hospital incurred traumas.
***The National Committee on Quality Assurance (NCQA) Most influential managed care quality assurance organization (provides voluntary accreditation)
Bad Apple theory Anitquated way of making healthcare better by only finding and dealing with exceptionally poor care. 85/15
The trio of persistent concerns about the health care system, often called the "iron triangle" care reform is: Access, quality, and cost
Of the levels of prevention associated with the natural history of disease, primary prevention refers to: Health promotion and specific protection
The service priorities of the US health care system reflect America's fascination with dramatic high-tech medicine. As a result: A. Little of the health care dollar is spent on prevention B. The US has the world's most advanced medical capability C. The US system is the most expensive in the world E. All of the above
While the aging of the U.S. population will significantly affect future health care costs, economists cite which of the following as likely to exert as great (or greater) impact on health care cost increases? Combination of technology advances and workforce shortages.
most significant social legislation passed by any congress in the history of the United States was the: Social Security Act of 1935
The single most important factor that stimulated the health care reform movement was: Rising costs
A major obligation of doctors when obtaining informed consent for a Medical procedure is to: Ensure that patient understands the risks and benefits of the procedure
The ultimate responsibility for everything that happens within a hospital, including the medical and nursing care provided, rests with the: Hospital institution and its board of directors
Until the mid 1980s, hospitals were reimbursed for their expenses for the prior year on a "retrospective" basis. Now they are paid a certain amount for each patient's care on a "prospective" basis. The amount they are paid is based on: Diagnosis related groups (DRGs)
As already demonstrated in capitated systems, health care reform wi11 produce the greatest change in: Hospital inpatient days
The future health care system will emphasize "vertical integration." This means that: Payers will contract with one party for a broad continuum of care
Hospitals, striving to find new sources of income since the advent of prospective payment, have enthusiastically adopted: Sub-acute care
The event that contributed most significantly to the decline of the charitable mission of voluntary hospitals was the: Passage of Medicaid and Medicare
Medicaid is the government health service program for the: Means tested eligible persons based on socio-economic status
An 18th century institution that provided welfare to the needy was known as: Almshouse
Medicare is a publicly financed program designed to pay for services based on: Entitlement
Which type of hospital is:non-profit,nonfederal,short-stay,and serves general public? Community hospital
Maldistribution of cares refers to: An uneven distribution of healthcare provideres in a given area
What is the largest hospital system in the U.S? VA
Primary care hospital were started in? 1980s
Group health insurance was establishe in? 1937
"Hospitals are at financial risk if the patient stay exceeds specific patient diagnosis" is a definition of: Prospective Payment System¬
The fastest growing field of medical practice is: Hospitalist
In MCO terminology, capitation means Co-payment: Per member per month
Benefit buy down Reducing the scope of benefits, increasing copaymenys and/or co-insurance, and increasing co-pays for prescription drugs.
Balanced budget act Reduced payments for Medicare patients, wrecked havoc on hospitals...
Capitation paid per member per month. Fee covers all that the enrollee will need an entire year.
The first state to restrict medical licensure to graduates of medical schools? Georgia
What organization is directly responsible for developing practice guidelines? Agency for healthcare policy ( Review)
Unconventional medicine that is used in place of conventional medicine is termed: Alternativ medicine
When an insurance company bases its premiums on a documented patter of utilization that has occured in the past? Experience rating
Created by: chirstine