Healthcare Delivery Module 1 | Quizlet

What are the 5 factors that have shaped the US health care delivery system.

Cultural beliefs and values (Self-reliance and welfare for underprivileged_

Social changes (Urbanization, immigration, etc.)

Technological advances

Economic constraints

Political opportunism

What are the 3 "Eras" that represent the change in the healthcare system?

Preindustrial

Postindustrial

Corporate Era

Describe the dent vs. west virginia supreme court landmark and what era it was in.

Postindustrial Era

Decision that no one had the right to practice without having the necessary qualifications of learning and skill

Key points of the American Medical Association and what year it was established

1847

Standardized the role in healthcare works, specifically physicians

Supported licensing laws

Established the first national ethical code for medical practice

Key player in healthcare reform and our commonly used CPT codes

Summarize the postindustrial era

Marked by urbanization, professionalization of medicine, growth of hospitals, and the rise of health insurance; medical education became standardized and science-driven

Define managed care

an organized approach to comprehensive healthcare developed in the late 1980s- early 1990s from a response to calls for cost containment, access, and quality of care. (think tricare select and prime)

Define market justice

healthcare is viewed as a good or a product. Distribution determined by forces in a free economy.

Great wealth = more goods

Dictated by supply and demand, not the government

Define social justice

Equitable distribution is a societal responsibility.

Viewed as a social good

Best achieved by government involved in production and distribution

Healthcare is different than other goods and services

Define individual mandate

one of the major components of the affordable card act

Law required every individual to obtain health insurance and put in place fines for those who did not.

Define guaranteed issue

one of the major components of the affordable card act

Someone wants health insurance and they can not be turned away because of a health condition. Does not dictate the plan, so it could still be really expensive

Define adverse selection

one of the major components of the affordable card act

Completely profit-driven. Occurs in an insurance marketplace where information asymmetry between the buyer and the seller leads to suboptimal pricing, efficiency loss, and even market failure

Define information asymmetry

An imbalance where one party, like patients or insurers, lacks the knowledge to evaluate care or risk effectively. This can lead to inefficiencies, suboptimal pricing, and poor decision-making

What are the major components of the affordable care act

Adverse selection

Guaranteed Issue

Individual mandate

Define access to care

the ability to obtain personal health services that are needed, affordable, convenient, acceptable, and effective in a timely manner

Access to care is best predicted by what 3 variables?

i. Race

ii. Income

iii. Occupation

What are the 10 main characteristics of the current healthcare system

Six dimensions of patient care as identified by the Institute of Medicine in Crossing the Quality Chasm.

safe, effective, efficient, timely, patient-centered, and equitable

True or false: The United States has largely operated through a fragmented system with a fee for service approach.

True

I worked to standardize the role of healthcare workers, played a pivotal role in healthcare reform and in the establishment of CPT codes used in physical therapy. Who am I?:

American Medical Association (AMA

One of the main goals of the Affordable Care Act was to expand the Medicaid program by increasing eligibility for individuals below a certain income level. The federal poverty level for a family of four in 2024 was $31,200. Considering the ACA this means they would qualify for medicaid if their income was below what amount?

138% × 31,200 = 43,056

What are micro levels of care?

Services at the point of delivery and their effects

Performance of caregivers and healthcare organizations (medical errors, quality of life, health outcomes, etc.)

What are macro levels of care?

population view

performance of the entire healthcare system

True or False: While healthcare costs may be higher in the U.S., the rate of medical, medication, and lab error is considerably lower than other developed countries

False

Within the Affordable Care Act the employer mandate exists for companies that have at least what number of employees?

50

Define managed care