US Health Care System Exam 1

value-based

Moving from a volume-based HC system to a _____ HC sytem

false

True or false- Americans are automatically covered for healthcare

17 million

Around this many people are employed by the US healthcare system

Medicare

Insurance for elderly and certain disabled people

Medicaid and CHIP

Insurance for indigent, poor, children

Affordable Care Act

Required all US citizens and legal residents to be covered by public or private insurance

none

This central agency governs the US healthcare system

need and demand

The two factors limiting patient decisions

item-based pricing

Fees charged for service (surgeon’s price)

phantom providers

Bill for services seperately

package pricing

Bundled fee for a group of related services

curative, restorative, preventative

Three categories of medical care services

false

True or false the United States healthcare system is governed by free market principles

the absence of disease

In the medical model, health is defined as…

physical, mental, social

The WHO definition of health includes these three types of well-being

acute

Short duration condition, often severe

subacute

Intermediate and transitional condition

chronic

Long duration condition, ongoing management

vaccines, smoking prevention, handwashing

Primary prevention level examples (3)

colonoscopy, mammography, BP screening

Secondary prevention examples (3)

rehabilitation, diabetes management, cardiac rehab

Tertiary prevention examples (3)

Global Health Security (GHS) Index

Framework for assessing the health security capabilities of countries around the world

social, political, economic,

Anthro-cultural values shaped the US healthcare system, but it evolved through the interactions of these three forces

the early 1900s

The practice of medicine was considered an insignificant trade during the preindustrial era until this time period

Truman

This president enacted the National mental Health Act in 1946

JFK

This president enacted the Community Mental Health Centers Act in 1963

1793

Philadelphia Fever Outbreak year

1873

NYC Cholera outbreak year

1900

By this year most states had public health departments and functions to address

the Baylor Plan

Allowed teachers to pay a small monthly fee for hospital coverage laying the foundation for modern health insurance (1929)

Medicare and Medicaid

The Social Security Act of 1935 created these programs

the HMO Act of 1973

Created federal support—grants, loans, and regulatory standards—to promote the development of HMOs

certification

The regulating process under which a state or voluntary professional organization such as a national board attests to the educational achievements and performance abilities

licensure

A state law defines the scope of practice and the educational and testing requirements that must be met to engage in the practice

registration

A mechanism to facilitate contacts and relationships among members of a profession, potential employers and the public

physicians

This group controls 60-70% of healthcare spending

false

True or false, the majority of physicians are generalists

54%

This percent of doctors are primary care physicians

internal medicine, family medicine, obgyn, general practice

Types of primary care physicians

DDS or DMD

Dentists (2)

OD

Optometrist (1)

ambulatory

This term is used interchangeably with outpatient

primary care

Less complex and specialized care, plays a central role in a healthcare delivery system

secondary care

Short term, sporadic consultation from a specialist, includes hospitalization, routine surgery, rehab, etc.

tertiary care

Most complex level of care that is highly specialized and treats uncommon conditions (usually at a teaching hospital)

complementary and alternative medicine

CAM stands for

six

To be considered a hospital the institution must have at least ___ beds

Hill-Burton Act of 1946

Provided federal grants and loans for constructing and modernizing nonprofit hospitals in exchange for obligations to offer community service and free or reduced‑cost care to eligible patients.

Roemer’s law

A built bed is a filled bed

the 1980s

After a huge boom, hospital downsizing has occurred since

average length of stay

ALOS

25

Rural and critical access hospitals typically have equal or less than ___ beds

financing, insurance, delivery, payment

Quad functions of a healthcare system

insurance status

What factor is the MOST predictive in determining if an individual will have access to health services in the US

managed care organization (MCO)

These organizations primarily focus on balancing cost, quality, and access, and are essential to the managed care model

system, no

A set of interrelated and interdependent components designed to achieve common goals. Is the US one?

telehealth, mobile testing, vaccines, emergency waivers

How was COVID-19 addressed within the US healthcare system?

hospital capacity, burnout, supply chain issues

What problems did COVID-19 cause for the US healthcare system?

defensive medicine, insurance

How do physicians protect themselves against malpractice lawsutits?

