Public Health Exam #1

Describe roles that education and credentialing play in the development of health professions, such as medicine and nursing

Education provides knowledge and skills to provide safe and effective care as well as implying that a student is pursuing a degree or certificate from an accredited institution, Credentialing involves the process of verifying the qualifications of those who have received a degree and making sure that they have the desirable or required qualifications. Such as a certification, licensure. Accreditation is the process of setting standards for these qualifications and enforcing institutions to go by those set policies.

Describe the continuum of public health education and identify educational pathways for becoming a public health professional

1915 Welch-Rose Report which was founded by the Rockefeller Foundation, and it was used to set the stage for development of separate schools of public health (focused on graduate education), 1980s a substantial portion of students entering graduate training in public health had a bachelor’s degree but no prior professional training, more growth (specialized tracks-MPH) happened including epidemiology, biostatistics, environmental health, administration, policy and communication, Doctoral Pathways became academic (PhD) and Oriented (DrPH), universal access in 2003 “all undergraduates should have access in public health”

educational pathways include undergraduate, community college education, and graduate public health education (MPH)

Identify recent changes in the education of physicians

The number of osteopathic medical schools has increased rapidly and is now totaled to 35 national wide, Allopathic medical schools have grown as well and number over 150, new specialties and subspecialities emerged, hospice and palliative medicine have recently been added to the specialty list, and hospitalists subspeciality certification has been developed and implemented for both adult and pediatric hospitals.

Describe the educational options in nursing and the growing role that nurses play in healthcare delivery

Certified Nurse Assistant/ Nursing Aids: short term certification program and are restricted to performing only the basic care of patients, Licensed Practical Nurse/ Licensed Vocational Nurses: Educational requirements vary by state 1 after highschool-2-year associates, provide a range of services often under registered nurses directions especially when practicing in hospitals, and Registered Nurse: responsible for hospital based services, licensure requirements vary by state, and educational paths including diploma programs from hospital based programs, associate’s degree in nursing (ADN), Bachelor of science (BSN), graduate degrees, and you need a state license

Infection control specialist, health navigation, Nurse case managers, patient safety, health information systems, and disaster and emergency management (roles are always expanding)

Identify components of prevention and public health that are recommended for inclusion in clinical education

screening, behavioral counseling, immunization, and the use of preventive medication. They also have roles such as being alert to new diseases or changes in well-known diseases, reporting adverse effects of drugs, vaccines, medical devices, coordinating screenings, and contact tracing efforts with public health agencies.

Explain the concept of primary care and differentiate it from secondary and tertiary care

Primary care traditionally refers to the first contact providers of care who are prepared to handle the great majority of common problems for which patients seek care. Meanwhile, secondary care refers to specialty care provided by clinicians who focus on one or a small number of organ systems or on a specific type of service, such as obstetrics and gynecology or anesthesiology. Tertiary care is often defined in terms of the type of institution in which it is delivered as well as the type of problems, this is usually seen in places like trauma centers, burn centers, and intensive care units

Identify a range of mechanisms used to compensate clinical health professionals and explain their advantages and disadvantages

Fee for service: (A) reward linked directly to work performed + encourages efficiency of delivery of services (D) may encourage delivery of unnecessary as well as necessary services, Capitation: (A) discourages unnecessary care, may encourage preventive care, allows for predictable budgeting (D) may discourage necessary care may encourage referral to specialists unless specialty care is financially discouraged, Episode of Care: (A) encourages rapid and efficient delivery of care (D) may encourage discharge prior to ability to provide self-care, Salary: (A) may allow focus on quality (D) may discourage efficiency, Pay for Performance “P4P”: (A) links income with quality providing strong incentive for quality and efficiency (D) difficult to measure quality outcomes may be related to factors outside clinicians control

What Institutions Make Up the Healthcare System?

