Midterm Exam and Final Exam

Chapter 6: Health Service Financing

Q: What is the role of health care financing?
A: It pays for health insurance premiums, determines access to healthcare, and influences the distribution of healthcare professionals.
Q: Define "premium" in health insurance.
A: The amount charged by insurers to cover specific risks, varying by plan.
Q: What are deductibles in health insurance?
A: The yearly amount paid by the insured before benefits begin.
Q: What are Medicare Part A and its financing features?
A: Covers inpatient services, funded through payroll taxes, and requires specific work credits.
Q: Describe Medicare Part D.
A: Prescription drug coverage requiring monthly premiums and deductibles.
Q: What is the purpose of cost-sharing in health insurance?
A: To distribute healthcare costs between insurers and insured individuals.
Q: Define "bundled payment."
A: Reimbursement method combining several related services into one price.
Q: What are high-deductible health plans?
A: Plans with low premiums but high deductibles, often paired with savings options.
Q: What is fee-for-service reimbursement?
A: Payment for individually billed services, now less common due to inefficiencies.
Q: Name two managed care reimbursement approaches.
A: Capitation and salary with productivity bonuses.

Chapter 7: Outpatient and Primary Care Services

Q: Define outpatient services.
A: Medical procedures/tests done without an overnight stay.
Q: What is a patient-centered medical home (PCMH)?
A: A care model emphasizing continuous, comprehensive, and coordinated care.
Q: What are community-based primary care principles?
A: Combines primary health care and community medicine for coordinated practice.
Q: Name two hospital-based outpatient services.
A: Wellness/prevention programs and diagnostic imaging.
Q: What are Medicare's eligibility requirements for home health care?
A: Patients must be homebound, require skilled care, and receive care from a Medicare-approved agency.
Q: Difference between ambulatory and primary care?
A: Ambulatory refers to mobility, while primary care is routine, ongoing health care.
Q: What is the main function of critical access hospitals?
A: Provide emergency and inpatient services in rural areas.
Q: What is telehealth?
A: Remote diagnosis and treatment of patients using technology.
Q: Why is coordination vital in primary care?
A: It ensures comprehensive management of patient health needs.
Q: What is the goal of community health assessments?
A: Evaluate local population health needs systematically.

Chapter 8: Inpatient Facilities and Services

Q: Define inpatient services.
A: Medical services requiring an overnight stay.
Q: What led to the growth of hospitals in the 20th century?
A: Advances in medical science, technology, and professional nursing.
Q: Name a factor responsible for hospital downsizing.
A: Shift from inpatient to outpatient care.
Q: What is a general hospital?
A: A facility providing a range of diagnostic, treatment, and surgical services.
Q: Define specialty hospital.
A: Focuses on specific diseases or conditions, like cardiac care.
Q: What is a critical access hospital?
A: A rural hospital meeting specific Medicare criteria for designation.
Q: What is the function of teaching hospitals?
A: Provide education and residency training alongside patient care.
Q: Define hospital-based swing beds.
A: Used for both acute and skilled nursing care as needed.
Q: What is a community hospital?
A: Serves the general population, often non-federal and short-stay.
Q: How do public and private hospitals differ?
A: Public hospitals are government-owned; private hospitals can be for-profit or nonprofit.

Chapter 9: Managed Care and Integrated Organizations

Q: What is managed care?
A: A healthcare delivery system managing costs, utilization, and quality.
Q: How do managed care organizations achieve cost savings?
A: Through choice restriction, care coordination, and utilization reviews.
Q: What is the staff model of HMOs?
A: Physicians are salaried employees providing care exclusively for the HMO.
Q: Describe the IPA model in managed care.
A: Independent Practice Association contracts with HMOs, representing multiple providers.
Q: Define capitation payment.
A: Providers are paid a set fee per enrollee, regardless of services used.
Q: What is practice profiling?
A: Evaluating provider patterns to improve efficiency and care quality.
Q: Describe the role of disease management in managed care.
A: Focuses on chronic conditions to reduce costs and improve outcomes.
Q: What are preferred-provider organizations (PPOs)?
A: Networks of providers offering services at discounted rates to members.
Q: Define utilization review.
A: Assessment of care to ensure necessity and cost-effectiveness.
Q: How does the group model differ from the network model in HMOs?
A: Group model contracts with one practice, while network model contracts with multiple.

Chapter 10: Long-Term Care

Q: What is long-term care (LTC)?
A: Services promoting independence for people with chronic limitations.
Q: Name two LTC service types.
A: Skilled nursing and assisted living.
Q: Who funds LTC services?
A: Private payments, insurance, Medicaid, and Medicare.
Q: What is subacute care?
A: Intermediate care for patients post-acute illness or injury.
Q: What are home health care services?
A: Medical and personal care provided in a patient's home.
Q: Define respite care.
A: Temporary relief for primary caregivers.
Q: What is the purpose of adult day care?
A: Provide daytime supervision and care for adults needing assistance.
Q: How does Medicare support LTC?
A: Covers short-term care, such as rehabilitation.
Q: What is hospice care?
A: End-of-life care focusing on comfort and quality of life.
Q: What role do informal caregivers play in LTC?
A: Provide unpaid support, often family or friends.

