Public Health Unit 4 Chapters 9-11 Exam Study Guide

Flashcards covering workforce, primary care, institutions, quality models, malpractice, insurance, international systems, and cost-control strategies from Chapters 9-11.

What is the exact distinction between accreditation and licensure in healthcare education and authorization?

Accreditation evaluates educational institutions or programs against established standards (for example, CEPH accredits a public health program), whereas licensure is legal permission granted by a state to an individual professional to practice.

How do credentialing and certification differ for an individual healthcare professional?

Credentialing verifies the qualifications and education of an individual professional, whereas certification is formal professional recognition typically granted after passing an examination, such as specialty board certification.

What were the key characteristics of the traditional Flexner-era model of medical education, and what historical impact did the $1910$ Flexner Report have on workforce equity?

The traditional Flexner model separated basic sciences in years $1$ and $2$ from clinical training in years $3$ and $4$, relied heavily on lectures, and had limited population health. The $1910$ Flexner Report helped standardize medical training but directly contributed to the closure of most Black medical schools, causing long-lasting workforce disparities.

How are primary, secondary, and tertiary care defined and distinguished from one another?

Primary care provides broad, ongoing care as the typical first point of contact (e.g., family medicine); secondary care consists of specialist care, commonly accessed through a referral (e.g., cardiologist); and tertiary care provides highly specialized care for complex conditions (e.g., transplant center). Regular visits to a specialist remain secondary care.

What are the Six Cs of ideal primary care?

The Six Cs are Contact (entry point into the healthcare system), Comprehensive (addresses most routine patient needs), Coordinated (manages referrals and information among providers), Continuity (maintains a relationship over time), Caring (trusting, individualized care), and Community (connects care to local needs and resources).

What are the financial mechanisms and primary potential risks of fee-for-service versus capitation compensation?

Fee-for-service pays for each service delivered, creating a risk of overuse or unnecessary services. Capitation pays a fixed amount per patient per period, creating a risk of underuse or avoidance of complex, costly patients.

What specific criterion determines whether a patient visit is classified as inpatient or outpatient?

Admission status determines the category (formal admission for care, generally involving an overnight stay), not simply the total amount of time spent at the facility.

What is the functional difference between a skilled nursing facility (SNF) and a custodial nursing home?

A skilled nursing facility (SNF) provides short-term skilled care and rehabilitation aimed at restoring and improving patient functioning, whereas a custodial nursing home provides long-term assistance with activities of daily living (ADLs) such as bathing, dressing, or eating.

What are the core purpose and qualifying criteria for hospice care?

Hospice provides comfort-focused, palliative care rather than curative treatment, typically delivered when life expectancy is approximately $6\text{ months}$ or less, often provided in the patient's home.

What five specific criteria define a Section $330$ community health center?

A Section $330$ center must: ($1$) serve a federally designated medically underserved area or population, ($2$) hold nonprofit, public, or tax-exempt status, ($3$) provide comprehensive primary care, referrals, and access-supporting services, ($4$) have a governing board whose majority of members are patients, and ($5$) serve patients regardless of ability to pay via an income-based sliding fee schedule.

What does each level of the Donabedian model (structure, process, outcome) evaluate?

Structure evaluates physical resources and organizational infrastructure (e.g., staffing ratios, equipment); process evaluates actions, procedures, and protocols used to provide care (e.g., medication verification checklists); and outcome evaluates what happens as a result of care (e.g., mortality rates, complications, $30\text{-day}$ readmissions).

What are the Institute of Medicine (IOM) six domains of healthcare quality?

The six domains are Safe (preventing harm), Effective (using evidence-based approaches), Patient-centered (respecting patient values, needs, and preferences), Timely (avoiding harmful delays), Efficient (avoiding waste), and Equitable (providing quality care without unjust disparities).

What are the four types of healthcare coordination and their primary failure points?

