Healthcare Systems Midterm (daltons)

Health

a state of complete physical, mental, and social well-being and not merely the absence of disease

Health Care System

All persons, institutions, and processes supporting diagnosis and treatment of health problems

Genetic inheritance

Social Environment

Physical Environment

Health Behavior

What are 4 determinate of health?

Health Behavior

What is the most common target for health improvement measures?

Primary, secondary, tertiary

What are the 3 levels of prevention?

Primary prevention

Ex. seat belts, condom use, sun screen, and tobacco-use cessation program

This type of prevention focuses on eliminating risk factors to prevent onset. It wants to prevent development of disease or injury.

Secondary prevention

is concerned with reducing the burden of existing disease after it has developed; early detection is emphasized. Its activities are intended to identify the existence of disease early so treatments that might not be as effective when applied later can be of benefit.

Tertiary prevention

Focuses on the optimum treatment of clinically apparent, clearly identified disease so as to reduce the incidence of later complications to the greatest possible degree. In cases where disease has been associated with adverse effects, it involves rehabilitation and limitation of disability.

Secondary and tertiary prevention

Health care is primarily concerned with what type(s) of prevention?

Complex and unique among nations

Highly decentralized and fragmented

Mis of private and public financing

Has produced high physician incomes and profits for suppliers of medical products

The US Healthcare System is:

12.7 million (2018)

How big is the US Healthcare System workforce?

We do not have a national ministry of health or an equivalent.

What is 1 way the US healthcare system is unique among other countries?

Primary, secondary, and tertiary

What are the 3 types of care?

Primary care

is the care that most people need most of the time for most of their health and illness concerns, for patients who are not hospitalized. Includes a range of personal treatment and preventive measures. Includes: immunizations, prenatal care, exercise, health exams

Secondary care

Includes services that are available in both community hospitals and physician offices. Ideally, it is arranged through referral or consultation after a preliminary evaluation by a primary care practitioner. Includes: most surgical procedures and the common diagnostic and treatment interventions of such specialists as radiologists, cardiologists, and ophthalmologists

Tertiary care

Consists of highly specialized diagnostic, therapeutic, and rehabilitative services, requiring staff and equipment "that transcend the capabilities of the average community hospital".

Includes: organ transplantation, open-heart surgery, and other technically complex procedures, complex chemotherapy and radiotherapy for cancer, and the preservation of very low-birth-weight premature infants.

Quality

Equity

Efficiency

What are the Aday criteria for evaluating the performance of a healthcare system?

allocative = attaining the most valued mix of health care services

productive = producing a given level of health care services at minimum cost

An allocative efficiency issue is how much to invest in preventive versus curative medical services, whereas a productive efficiency issue might concern whether and where to substitute relatively low-cost nurses for physicians in the provision of medical care.

In regards to efficiency, what is the difference between allocative and productive?

Values

Are emotional rules by which a nation governs itself

Attitudes

A manner of acting, thinking, or feeling that shows one's disposition or opinion.

Terminal values

These values are most important to you. Ex. Happiness, equality, peace, security

Instrumental values

Capable, cheerful, courageous, forgiving, helpful, are examples of what type of values?

Right of center

Where does pharmacy fall on the political spectrum of values?

Horizontal = hospitals acquiring other hospitals

Vertical = hospitals acquiring physician practices

What is horizontal and vertical integration?

Self-care

Refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health. These activities are undertaken without professional assistance, although individuals are informed by technical knowledge and skills derived from the pool of both professional and lay experience.

Ambulatory Care

Refers to medical services performed without admission to a hospital or other health care facility for an overnight stay.

physician offices (most), emergency departments (EDs), and hospital outpatient clinics

Where is most ambulatory care provided?

Community hospital is the workhorse of the hospital system. Community hospitals clearly dominate the hospital sector in number of hospitals and percent of the total. Not-for-profit hospital predominates among community hospitals.

What is the importance of community hospitals?

Even though the community hospital sector has fewer hospitals and fewer staffed beds and spends fewer days caring for inpatients now, the expenses have gone up dramatically

What is interesting about community hospital expenses relating to workload?

by the number of beds regularly maintained, by type of ownership, length of patient stay, annual admissions

How are hospitals classified?

A hospital that does not provide the full complement of acute inpatient services; they can accommodate an overnight stay but were not made for this

What is a microhospital?

80-95%; people take a lot of things as "take no action" or "wait and see"

What percent of health problems are never brought forward?

3 or 4

Most Emergency department (ED) visits are considered Level __ or __.

True. Only 8.4% had no insurance

T/F Most ED patients are insured.

False. A majority of these are for profit.

T/F Majority of home health services, nursing homes, hospice, and residential care communities are not for profit.

A. Home health services

These are often referred to as "hospitals w/o walls"

A. Home health services

B. Residential care communities

C. Hospice

D. Adult day services

Home health agencies, Adult day services, residential care communities, nursing homes, hospice

What are the 5 types of long-term care?

More than half of the financial support for nursing homes and adult day services comes from public funds, much of it under the Medicaid program, as Medicare provides little long-term care coverage

Who are the major payers for nursing homes?

where surgery that can be safely performed on an outpatient basis is done; are often created by hospitals so they can do outpatient surgeries here

What are ambulatory surgery centers (ASCs)?