Chapter 11: Health Services for Special Populations

Q: Who are vulnerable populations?
A: Groups facing greater barriers to accessing health care, such as minorities and the uninsured.
Q: What challenges do homeless populations face in healthcare?
A: Lack of access, untreated conditions, and economic instability.
Q: Define health disparities.
A: Differences in health outcomes linked to social, economic, or environmental disadvantages.
Q: How do language barriers affect healthcare?
A: They hinder understanding and access to appropriate services.
Q: What is the impact of cultural barriers in healthcare?
A: They affect trust, communication, and service utilization.
Q: Describe healthcare issues for migrant workers.
A: High rates of chronic conditions and limited access due to mobility.
Q: What is social determinants of health?
A: Conditions influencing health status, such as income and education.
Q: Define equity in healthcare.
A: Ensuring fair access to health services regardless of personal factors.
Q: What are community health programs?
A: Local initiatives to improve population health and reduce disparities.
Q: How does public health address special populations?
A: Through targeted policies and programs to meet their unique needs.

Chapter 12: Healthcare Costs, Access, and Quality

Q: What are the three meanings of healthcare costs?
A: Price of services, national expenditure, and providers' production costs.
Q: What factors have escalated healthcare costs?
A: Third-party payments, growth of technology, aging population, and defensive medicine.
Q: Define "access to care" and its dimensions.
A: Accessibility, accommodation, affordability, availability, and acceptability.
Q: What are the types of access identified by Andersen et al.?
A: Equitable, inequitable, realized, potential, and effective/efficient access.
Q: What are the three methods for evaluating National Health Expenditures (NHE)?
A: Comparing medical inflation, GDP growth, and ACA effects.
Q: What challenges exist in regulatory cost-containment approaches?
A: Fixed budgets reduce responsiveness to patient needs and lack incentives for efficiency.
Q: What is quality assessment?
A: Measuring quality against a standard, using variables, and collecting data.
Q: What is quality assurance?
A: Continuous quality improvement through institutionalized assessment.
Q: How does the ACA aim to improve healthcare quality?
A: Linking payments to quality outcomes, strengthening infrastructure, and promoting care models.
Q: What is the impact of waste and abuse on healthcare costs?
A: Overutilization and fraudulent practices like upcoding increase unnecessary expenditures.

Chapter 13: Health Policy and Legislation

Q: What is the definition of health policy?
A: Decisions guiding public health, including regulatory and allocative tools.
Q: Name the principal features of U.S. health policy.
A: Government as a subsidiary, fragmented policies, pluralism, and presidential leadership.
Q: How are legislative health policies developed?
A: Through a process influenced by government-private sector relationships and federalism.
Q: What is the role of public policies in healthcare?
A: Direct actions, behaviors, and decisions of individuals or groups.
Q: How does the Affordable Care Act impact healthcare?
A: Improves access, reduces costs, and enhances quality through coordinated models.
Q: What challenges does incrementalism pose to health reform?
A: Slow progress and fragmented implementation of policies.
Q: How do interest groups influence U.S. health policy?
A: They advocate for specific reforms and demand targeted policies.
Q: Define distributive and redistributive policies.
A: Distributive spreads benefits widely; redistributive reallocates resources to reduce inequality.
Q: What were the political challenges in passing the ACA?
A: Opposition from stakeholders, economic concerns, and partisan conflicts.
Q: How does the ACA promote patient-centered care?
A: Through medical homes and accountable care organizations enhancing coordination.

Chapter 14: Future of Healthcare

Q: What forces will drive future changes in healthcare?
A: National debt, economic growth, employment, and regulatory adjustments.
Q: What is patient activation?
A: Patients' skills, confidence, and motivation to engage in their care.
Q: Why is geriatric training important?
A: Increasing elderly populations demand specialized care, but training is underemphasized.
Q: What obstacles hinder cost-efficient care delivery?
A: Lack of efficiency models and high costs of technology and innovation.
Q: How does evidence-based medicine influence healthcare?
A: Improves quality, outcomes, and protocol adherence through data-driven decisions.
Q: What challenges exist in financing and delivering healthcare?
A: Rising costs, access barriers, and experimental delivery models.
Q: How does the Focused Factory Model improve care?
A: Specializes in conditions for efficiency and reduced costs.
Q: What is the role of quality measurement in healthcare infrastructure?
A: Enhances delivery by tracking and improving service standards.
Q: How does the workforce evolve in healthcare?
A: Adapts to demographic shifts and integrates technology for better outcomes.
Q: What is the dual outlook on healthcare's future?
A: Positive for technological progress, but risky due to high associated costs.