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| dominant healthcare delivery system in US |
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| an individual covered under a managed care plan |
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| a program financed by the DOD for families and dependents of active-duty or retired career military personnel |
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Veterans Integrated Service Networks
responsible for coordinating activities of hospitals and other facilities in its jurisiction.
responsible for equitable distribution of federal funds among hospitals and other providers
responsible for improving efficiency and containing costs |
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| people with health needs but inadequate resources to address them |
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one of the largest sources of public health insurance in the US
serves elderly, disabled and ESRD patients |
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3rd largest source of public health insurance in the US
insures 19% of the population
low income adults, children, elderly and disabled |
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| Children's Health Insurance Program |
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Integrated Delivery System
a network of healthcare providers and organizations providing coordinated healthcare to a population
responsible for health outcomes and health status of the population |
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accountable care organization
expected to respond to new payment incentives and be held accountable for better quality outcomes and lower costs |
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Long-term Care
medical and nonmedical care for individuals with chronic health issues and disabilities preventing them from performing daily tasks |
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| mission of US public health system |
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| improve and protect community health |
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| 10 essential public health services identified by the National Public Health Performance Standards Program |
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• Monitor health status to identify and solve community health problems
• Diagnose and investigate health problems and hazards Inform, educate, and empower people about health problems and hazards
• Mobilize the community to identify and solve health problems
• Develop policies and plans to support individual and community health efforts
• Enforce laws and regulations to protect health and safety
• Provide people with access to necessary care
• Ensure a competent, professional health workforce
• Evaluate the effectiveness, accessibility, and quality of personal and population-based health services
• Perform research to discover innovative solutions to health problems |
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| centrally controlled healthcare systems |
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Definition
less complex and less costly
manage total expenditures with global budgets
ability to govern availability and utilization of services |
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| negative outcomes of medical technology in US |
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Definition
create a demand for new services with shrinking financial resources
increased demand for high tech care = increased cost
newest is not necessarily best
hospitals compete for modernization and face pressure to recoup costs |
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| ability to obtain healthcare when needed |
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| costs of ancillary services which tend to accompany surgeries or other major procedures |
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| services bundled for an episode of care |
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| costs of all services a health plan enrollee may need for a year |
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| created by practitioners with a financial interest in ordering further treatments |
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| places responsibility for fair distribution of health care on market forces in a free economy |
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| emphasizes well being of community over that of the individual |
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| The Emergency Medical Treatment and Labor Act of 1986 |
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| requires screening and evaluation of all patients, provision of necessary stabilizing treatment, hospital admission when necessary - regardless of ability to pay |
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| result of over use of ERs - cost of uninsured users are passed to covered patients |
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prescribing additional diagnostic tests, scheduling checkup appointments, maintenance of abundant case documentation.
unnecessary and raise costs, decrease efficiency |
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Type: Socialized health insurance
Ownership: private
Financing: employer-employee (mandated payroll contributions and general taxes)
Reimbursement: per diem payments
Consumer copayment: negligible
Life expectancy for women: 80.7
Infant mortality per 1k live births: 3.3
Expenditures as % of GDP: 11.3 |
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Type: National Health System
Ownership: public
Financing: Global budgets
Reimbursement: salaries and capitation payments
Consumer copayment: negligible
Life expectancy for women: 81.0
Infant mortality per 1k live births: 3.9
Expenditures as % of GDP: 9.7 |
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| The four key functions necessary for health care delivery: financing, insurance, delivery, and payment. |
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Type: National Health Insurance
Ownership: public/private
Financing: Single payer (general taxes)
Reimbursement: Global budgets
Consumer copayment: negligible
Life expectancy for women: 81.7
Infant mortality per 1k live births: 4.8
Expenditures as % of GDP: 10.6 |
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Definition
Type: Pluralistic
Ownership: private
Financing: Voluntary, multi-payer system
Reimbursement: Varies (DRGs, negotiated fee for service, per diem, capitation)
Consumer copayment: small to significant
Life expectancy for women: 78.8
Infant mortality per 1k live births: 5.8
Expenditures as % of GDP: 17.2 |
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| Canadian Patient Safety Institute |
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| responsible for promoting best practices and developing tools, strategies and standards for quality of care |
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| a set of interrelated, interdependent components designed to achieve some common goals with logically coordinated components |
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| carried out through the healthcare delivery infrastructure consisting of hospitals, clinics, ltc providers and other settings |
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| critical issues and concerns surrounding what the health services system is |
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| How many people work in U.S. healthcare delivery systems |
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| ACA was ostensibly designed to |
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| push healthcare in the United States toward more integrated care |
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| Which developed country is the only one who does not provide universal health insurance programs |
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| annual health insurance deductible |
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Definition
| The amount of covered health care expenses you must pay yourself each year before your insurance will begin to pay |
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| the medical model focuses on |
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Definition
| individuals and the factors that are most immediately linked to the pathophysiology of a person's disease and good health is defined as the absence of disease and physical symptoms |
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| the medical model emphasizes _____ rather than _____. |
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| illness rather than wellness |
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| Applying holistic concepts of care, and integrating medical care with preventive and health promotion efforts, could significantly improve health, and would also |
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Definition
require individual responsibility for behavior and community partnerships to improve both personal and community health.
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| The medical model emphasizes |
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| Diagnosis and interventions to great disease |
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| WHO`s definition of health |
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| A complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity. |
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| WHO definition of health care system |
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All activities aimed at promoting, restoring, or maintaining health
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| Seeks to treat the whole person |
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| Holistic health incorporates |
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Spiritual
Physical
Mental
Social |
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| Religious and spiritual beliefs and practices |
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Definition
Positively influence:
Physical
Mental
and Social well-being |
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| the term illness differs from disease in that |
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| Illness included a person's perception and evaluation of how he or she feels |
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| Relatively severe, episodic, and often treatable |
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| Somewhere between acute and chronic |
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| Less severe, long continuous duration |
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| Overall patient satisfaction with life during and after an encounter with the healthcare delivery system |
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| 4 categories of Determinants of health |
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Definition
- Environment
- Behavior
- Lifestyle
- Heredity
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| Environmental factors include 4 dimensions of life |
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Definition
- Physical
- socioeconomic
- Sociopolitical
- Sociocultural
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| Income inequality is associated with health indicators such as |
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Life expectancy
Age-adjusted mortality rates
Leading causes of deatb |
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| the greater the gap between rich and poor in an area |
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Definition
the worse the overall health of the population in that area
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| Behavioral factors include |
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Diet
Exercise
Stress
risky or unhealthy behaviors |
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| market justice assumptions |
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healthcare is a good that can be governed by free market
individuals are responsible for their own achievement
people make rational choices in healthcare products and services
people with their physicians, know what is best for themselves |
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| overarching goals of Healthy People 2020 |
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Definition
attaining high-quality, longer lives free fo preventable disease, injury and premature death
Achieving health equity, eliminating disparities, and improving the health of all groups
Creating social and physical environments that promote good health for all
promoting quality of life, healthy development, and health behaviors across all life stages |
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