HSC CHAPTER 13+14 – Flashcards
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Spectrum of health care delivery system
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Health care in the US is delivered by an array of providers, in a variety of settings, under the watchful eye of regulators, and paid for in a variety of ways.
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Hill-Burton Act
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Federal money promoted hospital building. New issue: Health care as basic right vs. privilege.
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Primary medical care
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-Clinical preventive services, first-contact treatment services, and ongoing care for commonly encountered medical conditions. *ex. primary care provider offices; public clinics; managed care organizations; community mental health centers.
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Secondary medical care
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-Specialized attention and ongoing management for common and less frequently encountered medical conditions, including support services for people with special challenges due to chronic or long-term conditions. *ex. Emergency rooms; urgent/emergent care centers; hospitals special sub acute units in hospitals (e.g., transitional care units); skilled nursing facilities; home health care.
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Tertiary medical care
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-Specialized and technologically sophisticated medical and surgical care for those with unusual or complex conditions (generally no more than a few percent of the need in any service category). *ex. Specialty hospitals (e.g., psychiatric, chronic disease) and general hospitals with highly specialized facilities.
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Long term practice
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can be divided into 2 subcategories - restorative care and long-term care.
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Long term practice (Restorative Care)
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**Care provided after successful treatment or when the progress of an incurable disease has been arrested. -- nursing homes, assisted-living facilities, halfway houses and private homes.
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Long term practice ( long term care)
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**Different kinds of help that people with chronic illnesses, disabilities, or other conditions that limit them physically or mentally need. --provided in various settings such as nursing homes, facilities for the mentally and emotionally disturbed, assisted living facilities.
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Hospice Care
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A cluster of special services for the dying that blends medical, spiritual, legal, financial and family support services.
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Allopathic medicine
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The system of medical practice in which specific remedies for illnesses, often in the form of drugs or medication are used to produce effects different from those of diseases.
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Osteopathic medicine
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The recognition of the reciprocal interrelationship between the structure and function of the body.
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CAM
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Complementary Alternative Medicine, or complementary/integrative medicine. CAM has been defined as a "group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. usually much of the care provided by nonallopathic providers is often referred to as CAM.
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Non- allopathic providers
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Independent providers who provide nontraditional forms of health care. ex.: chiropractors, acupuncturists, herbalists, and homeopaths.
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Florence Nightingale
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Considered the founder of modern nursing. She set the current standards for nursing. she was born in Florence, Italy.
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RN
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Registered Nurse: One who has successfully completed an accredited academic program and a state licensing examination. The three typical educational paths to registered nursing are a bachelor's degree (BSN), and associate degree (ADN), and a diploma form an approved nursing program.
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Professional Nurse (BSN)
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A registered nurse holding a bachelor of science degree in nursing (BSN). They are considered to have been more thoroughly prepared for additional activities involving independent judgment.
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Nurse Practitioner
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examples: pediatric nurse practitioners and school nurse practitioners......
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Fee for service
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A method of paying for health care in which after the service is rendered, a fee is paid.
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CHIP
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Children's Health Insurance Program a title insurance program under the Social Security Act that provides health insurance to uninsured children.
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Health care insurance policy
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Deductible
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The amount of expenses that the beneficiary must incur before the insurance company begins to pay for covered services.
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Co-Payment
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a negotiated set amount that a patient pays for certain services.
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Co- Insurance
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the portion of the insurance company's approved amounts for covered services that a beneficiary is responsible for paying.
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Exclusion
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A health condition written into the health insurance policy indicating what is not covered by the policy.
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Pre-existing condition
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A medical condition that had been diagnosed or treated usually within the 6 months before the date a health insurance policy goes into effect.
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The Health Insurance and Portability Accountability Act of 1996 (HIPAA)
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Law created by congress, to ensure that people will not have to wait for health insurance to go into effect when changing jobs.
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Medicare Parts ABCD
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A national health insurance program for people 65 years of age and older, certain younger disabled people, and people with permanent kidney failure. Part A- hospital insurance Part B- medical insurance Part C- manager care plans Part D- prescription and drug plan.
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Medicare's DRGs
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Prospective reimbursement to help cut costs. The oldest is DRGs has been around since 1983. When patients with Medicare coverage are admitted to a hospital they are assigned a DRG and the hospital is reimbursed the predetermined amount of money for the DRG as opposed to the actual cost to render care.
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Medicaid
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A jointly funded federal-state health insurance program for low-income Americans.
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Medigap
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Private health insurance that supplements Medicare benefits.
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Managed care organizations (3rd party payers)
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MCOs: Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) Health Maintenance Organizations (HMOs) Mixed Model HMOs Staff Mode HMOs Independent Practice Associations (IPAs)
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PPOs
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Preferred provider organization An organization that buys fixed-rate health services from providers and sells them to consumers.
