Midterm Exam and Final Exam

What is the role of health care financing?

It pays for health insurance premiums, determines access to healthcare, and influences the distribution of healthcare professionals.

Define 'premium' in health insurance.

The amount charged by insurers to cover specific risks, varying by plan.

What are deductibles in health insurance?

The yearly amount paid by the insured before benefits begin.

What are Medicare Part A and its financing features?

Covers inpatient services, funded through payroll taxes, and requires specific work credits.

Describe Medicare Part D.

Prescription drug coverage requiring monthly premiums and deductibles.

What is the purpose of cost-sharing in health insurance?

To distribute healthcare costs between insurers and insured individuals.

Define 'bundled payment.'

Reimbursement method combining several related services into one price.

What are high-deductible health plans?

Plans with low premiums but high deductibles, often paired with savings options.

What is fee-for-service reimbursement?

Payment for individually billed services, now less common due to inefficiencies.

Name two managed care reimbursement approaches.

Capitation and salary with productivity bonuses.

Define outpatient services.

Medical procedures/tests done without an overnight stay.

What is a patient-centered medical home (PCMH)?

A care model emphasizing continuous, comprehensive, and coordinated care.

What are community-based primary care principles?

Combines primary health care and community medicine for coordinated practice.

Name two hospital-based outpatient services.

Wellness/prevention programs and diagnostic imaging.

What are Medicare's eligibility requirements for home health care?

Patients must be homebound, require skilled care, and receive care from a Medicare-approved agency.

Difference between ambulatory and primary care?

Ambulatory refers to mobility, while primary care is routine, ongoing health care.

What is the main function of critical access hospitals?

Provide emergency and inpatient services in rural areas.

What is telehealth?

Remote diagnosis and treatment of patients using technology.

Why is coordination vital in primary care?

It ensures comprehensive management of patient health needs.

What is the goal of community health assessments?

Evaluate local population health needs systematically.

Define inpatient services.

Medical services requiring an overnight stay.

What led to the growth of hospitals in the 20th century?

Advances in medical science, technology, and professional nursing.

Name a factor responsible for hospital downsizing.

Shift from inpatient to outpatient care.

What is a general hospital?

A facility providing a range of diagnostic, treatment, and surgical services.

Define specialty hospital.

Focuses on specific diseases or conditions, like cardiac care.

What is a critical access hospital?

A rural hospital meeting specific Medicare criteria for designation.

What is the function of teaching hospitals?

Provide education and residency training alongside patient care.

Define hospital-based swing beds.

Used for both acute and skilled nursing care as needed.

What is a community hospital?

Serves the general population, often non-federal and short-stay.

How do public and private hospitals differ?

Public hospitals are government-owned; private hospitals can be for-profit or nonprofit.

What is managed care?

A healthcare delivery system managing costs, utilization, and quality.

How do managed care organizations achieve cost savings?

Through choice restriction, care coordination, and utilization reviews.

What is the staff model of HMOs?

Physicians are salaried employees providing care exclusively for the HMO.

Describe the IPA model in managed care.

Independent Practice Association contracts with HMOs, representing multiple providers.

Define capitation payment.

Providers are paid a set fee per enrollee, regardless of services used.

What is practice profiling?

Evaluating provider patterns to improve efficiency and care quality.

Describe the role of disease management in managed care.

Focuses on chronic conditions to reduce costs and improve outcomes.

What are preferred-provider organizations (PPOs)?

Networks of providers offering services at discounted rates to members.

Define utilization review.

Assessment of care to ensure necessity and cost-effectiveness.

How does the group model differ from the network model in HMOs?

Group model contracts with one practice, while network model contracts with multiple.

What is long-term care (LTC)?

Services promoting independence for people with chronic limitations.

Name two LTC (Long Term Care) service types.

Skilled nursing and assisted living.

Who funds LTC services?

Private payments, insurance, Medicaid, and Medicare.

What is subacute care?

Intermediate care for patients post-acute illness or injury.

What are home health care services?

Medical and personal care provided in a patient's home.

Define respite care.

Temporary relief for primary caregivers.

What is the purpose of adult day care?

Provide daytime supervision and care for adults needing assistance.