Job loss, employer dropping coverage, employment chances, low hours

What are some ways that employer-based insurance can lead to someone becoming uninsured? (4)

moral hazard

The tendency for insured individuals to increase their utilization of health services because insurance lowers the out of pocket costs

higher income, higher education, white/Asian, younger age

Demographic characteristics exhibiting better health levels in the US (4)

most, lower

Compared to other countries, the US spends the ___ per capita but ranks ___ on key indicators like infant mortality, life expectancy, and preventable deaths

sanitation and infectious disease control

Initially, public health focused on these two things

population

Over time, public health has become most focused on ____ health

American cultural beliefs, interest groups, political conservatism

Factors preventing the US from adopting a nationalized healthcare system (3)

preindustrial

Evolution of the practice of medicine- primitive, unregulated, decentralized

postindustrial

Evolution of the practice of medicine- rise of medical science, professionalization, dominance of hospitals and physicians

almshouse

Poorhouses for destitution. Precursor to the modern hospital

asylums

Old medical institutions for mental health warehousing

pest houses

Old medical institutions for quarantining contagious diseases

dispensaries

Old medical institutions that provided outpatient drugs for the poor

the Flexner report

A 1910 Carnegie Foundation study by Abraham Flexner that evaluated 155 U.S. and Canadian medical schools, leading to higher scientific standards, widespread school closures, and long‑term impacts on race, gender, and access in medical education.

The Flexner report, germ theory, antiseptic techniques, modern medical education

These were considered driving forces and events improving medical science in the US (4)

employer-based

Wage controls during WWII led employers to offer health benefits to attract scarce workers, which the IRS later ruled tax-exempt, cementing the structure. This helped develop the US private ______ healthcare system

Florence Nightingale

This person was part of the rise and importance of the nursing profession

Advanced Practice Nurses

A registered nurse with advanced post-graduate education qualified to diagnose and treat illnesses.

Advanced Practice Providers

A broad umbrella term for mid-level clinicians who practice medicine under physician collaboration or supervision.

Non-Physician Practitioners

A billing and clinical term for healthcare providers who deliver medical care independently of a doctor's direct physical presence.

allopathic

Doctors of medicine practice this kind of medicine

holistic

Doctors of osteopathic medicine practice this kind of medicine

inpatient care

Healthcare services delivered to a patient who has been admitted to a hospital or healthcare facility for an overnight stay or longer

bed counts, occupancy rate, ALOS

Hospital metrics related to capacity, utilization, and throughput (one for each)

public, voluntary, proprietary

Three types of hospital ownership

true

True or false only for-profit hospitals pay taxes, while non-profit hospitals are exempt and reinvest profits into community benefit

prospective payment systems (PPS)

A method of paying Medicare providers using fixed, pre‑established amounts.

diagnosis related groups (DRGs)

A classification system that groups hospital cases into categories based on primary diagnosis, secondary diagnoses, procedures, and patient factors, used to determine fixed payments for inpatient care under Medicare and some insurers

the Emergency Medical Treatment and Labor Act (EMTALA)

A federal law requiring hospitals to provide emergency medical care to anyone, regardless of their ability to pay or insurance status.

safety-net hospitals

Hospitals providing care to low-income, uninsured, and vulnerable populations regardless of their ability to pay

Assisted living facilities, nursing homes, continuous care retirement communities, adult day care centers

Different types of long-term care facilities (4)

bathing, dressing, eating

Examples of activities of daily living (3)

cooking, shopping, managing money

Examples of instrumental activities of daily living (3)

assisted living facilities (ALFs)

Residential housing that provides personal care, support services, and social programs in a homelike setting.

nursing homes or skilled nursing facilities (SNFs)

Heavily regulated clinical institutions providing intensive, round-the-clock medical and personal care.

continuing care retirement communities (CCRCs)

A single campus or retirement community that offers a full continuum of housing and care options in one place.

adult day care centers

A daytime community-based facility where frail, impaired, or disabled older adults can go for supervised care during daytime hours.

specialty maldistribution

An overabundance of medical specialists compared to generalists/primary care physicians (driven by much higher pay and prestige for specialists).

geographic maldistribution

A severe shortage of doctors in rural/inner-city areas, with an oversupply in wealthy suburban areas. (Driven by lifestyle preferences, higher income potential, and better technology/schools in cities).

corporate

The current era dominated by large healthcare corporations and managed care, where high costs turned physicians into salaried employees and introduced strict insurance oversight.

no

ARE YOU HAVING FUN?????