Inpatient facilities which include hospitals, skilled nursing or rehabilitation facilities, custodial nursing homes, and institutional hospices. Outpatient facilities which include those providing clinical services by one or more clinicians and those providing diagnostic testing or treatment

Identify the range of inpatient and outpatient healthcare facilities that exist in the United States

Inpatient: general hospitals, specialty hospitals, VA hospitals, Military hospital systems, private nonprofit hospitals, state/local/federal government run hospitals, for profit or investor-owned hospitals, teaching and nonteaching hospitals, community hospitals, state hospitals, long term care hospitals, skilled nursing facilities, custodial nursing homes, assisted living facilities, dementia care facilities, and hospice care facilities

Outpatient: clinical services, shopping centers, workplaces, internet and community health centers

Describe approaches being used to define and measure the quality of health care

Structure Measures focuses on the physical and organizational infrastructure in which care is delivered

Process Measures focuses on procedures and formal processes that go into delivering care for example systems for ensuring credentialing of health professionals and procedures to ensure timely response to complaints

Outcome Measures: focus on the result of care from rates of infection to readmissions with complications

Describe types of coordination of care and methods available to facilitate coordination of care

Clinician-patient relationship: continuity as a mechanism for ensuring coordination of information and services and building connections,

Institutional Coordination: coordination of individuals information between institutions needed to inform individual clinical and administrative decision making,

Financial Coordination: patient has comprehension coverage for services provided by the full range of institutions and maximizes the efficiency of the care received and minimize the administrative effort required to manage the payment system

Coordination between health care and public health: coordination of services between clinical care and public health requires communication to ensure follow up and to protect the health of others

The two mays to facilitate coordination of care include integrated electronic health record (EHR) Systems (medical history, lab results), integrated healthcare delivery networks (Kaiser Permanente and Veterans Health Administration), accountable care organizations (ACOs) (hospitals, doctors, and other providers), and Demonstrative Programs (Medicare)

Identify ways that healthcare systems are attempting to improve the quality of care

Overall using an electronic health record system has the most potential to improve coordination of care and give better quality of care. Health information and data (records, lab stuff, etc), results management (integration of findings between different companies), order entry/management (ordering tests), decision support management (encouragement and electronic reminders), electronic communication and connectivity (communication between providers and patients), patient support, administrative processes (scheduling, billing, etc), reporting and population health (efficiency and improvements) are all ways of improvement.

Identify roles that may be played by electronic medical records in improving the delivery of health care

Improve patient safety, support the delivery of effective patient care, facilitate management of chronic conditions, and improve efficiency

Identify components of medical malpractice and disclosure of medical errors.

The components of medical malpractice include a duty was owed (undertook the care or treatment), a duty was breached (provider failed to meet standard care), the breach caused an injury (providers failure caused harm), and damages occurred (actual loss or harm occurred from injury)

Disclosure of medical errors include conveying to the patient:

facts about the event, presence of error or systems failure, expression of regret, and a formal apology

Identify the largest governmental insurance systems in the United States and explain the basic principles of their financing

Medicare: 65+, payroll taxes of 1.45% from employees and 1.45% from employers Part A (hospital care, skilled nursing care, and home health care), Part B general revenues that the government funds about 75% of the cost of this voluntary supplementary insurance that covers a wide range of diagnostic and therapeutic services, 25% by a monthly premium, Medigap can be used to cover the rest of the 25% if needed Part C Medicare advantage that encourages Medicare beneficiaries to enroll in prepaid health plans that limit services, Part D prescription drug coverage plan, have to be enrolled in plans A and B, requires a monthly premium

Medicaid: younger generations, government pays 50-80% depending on the per capita income of the state, income-based branches 185% of the federal poverty level for the medically needy, state flexibility, and open-ended matching

Describe the employment-based health insurance system in the United States and discuss how fee-for-service insurance and capitated insurance options have evolved in recent years.

The largest single category of insurance coverage in the USA, 50% have the option to it, grew rapidly in 1950s and 1960s based on a principle known as community rating, all the way until well into the 1990s clinicians and hospitals were paid using fee-for-service payments.

Fee-for-service payments consist of charges paid for specific services provided and encourages the provision of as many services as possible since it was a payment system, rising costs of healthcare thru services. Later on, they became PPOs (preferred provider organizations) and POSs (point of service plans)

1973 Health maintenance organizations (HMOs) took over and were encouraged over fee-for-service to combat rising costs, use a system called capitation which allowed clinicians and health organizations to be paid a fixed monthly fee per enrolled member regardless of the amount of services done,

Describe other options for obtaining health insurance and the consequences of un- insurance.

