Healthcare Policy and Management Practice Flashcards

These flashcards cover key concepts from healthcare policy, financing, delivery levels, quality measures, medical ethics, and management leadership styles.

Population Health Pyramid

A model showing healthcare resource distribution where the number of people decreases but the intensity and cost of care increase as you move up based on complexity of health needs.

Iron Triangle of Healthcare

The trade-offs and relationships between three key factors: cost, quality, and access.

Kingdon’s Three Streams

A framework for the 'policy window' consisting of the politics stream (national mood/interests), problem stream (recognition of issue), and policy stream (political climate).

Individual Mandate

A component of healthcare reform where individuals are required to have insurance; the tax associated with this was eventually zeroed out.

Broad Risk Pools

Insurance pools that include a balance of low-risk (low cost) and high-risk (high cost) individuals to promote financial stability.

Segmented Risk Pools

Problematic insurance pools that may include too many high-risk people, potentially making the insurance company financially unstable.

HMOs (Health Maintenance Organizations)

Organizations that emerged as an alternative to Fee For Service, often using capitation and sometimes criticized for restricting doctor choice to increase profits.

Medicare Part A

Covers hospital care, including inpatient, home health care, and hospice; financed through payroll taxes and deductibles.

Medicare Part B

Covers physician and other provider care (outpatient/clinics); financed through enrollee premiums, copays, deductibles, and tax revenue.

Medicare Part C

Also known as Medicare Advantage; a capitation payment option and alternative to Fee For Service administered by private health plans.

Medicare Part D

Provides prescription drug coverage through private plans using cost-sharing.

Medicaid

A program authorized by the federal government (which pays for $2/3$ of total spending) but administered by states for low-income eligibility.

Triple Aim

A framework to optimize health system performance by focusing on: Health of Population, Experience of Care, and Per Capita Cost.

Primary Care

The level of care for common health problems and preventive measures, characterized by first contact care, continuity, and coordination.

Secondary Care

Specialized clinical care provided by specialist doctors for specific health issues.

Tertiary Care

Clinical care for severely ill patients and those with rare diseases, typically involving subspecialist doctors.

Horizontal Integration

The coordination or merger of providers operating at the same level of care, such as hospital mergers.

Vertical Integration

The coordination of different levels of care, such as when hospitals purchase physician practices.

Sapolsky Gradient

A principle stating that for every step down the Socioeconomic Status (SES) ladder, an individual's health is worse.

Anchor Strategy

A business approach by hospitals or universities to build community health and wealth through local hiring and community engagement.

Fee-for-Service (FFS)

A payment method where doctors or hospitals are paid for each specific 'unit of service,' visit, or procedure.

Capitation

A payment method where providers are paid a fixed amount for all healthcare services per person enrolled per month or year.

Pay for Performance (P4P)

An alternative payment model providing bonus payments to providers for achieving cost reduction or quality improvement targets.

Painless Cost Control

Methods to reduce healthcare costs without reducing necessary patient care, such as reducing administrative waste or eliminating unnecessary services.

Underinsurance

A state where an individual has health insurance, but it lacks coverage for essential needs like dental, vision, or long-term care, or has high out-of-pocket costs.

IOM Six Domains of Quality

The six standards for high-quality care: Safe, Effective, Patient-centered, Timely, Efficient, and Equitable.

Adverse Event

An injury caused by medical care rather than the underlying disease; equivalent to the term 'iatrogenic'.

Near Miss

An event that did not cause patient injury, but only due to chance; also referred to as a 'close call'.

Structure (Quality Measure)

A measure of the resources a healthcare organization possesses, such as the number of nurses or MRI machines.

Process (Quality Measure)

A measure of what providers actually do, such as washing hands, giving vaccines, or following clinical guidelines.

Outcome (Quality Measure)

A measure of the actual results for the patient, such as survival rates, infection rates, or patient satisfaction.

Continuous Quality Improvement (CQI)

An ongoing cycle of identifying problems, collecting data, making changes, and measuring results to improve healthcare services.

Autonomy

The ethical principle representing the right of patients to make their own medical choices, including accepting or refusing treatment.

Beneficence

The ethical obligation for healthcare providers to act in ways that help people in need.

Non-Maleficence

The ethical principle of 'doing no harm' and weighing benefits against potential risks.

Justice (Medical Ethics)

The concept of treating everyone fairly, ensuring equal access to care and fair organ allocation regardless of race or income.

EMTALA

The Emergency Medical Treatment and Active Labor Act (1986), requiring ERs to stabilize patients before asking about insurance or payment.

Matrix Structure

An organizational structure where staff report to both a functional department supervisor and a service line supervisor (two bosses).

Transactional Leadership

A leadership style focused on specific goals, rewards, punishments, and operational efficiency to maintain the status quo.

Transformational Leadership

A leadership style based on the '4 I’s' (Idealized Influence, Inspirational Motivation, Individual Consideration, Intellectual Stimulation) to foster creativity and vision.

Social Marketing Eight Ps

The framework for promoting health behaviors: Product, Place, Price, Promotion, Publics, Partnerships, Policy, and Purse Strings.

Clinical Decision Support

An EHR function that provides automated alerts, reminders, and clinical guidelines to assist in patient care.