Healthcare Systems Test 1 study guide PDF

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Summary study guide of all material that is on Test 2 for Timothy Howley's health care systems class....

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Chapter 1 - Introduction Basic components of health services delivery system 1.Financing (Employers, government, independent) 2. Insurance (Protection) 3. Delivery(Health care providers, hospitals, etc) 4.Payment(Pay for service – through insurance and out of pocket) Affordable Care Act - Reduce number of uninsured - Passed in 2010 but most provisions not implemented until 2014 - Mandate for employers to provide health insurance postponed until 2015 - Not universal coverage Major characteristics of US Health Care System 1.No central agency 2.Partial access 3.Imperfect market 4.Third party insurers and payers 5.Multiple payers 6.Power balancing 7.Litigation risks 8.High technology 9.Continuum of services 10. Quest for quality

National Health Insurance (NHI) – Canada National Health System (NHS) – Great Britain - Government owned hospitals, all government run, longer wait times, better preventative medicine Socialized Health Insurance (SHI) – Germany - Doctors not paid much, long wait times, excellent quality Social Health Insurance - Japan - Socialist, not free market, private hospitals, everyone covered *notes about country comparison video Taiwan has national insurance system - No wait, all care covered, billed directly to government, population happy - No free market, providers don’t make much Switzerland has universal coverage - 2nd most expensive healthcare system,

Chapter 2 - Beliefs, Values and Health WHO definition of health - A state of complete physical, mental, and social well being and not merely the absence of disease

Evaluation of Health Status - Morbidity (incidence, prevalence): rate of disease in a specific population - Epidemic: affecting a large number of individuals within the same population (SARs) - Endemic: Native to a particular people or country, happens at a constant (chicken pox) - Pandemic: global disease outbreak (HIV/AIDs, Influenza) - Mortality (death rates) - Infant mortality (5.8/1000, 55 other countries have a lower rate than US) - Life expectancy (79.8, 42nd in the world) US has highest health expenditure in the world - 17.1% of GDP (gross domestic product aka total economy of the nation) Acute: last less than three weeks Subacute: 3-8 weeks Chronic: lasting more than 18 weeks 75% of health expenditure in US goes towards treatment of chronic conditions

Prevention -

Primary (vaccines) Secondary (screening and early diagnosis) Tertiary (treatment and rehabilitation)

American Beliefs and Values *** still dont know exactly what this means 1. The advancement of science 2. A champion of capitalism 3. Entrepreneurial spirit and self 4. Free enterprise and distrust of government

Market Justice vs. Social Justice

Chapter 3 - Evolution of Health Services in the US Four eras - Preindustrial - Post industrial - Corporate - Era of Health Care Reform Preindustrial - Medical practice in disarray - Primitive procedures (bleeding) - Institutional core missing (no community hospitals) - Unstable demand - Medical education substandard - Early med schools were for profit and had low standards compared to state schools -

Post-industrial (late 1800-mid 1900) - Urbanization - Science and technology - Institutionalization - Dependancy - Autonomy - Licensing - Education reform - Harvard and Hopkins anesthesia (nitrous oxide) for tooth extractions came first (Horace wells) then hand washing before surgeries (Ignaz Semmelweis) then Louis Pasteurs germ theory then X rays (Wilhelm Roentgen)

Rise of Private Health Insurance - Early blanket insurance policies - Economic necessity of the Baylor Plan - Teachers paid 50 cent monthly for coverage - -> led to Blue Cross & Blue Shield - Blue Cross is hospital services - Blue Shield is physician services -> check-ups etc Led to employment based Health insurance - WWII: wage freezes and incentives, health insurance as incentive to come work - 1948: Supreme Court rules that employee benefits can be part of union management bargaining - 1954 IRS Revision: Health Insurance is tax exempt Failure of National Health Care initiatives - At the state level - In 1945 FDR’s Wagner-Murray-Dingell Bill dies - In 1946 Harry Truman calls for universal health insurance - In 1992 Bill Clinton universal health care Opposition to Universal Health Care - American Medical Association - Labor unions - Insurance companies - Pharmaceutical companies

Medicare and Medicaid

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Kerr-Mills act law went into place in 1960 before medicare and was very ineffective Title 18 (XVIII) of Social Security Amendment of 1965 -> Medicare -> *** Lyndon B. Johnson signed this into law - Part A (Blue Cross) - Part B (Blue Shield) Title 19 - Medicaid - “Means tested” -> impoverished

Corporate Era - Corporatization of Health Care delivery - Information Revolution - Globalization Era of Health Care Reform - State precedents of ACA - OREGON - MASSACHUSETTS - Passage of ACA - Based off of Massachusetts Plan - Supreme Court Rulings Oregon Plan - Late 1980s - Expansion of medicaid - Oregon medical insurance pool (couldn’t disallow people with pre-existing conditions) - Employer mandate (pay or play doesn’t materialize) Massachusetts Plan - 2006 - Individual mandate - Employer mandate - Large government subsidies - “Health Exchange”

*** The Veterans Affairs started after WWI to give vets health insurance *** Dent v. West Virginia established medical training with necessary skills

Chapter 4 - Health Services Professionals ** stuff about NPR recordings and NP article (not that much important test info)

Primary versus specialty care (42% vs. 58%) US health care industry is the largest employer in the nation - Work in variety of different settings Physicians: MD or DO - Most physicians are specialists (about 58%) - Maldistribution to care geographically (rural areas with access to certain care) - International Medical graduates (more steps to practice in the US) Other doctoral level professionals (limited care providers) = Dentist, optometrist Nurses PAs or NPs Allied Health professionals (OT, PT, Tech) Health service admins Salaries for speciality care providers vs primary care providers Speciality pays much much more Primary care is stigmatized medicaid expansion: PA, MD, WV, CA, NY, KY, OR, WA, DC no expansion: TX, VA, FL, NC, SC, GA, AL, MS, TN Full practice: WA, OR, AK, HI, DC limited: NY, PA, MD, WV restricted: VA, NC, SC, TX, CA...