Practitioners and technical occupations

Healthcare Support occupations

The Bureau of Labor Statistics (BLS) has 2 major categories of healthcare workers. What are these?

False. Nursing is the largest with about 3 million nurses.

T/F Physicians are the largest health care occupation.

Declining. The percentage of physicians practicing in larger practices has increased.

Is the percentage of US physicians who own their own practice rising or declining?

True

T/F Graduates of any of the nursing education pathways must still pass a state licensing exam to become a RN.

Telehealth

Physician home visits

Retail pharmacies

Diagnostic imaging and laboratory centers

Ambulatory surgery centers (ASC)

Urgent care cent

What are some expanding/emerging areas of ambulatory care?

Centers for Medicare and Medicaid Services (CMS); the federal agency that provides health coverage to more than 100 million through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace.

CMS

Agency for Healthcare Research and Quality (AHRQ)

The Healthcare Cost and Utilization Project (HCUP) is conducted by the AHRQ.

AHRQ

National Institutes of Health (NIH)

Primary agency of the United States government responsible for biomedical and public health research.

NIH

a member supported, nonprofit organization founded in 2000 with the aim of mobilizing

employer purchasing power to alert America's health industry that big leaps in health care

safety, quality, and customer value will be recognized and rewarded.

* "A nonprofit watchdog organization that serves as a voice for health care purchasers, using

their collective influence to foster positive change in US health care"

Leapfrog

Joint Commission on Accreditation of Healthcare Organizations (JCAHO); Now called The Joint Commission; oldest and largest healthcare accreditation organization in US; governed by 21 member board of commissioners

JCAHO

18.3% of GDP of US went to Healthcare System

GDP

5.5%

What is the average annual growth of healthcare systems?

Private = 52%

Government = 48%

What percentage do private and government contribute to health care expenditures?

American Hospital Association (AHA): the primary association that represents and coordinates among hospitals, health systems, and other related organizations. In its role to represent the hospital sector, it surveys nearly all hospitals in the United States each year

AHA

Association of American Medical Colleges (AAMC)

AAMC

Private insurance represented 52% of spending in 2022; Government services made up the

other 48%.

* Over half of the money was spent on physicians (20%) and clinics, and hospital care (31%).

* Retail prescription drugs brings up the next largest percentage at 9%

Health Care Expenditures

Increased; physician satisfaction is shrinking

______________ (increased or decreased) oversight of physicians is sought by health care payers like the Centers for Medicare & Medicaid Services (CMS) and the private insurance companies. What is this doing to physician job satisfaction?

Medicare is a health insurance program for:

•People age 65 or older

•People under age 65 with certain disabilities

•People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

Who is Medicare for?

Medicaid provides health coverage to low-income people and is one of the largest payers for health care in the United States. It insures the young and old.

Who is Medicaid for?

CHIP provides states with federal matching funds to cover children in families with incomes too high to qualify for Medicaid, but not high enough to afford private health insurance.

CHIP = Children's Health Insurance Program

Who is CHIP for?

The BHP is an option for states to provide affordable coverage and better continuity of care for those whose income fluctuates above and below Medicaid and CHIP eligibility levels.

Who is Basic Health Program (BHP) for?

Hospital care

What area of healthcare is responsible for the largest expenditure?

28 million

According to Health Insurance Expenditures of 2022, how many people were considered uninsured?

Medical supplies

Products typically used once

Medical equipment

Products designed to be used repeatedly

Insatiable; limited

Demand is ___________ and supply is ___________.

Class 1 = bandages, gloves (no pre-approval)

Class 2 = infusion pumps (pre approval demonstrating similarity)

Class 3 = heart valves, silicone breasts (required to prove safety and efficacy)

What are examples of the 3 classes of medical devices?

True. Generics are cheap

T/F Most money is spent on patented drugs.

* Diabetes is higher in men than in women. That is, 12.8% in men versus 11.2% in women.

* Diabetes prevalence is much lower in whites than in all other racial and ethnic groups.

* Moreover, like so many health problems, the prevalence of diabetes is also related to poverty.

* In the 2010s, persons with incomes over 400% of the federal poverty level were least likely to have diabetes (8.6%) versus the 17.4% of people under the federal poverty line.

* The prevalence decreased as poverty declined

Prevalence of Diabetes in Groups

* A system of triage based on expert consensus

* The ED usually uses this system as to determine the severity of a person needing medical

attention.

* ESI 1 = requires immediate life-saving intervention

* ESI 2 = high risk situation, or confused/lethargic/disoriented, or severe pain/distress. If dangerous vitals are observed, consider using ESI 2

* ESI 3 = No dangerous vitals but many resources are needed

* ESI 4 = At minimum one resource is needed

* ESI 5 = No medical resource is needed

Emergency Severity Index

Medically Underserved Area (MUA)

An area with a shortage of primary health care services for residents within a geographic area

1. Develop quality-of-care standards and measures

2. Collect quality-of-care data

3. Monitor and/or enforce quality standards

What does the Leapfrog group do?

Level 2 (emergent)

What ESI level is Medicare or medicaid likely to cover?