Health Exam SUGOI

Flexner Report

A 1910 study that revolutionized medical education by closing substandard schools and standardizing scientific curricula based on Western models.

Affordable Care Act (ACA)

Legislation enacted in 2010 aiming to expand health insurance coverage, lower costs, and improve quality through mandates, exchanges, and subsidies.

Health expenditures data

General trends show consistent growth outpacing inflation, driven largely by hospital care, physician services, and prescription drugs

6 Critical problems

High cost, uneven quality, unequal access, administrative inefficiency, lack of prevention focus, and health disparities, addressed via value-based care and delivery reforms

The Joint Commission

An independent, nonprofit organization that accredits and certifies health care organizations in the US to ensure quality and safety standards

Hospital classifications

Major types include general, specialty, public, private non-profit, and investor-owned, alongside teaching hospitals affiliated with medical schools

Integration

Horizontal integration involves merging similar facilities (e.g., hospital chains), while vertical integration links different levels of care (e.g., hospitals, clinics, and home health)

Joint Commission Goals

Annual patient safety standards focused on correct patient identification, medication safety, infection prevention, and preventing surgical errors

Pharmacy services

Clinical, retail, institutional, and consultant services involving dispensing, drug utilization review, medication therapy management, and patient counseling

ADL

Activities of Daily Living (bathing, dressing) measure basic self-care

IADL

Instrumental Activities of Daily Living (cooking, managing finances) measure independent living skills.

SNF characteristics

Skilled Nursing Facilities provide 24-hour nursing care; primary risk factors include advanced age and cognitive impairment, with Medicaid as the primary payor

Medication Regimen Review

Regular pharmacist-led evaluations of resident medication profiles in long-term care, strictly regulating psychotropic medications to prevent over-medication.

Home Health Services

Clinical and support services provided at home for patients who are homebound and require skilled nursing or therapy

Life Care Communities

Continuing care retirement communities offering independent living, assisted living, and skilled nursing in a single campus.

Hospice

Comfort-focused end-of-life care for individuals with a terminal prognosis of 6 months or less, where pharmacy optimizes symptom management.

Risk and types

The possibility of financial loss; types include pure risk (chance of loss only) and speculative risk (chance of loss or gain)

Moral Hazard

The increased use of health services when individuals are insulated from the full cost because they have insurance

Adverse Selection

A phenomenon where individuals with higher health risks are more likely to purchase insurance, driving up overall system costs

Premium

(monthly payment)

deductible

(out-of-pocket before insurance pays)

copay

(fixed fee per service)

co-insurance

(percentage-based cost sharing)

Service

Service plans directly contract with providers to cover care

Indemnity

indemnity plans reimburse the patient or provider a set fee per service.

Uninsurance demographics

Disproportionately affecting low-income adults, young adults, minorities, and part-time or seasonal workers without employer-sponsored plans

Consequences of Uninsurance

Delayed care, poorer health outcomes, higher financial liability, increased reliance on emergency rooms, and uncompensated care burdens

Community Health Centers

Patient-directed, federally qualified clinics providing primary and preventive care in underserved medically vulnerable areas regardless of ability to pay