SPEA-H 124 1st EditionExam # 1 Study GuideDefinitions to know throughout the semester: Healthcare systems: formal and informal system of delivery services to keep people functioning - Medical care: for profit enterprises (hospitals)- Public health: government that does what other programs wont doHealth insurance: a contract between health insurance company and an individual; shifts costs of a risk to the company - Claim: how healthcare providers get paid- Reimbursement: healthcare company pays doctor; used to be patient paid doctorthen got paid backUninsured/underinsured: no insurance; people must take initiative to buy insuranceIndigent: a poor person with no insurance and can’t payAccess, cost, quality: the 3-legged stool- Access: can you get in to see a provider? - Cost: large part of macro and micro budgets - Quality: is the service benefiting the person? - An improvement in one affects one or more of the others Provider: healthcare organization (company)- Private sector; all healthcare providers Practitioner: person with credentials to provide healthcare Patient: clientPayor (“third party payor”): insurance company Healthcare reform: efforts by government or society to improve cost, quality or access to health care - Medicare: old people assistance- Medicaid: poor people assistance- Eligibility: criteria to be met to receive benefits - Means test: financial means Diagnostic: attachment of diagnosis by having tests done Therapeutic: treatment/prescription Mortality: deathMorbidity: illnessStakeholders: a person who can be affected by another person’s action Managed care organization (MCO): insurance company with rules to how health services must be used and incentives as to how deductibiles are used; used to encourage health and keep patients out of hospitals - Health maintenance Organization (HMO)- Preferred Provider Organization (PPO)Voluntary (Not-for-profit): community hospitals; has to give free community benefits; federally acknowledged; no taxes Public: hospital owned by county/state; VA clinic Acute: short term illness <30 days or deathChronic: long term terminal illness that can only be managed Inpatient: person admitted to hospital and spends the nightOutpatient: comes in for a test and leaves the same dayAmbulatory care: getting around without help; physician’s office/primary care Tertiary care: specialized hospitals Diagnostic imaging: x-rays, ultrasound, MRI; used to get a diagnosis Palliative care: focus on relieving pain of disease rather than curing it Competent adult: can make their own decisions and consent to medical care Chapter 1 Overview of Health Care: A Population PerspectiveAn Enormous Industry…*know general numbers and dates, not specifics for each part*U.S Health care: - $2.7 trillion in spending, roughly 11% of U.S employment and 17% of GDPo World’s 8th largest “economy”The number one cause of bankruptcy is high medical costsProblems of HealthcareThe system is extremely complex-not many people know how to navigate the Medicaid system nor are there many resources for help- There are different “rules” between government (public) and private payment sources - One of the many problems with the system is the lack of communication between doctorso Person is referred to a specialist and has to have tests repeated - Public health only gets 5% of our Health care dollar- Different rates of putting people through surgery? Why? Doctors trained differently across the country Reform Efforts: 50 year history of government attempts 1960s: Medicare (Title 18) and Medicaid (Title 19) made by Johnson: - Hospital sent bill to Medicare; Medicare paid cost plus 5% leading to hospitals spending excessively (merely because they could)- Increased access for low income and older Americans plus retirement benefits - Medicare/Medicaid improved access but skyrocketed costs 1970s-1980s: control to slow cost; “regulatory era”: hospitals had to get government approval for - expansions - HMO act of 1973: effort for federal govt to stimulate health maintenance organization; HMO option offered in addition to regular insurance; decreased quality - Emergence of technology - Certificate of Need: submitted by hospitals to prove they needed money for projects1990s: more cost control +quality improvements; “managed care”; hospitals competed based on Quality; recognition that the system needed reform2010 and beyond: cost, quality and access: Patient Protection and Affordable Care act- ObamaCare- ACAWhat is government’s role? Policy makers use (legislative proposals)to try to balance cost, quality and access-Why mandate insurance now? 1. Only unhealthy people would buy insurance if it wasn’t required2. This would cause skyrocketed rates for insurance companies because of lack of balance3. Point of insurance is to “spread risks”What is the primary market goal? Providers want to make more money from patientInsurance and patience want to spend less**primary market is not concerned with reaching the uninsured; mainly concerned with makingmoney Understanding Health Care “Old system” was started by charity; doctors had unquestionable authority: “aura of mystique” -people never doubted the “doctor’s orders” “New system” where patients educate themselves online and come in to compare doctor’s prescription vs what the internet said; doctors are bound by insurance rules Main problem is that the doctor doesn’t know each patients insurance plan regulation and can’tplan prescriptions the patients need based on their ability to afford themPublic cynicism: results from widespread exposure to the inadequate health care system; no room for mistakes, the expectation is to be cured- Pay of CEOs: why are they paid so much? - When is something malprofit and when is it someone’s fault? - “handoffs” when nurses give patient to physical therapists or next step without communicating “when you hear hoofbeats, think of horses, not zebras”-what is the most common diagnosis for this patient? 1/1000 will be commonHealth: state of complete physical, mental and social well-being and not merely the absence of disease” World Health OrganizationUS is 37th in world ranking of health and spends much more than the top ranked countries; $8000 per year per personThe largest potential for improving health lies in improving behaviorKnow that there are lobbyists that represent groups in