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HCD 303 Final Exam Study Guide
QUESTIONS WITH COMPLETE
SOLUTIONS. ALREADY GRADED A+
System - CORRECT ANSWER -a set of connected things or parts forming a
complex whole.
Quality - CORRECT ANSWER -the degree to which health care services for
individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Access - CORRECT ANSWER -refers to entry into or use of the health care
system
Cost - CORRECT ANSWER -total medicare spending, health expenditures (%
GDP), variability in the cost of care
Universal coverage - CORRECT ANSWER -a health care system that provides
health care and financial protection to all citizens of a particular country
Globalization - CORRECT ANSWER -the process by which businesses or other
organizations develop international influence or start operating on an international scale
Centralized - CORRECT ANSWER -organized at the federal level
Decentralized - CORRECT ANSWER -organized at the regional level
Federal - CORRECT ANSWER -The central government
Regional - CORRECT ANSWER -provincial, state, cantonal, territorial or other
sub-unit governments
Public Health Services/Insurance - CORRECT ANSWER -owned and run by the
government at any level
Private Health Services/Insurance - CORRECT ANSWER -non-profit companies,
usually medisave approved integrated shield plansCovers upgraded hospital wards, can cover primary care services and other outpatient services not owned, not run by the government
Copayment - CORRECT ANSWER -The amount that you must pay at the point
of service, that is prospectively a dollar amount
Coinsurance - CORRECT ANSWER -The amount that you must pay at the point
of service, that is prospectively set percentage of your bill
Deductible - CORRECT ANSWER -The amount that you must pay out-of-pocket
before your insurance will cover your medical expenses
Premium - CORRECT ANSWER -The amount that you must pay each month to
remain covered by your insurance
Sickness funds - CORRECT ANSWER -a form of health insurance; sum of
money used to cover medical costs
Safety nets - CORRECT ANSWER -government programs that protect people
experiencing unfavorable economic conditions.children under 18 are exempt from cost sharing; annual cap=2% household income, 1% if chronically ill; unemployed do not lose health insurance, government steps in.
Cost-sharing - CORRECT ANSWER -Provision of a healthcare insurance policy
that requires policyholders to pay for a portion of their healthcare services; a cost- control mechanism.
Subsidy - CORRECT ANSWER -a sum of money granted by the government or
a public body to assist an industry or business so that the price of a commodity or service may remain low or competitive.
Generalized Reciprocity - CORRECT ANSWER -the principle belief of giving
without any expectation of an immediate return
Subsidiarity - CORRECT ANSWER -an organizing principle that matters ought to
be handled by the smallest, lowest or least centralized component of government
Social Solidarity - CORRECT ANSWER -the federal government has the
responsibility to ensure that all citizens have access to fundamental social services, including healthcare
Shared vision - CORRECT ANSWER -what you and the other members want to
create or accomplish as part of the organization
Shared reality - CORRECT ANSWER -product of the motivated process of
experiencing a commonality of inner (mental) states with others about the world
Attitudes/Beliefs - CORRECT ANSWER -Commonly held views of persons,
objects, and ideas
Population Health Management - CORRECT ANSWER -the management of the
health outcome of a group of individuals, including the distribution of such outcomes within the group
Nudging: definition and the different types - CORRECT ANSWER -Definition:
interventions that rely less on conscious choice by individuals and more on influencing behaviors through environment/societal norms are more likely to succeed Types: -Environmental: Easy access to stairs instead of elevators -Economic: Sin taxes -Educational:Learning about the effects of bad habits on health
Primary prevention - CORRECT ANSWER -Primary prevention aims to prevent
disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur Examples: -ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) -education about healthy and safe habits -immunization against infectious diseases.
Secondary prevention - CORRECT ANSWER -Secondary prevention aims to
reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. Examples: -regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer)
-daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes -suitably modified work so injured or ill workers can return safely to their jobs.
Tertiary prevention - CORRECT ANSWER -Definition: Tertiary prevention aims
to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples: -cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) -support groups that allow members to share strategies for living well -vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.
Quaternary prevention - CORRECT ANSWER -Action taken to identify patient at
risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.
Health disparities - CORRECT ANSWER -higher burden of illness, injury,
disability, or mortality experienced by one population group relative to another group
Healthcare disparities - CORRECT ANSWER -difference between groups in
health insurance coverage, access to and use of care, and quality of care.