Clinician-patient (communication and follow-up between provider and patient/family), Institutional (information and record exchange across facilities), Financial (coverage and payment continuity across settings), and Health care-public health (linking clinicians with public health agencies, such as reporting infectious disease cases).

What four legal elements are required to prove medical malpractice?

Duty owed (the provider undertook responsibility for the patient), Duty breached (the provider failed to meet the relevant standard of care), Causation (the breach directly caused an injury), and Damages (the patient suffered compensable harm). A poor clinical outcome alone does not establish malpractice.

How do deductible, copayment, coinsurance, and premium differ in health insurance?

A premium is the monthly or yearly price paid to keep an insurance policy active; a deductible is the fixed dollar amount paid out-of-pocket before insurance coverage begins; a copayment is a flat dollar fee paid per covered service; and coinsurance is the percentage of covered costs paid by the patient.

How do governance and populations served differ among Medicare, Medicaid, and SCHIP/CHIP?

Medicare is purely federal and covers adults aged $65$ and older plus qualifying disabled individuals; Medicaid is a joint federal-state program serving eligible low-income individuals; and SCHIP/CHIP is a joint federal-state program covering eligible children whose family incomes exceed standard Medicaid eligibility.

What major services are covered under Medicare Parts A, B, C, and D?

Part A covers hospital inpatient care, qualifying skilled nursing, hospice, and certain home health care; Part B covers physician services, outpatient care, and diagnostic/therapeutic procedures; Part C (Medicare Advantage) is a private-plan alternative combining benefits; and Part D covers prescription medications.

Which public insurance programs finance short-term skilled rehabilitation versus long-term custodial nursing home care?

Medicare can cover qualifying short-term skilled nursing facility (SNF) rehabilitation; Medicaid is the primary source of public support for eligible individuals needing long-term custodial nursing home care.

What is the operational difference between being uninsured and being underinsured?

An uninsured individual has no health coverage at all and often relies on emergency departments. An underinsured individual holds health insurance, but high deductibles, copayments, coinsurance, or exclusions still create major financial barriers that cause them to delay or skip care.

How do the healthcare systems of the United States, Canada, and the United Kingdom compare regarding funding, delivery, and market versus social justice?

The U.S. leans toward market justice, financed by mixed employer, government, and individual funds with mostly private delivery and high specialist concentration. Canada blends public funding for medically necessary care with private delivery emphasizing primary care. The U.K. aligns with social justice, providing universal care through a tax-funded National Health Service (NHS) with government hospitals.

How does national healthcare spending as a percentage of GDP compare between the U.S., Canada, and the U.K.?

The United States spends substantially more ($\approx 18\%$ to $19\%+\text{ of GDP}$, or $\approx \$4\text{ trillion}$ to $\$5.3\text{ trillion}$ per year) compared to Canada ($\approx 10\%\text{ of GDP}$) and the United Kingdom ($\approx 8\%\text{ of GDP}$).

What is the single largest category of excess healthcare spending identified in the National Academy of Medicine $2011$ estimate?

Unnecessary services and overuse is the largest category at an estimated $\$210\text{ billion}$, followed by excess administrative costs at $\$190\text{ billion}$. Excess costs collectively represent approximately one-quarter of all healthcare spending.

What four conditions does the textbook identify as necessary for a competitive healthcare market to effectively lower costs?

Informed purchasers who can compare cost and quality, purchasing power enabling individuals to obtain care, multiple competing providers offering meaningful choice, and negotiation mechanisms to achieve improved price and value.

What are the three components of the Triple Aim in population health management?

The Triple Aim focuses on improving access to care, improving the quality of care, and reducing the per-person cost of care across an entire population.

What are the five essential implementation elements of population health management?

Value-based payments (rewarding quality and reduced per-person cost), comprehensive data systems (enabling tracking and evaluation), comprehensive scope of services (minimizing fragmentation), organizational quality engagement (staff and leadership commitment), and collaboration with public health and community partners (addressing social determinants and equity).