Healthcare systems exam 1

what does the simple revenue cycle look like?

patient → (monetary or bartered payment) → physician

physician → (delivery of care) → patient

what happened in the 1700s?

first incorporated hospital was founded by Bond and Franklin

first medical schools in the colonies

act for the relief of sick and disabled seamen → forerunner of today’s U.S Public Health Service

Washington dies due of inflammatory edema

surgeon general oversees Marine Hospital Service

what did medical training look like in the 1800s?

it was done through a physician that you would follow around (apprenticeship)

only took 2 years to have a medical degree

what did medical practice look like?

it was a trade, not much schooling, combined medical services + religious duties

what did medical institutions look like?

very few hospitals and they were run by the local government; it was very unsanitary

what happened in the 1800s?

Lincoln appointed someone to be in the department of agriculture → forerunner to the food and drug administration

appoitment of the first supervising surgeon → later called the Surgeon General

very early precursor to the national institutes of health

medical examination of arriving immigrants

Plessy v/s Ferguson = separate but equal doctrine

what is the American Medical Association?

helped protect the interests of physicians (organized medicine)

what are the tech advancements?

foundation of the American Medical Association

aseptic technique

what is the flexner report?

created a massive effort to reform medical education

resulted in changing the way physicians were educated

happened in the 1900s

what is the growth of medical specialties?

any physician could practice as a specialist with minimal specialist training

what are the educational reforms?

medical schools began affiliating with universities

adopting the European model

Nightingale helped lay the foundation of professional nursing

what happened in the 1900s?

the pure food and drugs act (1906)

forerunner to the Indian Health Service

what is worker’s compensation?

first broad-coverage health insurance

became compensation for medical expenses and death benfits for survivors were added

what is the influenza pandemic (1918)?

began during WW1

resulted in hospitals being overwhelmed and staffing shortages

had 3 waves

wartime conditions worsened the spread

what is the out-of-pocket model?

healthcare is paid for by individual funds

delivered through a mix of public and private providers

pay-to-play system

what is the iron triangle?

quality = dramatic improvements in science and public helath

cost = improving technology and services leads to increased cost

access = access is still very uneven (rural areas are severely underserved)

what are the top causes of death in the 1900s?

heart disease, influenza + pneumonia, cancer, kidney disease

how did private insurance start?

began as a form of disability coverage that provided income during temporary disability due to bodily injury/ illness

people could not predict their future needs for medical care or its costs

what is the hospital plan?

Kimball began a hospital insurance plan for teachers, where teachers would go to one hospital, and the cost would be cheaper. This later became the model for the Blue Cross plan.

what is employer based health insurance?

it was compensation for the loss of raises

Supreme Court ruled in 1948 that employee benefits were a legitimate part of union management negotiations

employer provided health coverage was made nontaxable

what are the major healthcare legislation of this era?

social security act (1935) and federal food, drug, and cosmetic act (1938)

what happened in the 1900s?

The Hill-Burton Act supports federal funds to expand rural access

communicable disease center was establised → forerunner of the centers for disease control and prevention

what is the centers for disease control?

detecting + responding to new and emerging health threats

handling big health problems

develops leaders + gives training for public health workforce

what happened in the mid 1900s?

Simkins v/s Moses overturned Hill Burton Act → prohibiting federal funds from going to segregated hospitals

release on the first smoking and health report

congress passed the medicare and medicaid act of 1965

what is medicaid and medicare?

medicare part A = uses Social Security funds to finance hospital care

medicare part b = covers phsician’s services

different in every state

what is medicaid?

provides free or low-cost health coverage to some low-income people, pregnant women, elderly, and people with disabilities

biggest government health insurance program

what are patient’s bill of rights?

access + respect

information + informed decisions

provider transparency + communications

privacy + control

continuity + records access

what is fortitude?

strength of mind that enables a person to encounter danger or bear pain in adversity with courage

what is indemnity care?

healthcare plan that allows individuals to choose their own doctors and hospitals

what is managed are?

creates a “network” of providers, quality programs, emphasizes reduction of services, and financially incentivizes

what happened in the late 1900s?

Healthcare Financing Administration was created to manage Medicaid

The Surgeon General released the first Healthy People report

Federal funding was provided for foster care to states

Agency for health care policy and research was created

what is agency for healthcare quality and research?

lead federal agency charged with improving the safety and quality of healthcare

what are the major healthcare legislation of the late 1900s?

national organ tranplantaion act was signed

COBRA
EMTALA

McKinney act was passes to provide healthcare for the homeless

what is EMTALA (1986)?

emergency medical treatment and labor act = guarantees access to emergency medical treatment regardless if the patient can pay or not

what is COBRA (1985)?

consolidates omnibus budget reconciliation act = allows employees to continue on their existing health insurance even if their hours have decreased or they no longer have that job