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HMOs
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Health maintenance organizations groups that supply prepaid comprehensive health care with an emphasis on prevention.
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Environmental hazards
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Factors or conditions in the environment that increase the risk of human injury, disease, or death.
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Natural environmental hazards
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Naturally occurring phenomenon or event that produces or releases energy in amounts that exceed human endurance, causing injury, disease, or death (such as radiation, earthquakes, tsunamis, volcanic eruptions, hurricanes, tornados and floods.)
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Solid waste
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Solid refuse from households, agriculture, and businesses.
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RCRA
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Resource Conservation and Recovery Act of 1976 the federal law that sets forth guidelines for the proper handling and disposal of hazardous wastes.
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Sanitary landfills
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Waste disposal sites on land suited for this purpose and on which waste is spread in thin layers, compacted, and covered with a fresh layer of clay or plastic from each day.
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Leachates
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Liquids created when water mixes with wastes and removes soluble constituents from them by percolation.
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Dumps
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Composting
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The natural, aerobic biodegradation of organic plant and animal matter to compost.
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Deep well injection
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underground injection, which is used for disposal of about 50% of hazardous waste. most of the wells are found in Texas and Florida.
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Incineration
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Combustion (incineration) The burning of solid wastes. considered to be the second major method of refuse disposal.
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Recycling
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The collecting, sorting, and processing of materials that would otherwise be considered waste into raw material for manufacturing new products, and the subsequent use of those new products.
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EPA
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Environmental Protection Agency The federal agency primarily responsible for setting, maintaining, and enforcing environmental standards.
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Hazardous waste
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A solid waste or combination of solid wastes that is dangerous to human health or the environment.
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Superfund Law (CERCLA)
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Comprehensive Environmental Response, Compensation, and Liability Act The federal law (known as the Superfund) created to clean up abandoned hazardous waste sites.
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Asbestos
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A naturally occurring mineral fiber that has been identified as a Class A carcinogen by the Environmental Protection Agency.
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Formaldehyde
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(CH2O) A water-soluble gas used in aqueous solutions in hundreds of consumer products.
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Radon
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A naturally occurring colorless, tasteless, odorless, radioactive gas formed during the radioactive decay of uranium-238.
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Ground level ozone
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one cause of excessive levels of ground-level ozone is a phenomenon referred to as a thermal inversion. This occurs when a layer of warm air settles above cooler air close to the earth's surface, preventing the cooler air from rising. Ozone then accumulates in the cooler air, the air we breathe.
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Second hand smoke
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Environmental tobacco smoke.
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1. The author of the textbook explains that our health care system lacks some of the characteristics of a "system". What characteristics are those? what do we need to do to make our health care delivery more systematic according to him & our class discussion?
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The US health care system lacks order, integration and accountability. Communication, collaboration, or systems planning among these various entities is limited and almost incidental to their operations.
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2. What is the reason why physicians switched from treating more patients at home, to providing, treatment in a hospital facility? what is the advantage to that?
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The primary reason was because of the building and staffing of many new hospitals. It was felt that patients could receive better care in a setting designed for patient care, staffed with trained people and equipped with the latest medical supplies and instruments. Also physicians were able to treat more patients in a central location because of the reduced travel time.
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3. What is a third party system, in terms of health care delivery?
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A health insurance term indicating that bills will be paid by the insurer and not the patient or the health care provider.
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4. What is the difference between an allopathic doctor and an osteopathic doctor?
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**allopathic- are those who use a system of medical practice in which specific remedies for illnesses, often in the form of drugs or medication, are used to produce effects different from those of diseases. The practitioners who fall into this category are those who are referred to as Doctors of Medicine (MDs). **osteopathic- Doctors of Osteopathic Medicine (DOs). Are independent health care providers whose remedies emphasize the interrelationships of the body's systems in prevention, diagnosis, and treatment.
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5. What is the philosophy behind chiropractors? To what do they attribute disease? What is the category of health provider that, according to the textbook, chiropractors belong to? what is the philosophy behind acupuncture?
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A chiropractor is a nonallopathic, independent health care provider who treats health problems by adjusting the spinal column. The underlying premise of the care provided by chiropractors is that all health problems are caused by misalignments of the vertebrae in the spinal column. The chiropractic (done by hand) approach to the treatment is the identification of the misalignment through X-rays, and the realignment of the bones through a series of treatments called "adjustments". Chiropractors belong to the nonallopathic category.
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Acupuncture:
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The theory believed that the chi (Qi) is disturbed when a person is sick. Needles are used to restore the natural flow of the chi in the body.
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6. What is the main difference, in terms of services, between a clinic and a hospital?
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One big difference is that clinics do not have inpatient beds while hospitals do.
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7. According to our textbook (Kissick), what are the 3 main shortcomings/problems or variables of our health care delivery system? explain each of them.
