Pub Affr 201 Quiz #3 - Workforce and long-term services & supports

T/F: The many types of "safety net" providers reflect a well-organized, continuous system of care in the U.S. 

False

• The many safety net providers in the U.S. reflect the fragmentation of eligibility for insurance coverage, multiple payers, and the history of patchwork solutions to providing access to often marginalized groups. 

How did the biomedical model define "health?"

In the biomedical model, health was the absence of illness. 

• In the early 20th Century, proponents of the biomedical model of health and illness did not tend to view environmental, social, and economic factors as fundamental drivers of health status or outcomes. 

Name drivers of health care specialization in the U.S. 

1. Flexner Report (1910) emphasized the biomedical model: Favored professionalization, sovereignty of MDs through specialized training

2. Mid-20th Century: Blue Cross covered hospital costs but not physician visits and other outpatient services

3. Payment differential between generalist and specialist physicians >> disparity in income

4. Post-war enthusiasm for hospital construction: Hill–Burton Hospital Construction Act of 1946 

5. Medicare and Medicaid reimbursement formulas favored hospital-based (specialty) care: 1965 

6. Medicare paid hospitals to cover costs associated with residency training, which was biased against community-based primary care training

What is care coordination?

• What is the goal of care coordination?

The process of organizing and managing a patient's healthcare activities across multiple providers, settings, and timeframes.

• Goal: Ensure patients receive appropriate care, in the right place, at the right time, while minimizing fragmentation and duplication of services 

What are the four key tasks of primary care?

1. First contact care

2. Continuity

3. Comprehensiveness

4. Coordination

T/F: Critical access hospitals are smaller facilities that mainly serve rural communities.

True

• Critical access hospitals have 25 or fewer acute care inpatient beds. Serving primarily rural communities, they must be located more than 35 miles from another hospital.

Why do trauma centers and critical access hospitals face risk of closure?

1. Staffing shortages in rural areas

   • Rural communities often cannot attract health care professionals to live where there may not be amenities.

2. Payer mix dependent on Medicare & Medicaid 

   •  Public payment often falls short of reimbursement rates needed to cover the real cost of providing care.

What is an FQHC?

A Federally Qualified Health Center is a community-based healthcare organization

• provides comprehensive primary care and support services to underserved populations, regardless of their ability to pay or insurance status

Who is the primary payer for FQHCs? 

Medicaid

T/F: Medicare pays for most long-term care services.

False

• Medicare covers limited post-acute care following a hospitalization but does NOT cover ongoing care related to chronic disease maintenance. It does not cover “custodial services” that involve assistance with ADLs and IADLs. 

What is an ADL?

• Why is it important for health policy?

Activities of Daily Living - basic self-care tasks that are necessary for maintaining daily life. These tasks include bathing, dressing, toileting, eating, transferring between beds or chairs, or rooms, mobility, and grooming.

• ADLs (and IADLs) are important because they are used to determine eligibility for long-term care benefits and assess the level of care needed.

The combination of chronic disease prevalence and an aging population presents multiple future policy problems in long-term services and supports. Name one.

1. Demand for care increases while caregiver supply decreases

2. Fewer workers to pay into tax base to support caregiving

3. Higher levels of chronic-disease disability

T/F: Most adults in the U.S. who have difficulty with daily activities get the help they need.

False

• Over half of adults who need assistance for the most common needs do not receive it.

T/F: As people age, most of them want to stay in their homes and home communities.

True

• Aging in place and Dementia-Friendly Communities are two examples of community-based approaches to make this more possible.

Who provides care for most people needing long-term services and supports?

Most long-term care for older adults is provided by family or loved ones

• 75% of these caregivers are women.

When does Medicaid cover long-term care for people?

Known as "Medicaid spend-down," people spend down their assets, usually on long-term care services, to a level that is low enough to qualify them to receive Medicaid. 

What are some of the reasons that students from underrepresented groups cannot advance toward heatlh professional training? 

1. Inequity in educational attainment, barriers of poverty among many marginalized groups

2. Fewer students from underrepresented communities complete qualifications or are able to “compete” for slots

3. High costs of higher education and health professional education

4. Lack of "concordant" mentors and role models (health professionals who they can identify with)