Health insurance exchanges: provide a mechanism to obtain health insurance for those who are not eligible for affordable forms of comprehensive health insurance

Private Insurance

Subsidies: poor

Consequences of Un-insurance: receive less preventive care, are diagnosed at more advanced stages of disease, receive less treatment once diagnosed, much less likely to have a usual source of health care, more likely to use the emergency department for routine care, and increased mortality rate

Describe the basic structure and financing aspects of the healthcare systems in Canada and the United Kingdom and compare them to those of the United States

Canada: Government insurance for basic medically necessary services, single payer for basic/medically necessary services and financing: national policy to keep expenditures at approximately 10% of GDP combination of provincial and federal (70%) government through taxes and private insurance payments (30%) by individuals

UK: Single payer with capitation plus incentives for general practitioners

Financing: budget about 8% of GDP, does not include private insurance costs, tax supported comprehensive and universal coverage through National Health Service, private insurance system with overlapping coverage purchased at additional cost by 15% of the population with perception of easier access and higher quality

Comparison to the USA: The USA’s structure is employment-based insurance plus government insurance through Medicare and Medicaid provide most insurance, Exchanges can be used too

Financing: cost 20% of GDP and continuing to increase and complicated mix of federal, state, employer and self-pay

When it comes to the statistics the US is the winner but there is a couple sections that Canada or the United Kingdom win on such as life expectancy at birth and adult obesity,

Identify and describe six sources of excess costs in the U.S. healthcare system.

Unnecessary services and overuse: discretionary use beyond benchmarks + unnecessary choice of higher cost services

Inefficiently delivered services: mistakes, care fragmentation, unnecessary use of higher cost providers, operational inefficiencies care delivery sites

Excess administrative costs: insurance paperwork costs, insurers’ administrative inefficiencies, inefficiencies due to care documentation requirements

Prices that are too high: service prices beyond competitive benchmarks, product prices beyond competitive benchmarks

Missed prevention opportunities: primary prevention, second, and tertiary prevention

Fraud: all sources-payers, clinicians, patients

Identify strategies for reducing the costs of health care in the United States

increasing competition between providers, increasing competition between insurance companies, utilizing market-oriented programs, creating an informed purchase, purchasing power, multiple competing providers, and negotiation

Which of the following types of wellbeing is NOT included in WHO's definition of health?

Economic

who is responsible for approving vaccines and overseeing clinical trials?

The Food and Drug Administration

True or False: Public Health addresses health issues after they have already manifested.

false

Which statement public health professionals is NOT true?

graduate public health degrees require previous medical training.

__________ Medicine is centered around the idea of the human body's innate capacity for self-healing.

osteopathic

How many parts of National Boards of Medical Examiners do prospective doctors need to pass?

3

_________ evaluates an individual while _________ evaluates an institution.

credentialing, accreditation

Which characteristics are NOT relevant in primary care?

specialization

True or False: There is little formal specialization within nursing.

true

Which of the following is NOT an inpatient facility?

Dermatology Office

True or False: The United States consistently performs high among other high-resourced nations.

false

Which service does the United States spend the most on annually?

Hospital Care

who posited the idea that the volume of hospital beds predicts the volume of hospitalizations?

roemer

which of the following is an example of clinical and public health coordination?

health promotion and disease prevention services

Which of the following is NOT a characteristic of the U.S. Healthcare System?

majority of physicians in primary care

The majority of Healthcare Insurance is privately owned.

true

Which Part of Medicare covers pharmaceutical-based services?

part D

Medicaid is the Federal-State program of health insurance for which category of people?

low-income individuals, children, people with disabilities, pregnant women

________ is an approach to health care provider compensation where the practitioner is paid a fixed amount per patient.

capitation

Which of the following is a disadvantage of the Pay for Performance compensation model?

quality of care is hard to measure, sometimes out of clinician's control

coinsurance is…

what you pay as your share of the cost of services after deductible is met

Which of the following is NOT a goal of the Affordable Care Act (ObamaCare)?

Pivot the US to a socialized medical system

The Affordable Care Act required all states to expand Medicaid.

false

Failure to expand Medicaid disproportionally impacts people of color in the South.

true

Which of the following statements is true about U.S. employer-based health insurance?

Most Americans are insured by employer-based health insurance programs., many employers offer a choice of health insurance plan options., and they often include deductibles and co-payments.

which of the following must be established to claim an error as medical malpractice?

a duty was owed and breached, a breach in duty resulted in injury, and damages occurred

The amount the federal government pays into Medicaid per state is dependent on

the per capita income of the state

Which of the following is NOT an Essential Health Benefit under the Affordable Care Act?

vision coverage

Which of the following is NOT a consequence of a lack in adequate health insurance?

being substantially fined

which source of disability payment requires 12 months' disability and complex disability determination?

Social Security Disability Insurance (SSDI)