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Access to health care, the Cost containment to health care and the Quality of health care. Ex. if we increase access, cost will go up and the quality will decrease. Or if we concentrate on containing costs, access and quality will decrease. The triangle has to be an equilateral triangle for healthcare to work. Access: Even with several different means of gaining access to health care services access has been and continues to be a major health policy issue in the US. Quality: doing the right thing, the right way, at the right time, in the right way, for the right people, and having the best results. Containment Cost: The cost of health care and paying for health care continue to be burdens on both the individual and the US population as a whole.
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8. Why do we have so many people without health care insurance, if we have Medicaid?
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The greatest reason for lack of insurance coverage is cost of insurance followed by lost job or change in employment. **Because of total lack of health insurance, inadequate insurance, and poverty. Some people are ineligible for Medicaid , because of their poverty level.
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9. What does the author refer to as "the working poor"?
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Those who have a job but are unable to afford health insurance. It has been estimated that there are 30 million working poor in the US.
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10. Who are the most likely to be uninsured in the US, according to your book?
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Those people who cannot afford their out-of-pocket costs or health insurance premiums, small businesses and their employees, young adults who will be able to stay on their parents' policies until they find a job with health benefits, and those who are denied coverage because they have preexisting conditions or major health problems.
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11. What are the immediate changes in our health care system approved by the Affordable Care Act (Obama Care), mentioned in class? Which ones are still to be implemented?
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Health insurance coverage cannot refuse renewal (unless a person lies); all insurance need to cover immunizations & preventive care; unmarried dependents can remain in parents' policy until age 26 or remain unmarried.
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12. List and explain the difference between PPOs & HMOs, be sure to be able to compare & contrast both of them.
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PPOs= an organization that buys fixed-rate health services from providers and sells them to consumers. A PPO differs from the traditional fee-for-service plan in that the fee has been fixed (at a discounted rate) through a negotiation process between a health care provider and the PPO, and the provider agrees to accept this discounted rate as payment in full. HMOs= groups that supply prepaid comprehensive health care with an emphasis on prevention. HMOs are obligated to provide the members with a comprehensive range of outpatient and inpatient services that are spelled out in the contract for a specific period of time.
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13. According to your book, what are some recurrent problems with Medicare & Medicare in the US?
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14. What happened with hazardous wastes before they were regulated in 1976-1980?
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15. What are some examples of biological water pollutants?
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Pathogens such as parasites, bacteria, viruses, and other undesirable living microorganisms. They enter through human and animal wastes that were improperly disposed. ex. runoff form animal farms that contain manure; failed septic systems that leach untreated or only partially treated human fecal waste to groundwater and surface water.
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16. What are the advantages of incineration of trash?
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They are energy recovery plants, by converting some of the heat generated from the incineration process into steam and electricity. Combustion reduces the weight of solid waste by 75% and the volume of solid waste by as much as 90%. The resulting waste is nontoxic and will take up less sanitary landfill space, and because an incinerator can be located closer to the source of the solid waste, transportation costs may be less than for landfills.
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17. Mention and explain the 3 types of waste water treatment we have available in the US.
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Primary wastewater treatment- occurs in a sedimentation tank, also called a clarifier, where waste water remains in a quiescent condition for about 2-4 hours. Heavier solid particles settle to the bottom, forming a layer referred to as a sludge. The sludge includes bacteria, viruses, organic matter, toxic metals. Above the sludge is most of the wastewater. On top of the aqueous layer is a layer of oils and fats, called scum. Sludge and scum are removed and clarified water enters second stage of treatment.
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Secondary wastewater treatment:
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2. During this treatment, aerobic bacteria are added and mixed with clarified wastewater to break down the organic waste; the mixture then flows to aeration tanks. Oxygen is continuously added to support aerobic decomposition of organic waste into carbon dioxide, water and minerals. takes 6-10 hours, wastewater is sent to sedimentation tanks where solids and flocks of bacteria are separated from the treated liquid portion of wastewater. Then the treatment plants disinfect and discharge the treated wastewater to surface water bodies while other wastewater plants perform 3rd treatment.
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Tertiary wastewater treatment
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involves filtration through sand and carbon filters. Many remaining dissolved pollutants are removed. The treated h2o is finally disinfected and discharged. Water is chlorinated to be disinfected and then chlorine is removed from water through dechlorination to prevent poisoning of aquatic life in streams or rivers downstream of the discharged point.
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18. What are the warning signs of malignant melanoma, according to the ACS, mentioned in the book?
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A- Asymmetry- half of the mole does not match the other half. B- Border irregularity- the edges are ragged, notched, or blurred. C- Color- the pigmentation is not uniformed. D- Diameter greater than 6 millimeters- any sudden or progressive change in size should be of concern.
