HLTH_SCI-3700 Exam 2: Mizzou

Medicare requirements (3)

- 65 or older

- Disabled (2 year)

- Diagnosis of end stage renal disease or ALS

Traditional Medicare cons (3)

- No out-of-pocket (OOP) max

- Limited coverage: hearing, vision, dental

- No pharmaceuticals

Medicare Part C (Medicare Advantage)

Private insurance in place of Medicare (offers more benefits)

- Covers: vision, hearing, dental

- Includes pharmaceuticals

- Has OOP max

Medigap

Optional private insurance that helps pay for OOP Medicare costs

Military Health System (MHS)

Covers active duty, reserves, dependents, spouses

Indian Health Service (IHS)

Healthcare for Native Americans

- Poorly funded, many are on Medicaid

What percentage of IHS workers are Native?

70%

Common health disparities in Native Americans

TB, substance abuse, diabetes, suicide rate, lower life expectancy

Veteran Health Administration (VA)

Covers active duty and veterans only

Tricare

Covers same as MHS

- Active members don't pay

What needs to be addressed in Prison Healthcare? (2)

Mental health & chronic disease

What makes it difficult to give proper Prison Healthcare?

Lack of communication with outside providers (lack of electronic medical records)

What are the 2 behavioral health components?

Mental health and substance abuse

Who funds mental healthcare? (2)

Federal and state government, mostly federal

Mental Health Parity and Addiction Equity Act of 2008

Insurance must offer equal mental health insurance coverage as general medical care

(ex: unlimited PT sessions = unlimited therapy sessions)

Who can prescribe medication? (4)

- Psychiatrist

- Personal care provider

- PA

- Advance practice nurse

Access to dental healthcare for:

1. Private insurance

2. Medicare

3. Medicaid

1. Purchased separately

2. Purchased with MA

3. Provided for children, shortage of providers accept this form

At what age range in life do people start experiencing dental problems?

Early childhood

What type of care is covered by dental insurance?

Preventative care

Who runs pharmaceutical applications?

FDA

10 Steps of Drug Applications

1. Drug development

2. Clinical trials

3. Randomized control trial (100s people)

4. Random people trial (1000s people)

5. Review meeting with FDA

6. NDA application

7. Application review

8. Drug labeling

9. Facility inspection

10. Drug approval

Average time for drug application?

10-15 years

How long are drugs patented for?

20 years

What percent of drugs pass the drug applications?

12% pass

3 steps of Emergency Drug Authorization

1. Priority review

2. Breakthrough therapy

3. Fast track

Who creates and negotiates drug formulary?

Pharmacy Benefit Manager (PBM)

Universal healthcare system definition

All country's citizens are covered by insurance

Single-payer system definition

A method of achieving universal healthcare, paid for by one entity (usually country's government)

Beveridge Model of Healthcare (and US example)

Government controlled and funded; Govt. controlled (VA)

Bismarck Model of Healthcare (and US example)

Private but government regulated, funded by employees; Private-ish (private insurance)

National Health Insurance Model of Healthcare (and US example)

Private providers but paid for by government; Mix (Medicare)

Out-of-Pocket Model of Healthcare (and US example)

No insurance; private for very wealthy (uninsured)

What 2 outcomes does the US do well in?

1. Certain cancer screenings

2. Stroke & heart attack mortality rates

What is NOT a goal of the healthcare system?

Prevention

6 Domains of Quality

1. Safe

2. Effective

3. Timely

4. Patient-centered

5. Efficient

6. Equitable

Donabedian Triad Model of Healthcare safety

Structure, process, outcomes

Punitive Culture Response Type

Errors are punished by termination or lack of promotion

Blame-free Culture Response Type

Employees are never reprimanded for errors

Just Culture Response Type

Accountability through 3 solutions

Solution for Human Error (Just Culture)

Console

Solution for At-Risk Behavior (Just Culture)

Coach

Solution for Reckless Behavior (Just Culture)

Punish

Error prevention form for employer

Patient Safety Network (PSN)

What is the Root Cause Analysis (RCA)?

Fishbone diagram process to investigate errors/safety issue

4 "Bones" of RCA diagram

1. Human

2. Communication/Documentation

3. Procedural

4. Equipment