How does Medicare support LTC?

Covers short-term care, such as rehabilitation.

What is hospice care?

End-of-life care focusing on comfort and quality of life.

What role do informal caregivers play in LTC (Long Term Care)?

Provide unpaid support, often family or friends.

Who are vulnerable populations?

Groups facing greater barriers to accessing health care, such as minorities and the uninsured.

What challenges do homeless populations face in healthcare?

Lack of access, untreated conditions, and economic instability.

Define health disparities.

Differences in health outcomes linked to social, economic, or environmental disadvantages.

How do language barriers affect healthcare?

They hinder understanding and access to appropriate services.

What is the impact of cultural barriers in healthcare?

They affect trust, communication, and service utilization.

Describe healthcare issues for migrant workers.

High rates of chronic conditions and limited access due to mobility.

What is social determinants of health?

Conditions influencing health status, such as income and education.

Define equity in healthcare.

Ensuring fair access to health services regardless of personal factors.

What are community health programs?

Local initiatives to improve population health and reduce disparities.

How does public health address special populations?

Through targeted policies and programs to meet their unique needs.

What are the three meanings of healthcare costs?

Price of services, national expenditure, and providers' production costs.

What factors have escalated healthcare costs?

Third-party payments, growth of technology, aging population, and defensive medicine.

Define 'access to care' and its dimensions.

Accessibility, accommodation, affordability, availability, and acceptability.

What are the types of access identified by Andersen et al.?

Equitable, inequitable, realized, potential, and effective/efficient access.

What are the three methods for evaluating National Health Expenditures (NHE)?

Comparing medical inflation, GDP growth, and ACA effects.

What challenges exist in regulatory cost-containment approaches?

Fixed budgets make it hard to respond to patient needs and don't encourage efficiency in healthcare systems.

What is quality assessment?

Measuring quality against a standard, using variables, and collecting data.

What is quality assurance?

Continuous quality improvement through institutionalized assessment.

How does the ACA aim to improve healthcare quality?

Linking payments to quality outcomes, strengthening infrastructure, and promoting care models.

What is the impact of waste and abuse on healthcare costs?

Overutilization and fraudulent practices like upcoding increase unnecessary expenditures.

What is the definition of health policy?

Decisions guiding public health, including regulatory and allocative tools.

Name the principal features of U.S. health policy.

Has a limited government role, fragmented rules, multiple groups involved, and presidential influence.

How are legislative health policies developed?

Through a process influenced by government-private sector relationships and federalism.

What is the role of public policies in healthcare?

Direct actions, behaviors, and decisions of individuals or groups.

How does the Affordable Care Act impact healthcare?

Improves access, reduces costs, and enhances quality through coordinated models.

What challenges does incrementalism pose to health reform?

Slow progress and fragmented implementation of policies.

How do interest groups influence U.S. health policy?

They advocate for specific reforms and demand targeted policies.

Define distributive and redistributive policies.

Distributive spreads benefits widely; redistributive reallocates resources to reduce inequality.

What were the political challenges in passing the ACA?

Opposition from stakeholders, economic concerns, and partisan conflicts.

How does the ACA promote patient-centered care?

Through medical homes and accountable care organizations enhancing coordination.

What forces will drive future changes in healthcare?

National debt, economic growth, employment, and regulatory adjustments.

What is patient activation?

Patients' skills, confidence, and motivation to engage in their care.

Why is geriatric training important?

Increasing elderly populations demand specialized care, but training is underemphasized.

What obstacles hinder cost-efficient care delivery?

Lack of efficiency models and high costs of technology and innovation.

How does evidence-based medicine influence healthcare?

Improves quality, outcomes, and protocol adherence through data-driven decisions.

What challenges exist in financing and delivering healthcare?

Rising costs, access barriers, and experimental delivery models.

How does the Focused Factory Model improve care?

Specializes in conditions for efficiency and reduced costs.

What is the role of quality measurement in healthcare infrastructure?

Enhances delivery by tracking and improving service standards.

How does the workforce evolve in healthcare?

Adapts to demographic shifts and integrates technology for better outcomes.

What is the dual outlook on healthcare's future?

Positive for technological progress, but risky due to high associated costs.