Marginalized/Underserved Community - CORRECT ANSWER -people who, for
whatever reason, are denied involvement in mainstream economic, political, cultural, and social activities
Uninsured/Underinsured - CORRECT ANSWER -people with public or private
insurance policies that do not cover all necessary healthcare services, resulting in out- of-pocket expenses that exceed their ability to pay
Components of a healthcare system - CORRECT ANSWER -People, parts,
interrelationships, culture US rankings in WHO report, Bloomberg Business report, & Commonwealth Fund report
- CORRECT ANSWER -WHO- 37, Bloomberg-50, commonwealth- Goals of a healthcare system (3). How do you measure the various goals? -
CORRECT ANSWER -quality, access, and cost
region"5 year plan: did not include healthcare1980's: first comprehensive healthcare plan is introduced1984-1993 Medisave, Medishield, Medifund
Beveridge - who was he and what was his role - CORRECT ANSWER -•Civil
servant, educator •Worked in London's lower east side - before, during & after WWII •1942: wrote & released The Beveridge Report -Official Name: Social Insurance & Allied Health Services -Government report -Laid out the entire plan on how to develop & implement a fully federally-run healthcare system
Lee Kwan Yew - who was he and what was his role - CORRECT ANSWER -
Singapore's founding father had vision of first world oasis in third world region
Bevan - who was he and what was his role - CORRECT ANSWER -Aneurin
Bevan, Minister of Health (1945 - 1951) •Shared in Beveridge's vision •Official founder of the NHS when it was passed into law in July, 1948 •Had to make many compromises, especially w/ specialists The belief systems that were the foundation of each countries healthcare system -
CORRECT ANSWER -UK- "Illness is neither an indulgence for which people
have to pay, nor an offense for which they should be penalized, but a misfortune, the cost of which should be shared by the community." Germany-social solidarity Singapore- "the people's desire to achieve and succeed must never be compromised by an overgenerous state"
Bismarck - who was he and what was his role - CORRECT ANSWER -Otto von
Bismarck: Germany's 1st Chancellor (1871) •Hundreds of "sickness funds" already in operation throughout Germany •Bismarck saw working class movement at that time as a threat (labor unions were gaining strength) •In attempt to quell social unrest among workers and to control growing strength of labor unions Bismarck proposed a national social insurance system -1883: Sickness Insurance Act Passed •1st social insurance program organized at a national level •Organization & operation the sickness funds remained at the union level -Remained primary structure of the system until WWII. FFS:
- Define
- Their associated incentives
- An example of where it's utilized, either in the US or around the world -
CORRECT ANSWER -definition: A payment model where all healthcare
services, products, and prescription medications are unbundled and paid for separately physician incentive: Overtreatment Provide more services, testing, and treatments that are billable through an ICD-code example: 4 models of healthcare Clearly define each Be able to list a country where each model is represented
Where in the US are each of the models represented - CORRECT ANSWER -
Beverage model -definition: -country: UK -US representation: Veterans Affairs/Tricare National Health insurance model -definition -country: Canada -US representation: Medicare Bismark Model -definition -country: Germany -US representation: Average Worker Out-of-pocket model -definition: Medical and healthcare services are provided through both public and private entities and paid for by the individual receiving service -country: -US representation: 10% with no access to health insurance - Out-of-pocket model Per Diem
- Define
- Their associated incentives
- An example of where it's utilized, either in the US or around the world -
CORRECT ANSWER -Definition: A type of prospective payment model in which
the cost of healthcare is established prior to treatment and paid to the hospital or provider based on the number of days treatment was given. Physician Incentive: Increase length of stay Example: UK P4P
- Define
- Their associated incentives
o Financing - how are funds accumulated? Payment models used? o Cost sharing? o Safety nets? o Population health management efforts? Health disparities present?
o Current reform efforts/lessons for the US - CORRECT ANSWER -
Decentralized Federal ministry of health: Providers (outpatient) Sickness FundsRegional physicians Regional Sickness fundsNational Association National Association of SHI physicians SHI sickness funds State Ministry of Health: Sickness Funds Hospitals (inpatient phys)Regional SF regional hosp organizatio National Association German Hospital of SHI sickness funds federation DRG
- Define
- Their associated incentives
- An example of where it's utilized, either in the US or around the world -
CORRECT ANSWER -Definition: A prospective payment model in which
hospitals are reimbursed with a fixed fee regardless of the actual costs. Includes hospital expenses only. •ACA required 30-day readmission penalty Physician Incentive: •Reduce length of stay •Discharge appropriately •Keep costs to a minimum Example: US Singapore's Model: o Centralized or Decentralized & why? o Role of federal government o Health services & insurance - public or private? Insurance program(s)? o Financing - how are funds accumulated? Payment models used? o Cost sharing? o Safety nets? o Population health management efforts? Health disparities present?
o Current reform efforts/lessons for the US - CORRECT ANSWER -Centralized
Federal Government breaks into Ministry of health and monetary authority Ministry of health: Statutory Boards or Healthcare Institution medisave: everyone is covered, madatory hospitalizations and certain outpatient expenses are covered (maternity, palliative/hospice, psychiatric treatment, rehabilitation, testing) applies to any hospital medishield: People w prolonged illness are covered treatment in subsidized wards of public hospitals, outpatient care for certain conditions (kidney dialysis or cancer treatment)
medifund: Indigent (government endowment) must qualify by not being able to pay medical bills even with medisave and medishieldcovers additional financial support for necessary medical treatment, must be received at approved facilities Percentage of health determined by behaviors & examples of those behaviors -
CORRECT ANSWER -40%
examples: -smoking -eating and exercise habits Reference Pricing:
- Define
- Their associated incentives
- An example of where it's utilized, either in the US or around the world -
CORRECT ANSWER -Definition: the payment amount now going towards to
medical centers with high quality and low cost Incentive: low expenses, and high quality of care Example: Norway Capitation
- Define
- Their associated incentives
- An example of where it's utilized, either in the US or around the world -
CORRECT ANSWER -Definition: A prospective payment model where the
hospital or provider is paid a contracted rate per-member-per-month, regardless of the number of services provided. Rates are typically (but not always) risk-adjusted Physician Incentive: •Keep the patient healthy and living their daily lives in their own home •Keep patient out of the hospital/clinic •Freedom to provide non-traditional healthcare services Example: UK
Organizational Culture vs. Societal Culture - CORRECT ANSWER -
Organizational: encompasses values and behaviors that "contribute to the unique social and psychological environment of an organization" Societal: The commonly held beliefs or values that exist and are agreed upon in a given population
Opt-in vs. Opt-out programs - CORRECT ANSWER -Controversial Web site
policies over personal data gathering: opt-in means Web sites must gain explicit permission from online consumers before the site can collect their personal data; opt- out means that Web sites can automatically collect personal data unless the consumer goes to the trouble of filling out a specific form to restrict the practice.
What are social programs & what is their role in health and healthcare - CORRECT
ANSWER -Governmental programs, such as social insurance and poverty programs,
directed specifically toward promoting the well-being of individuals and families. Social insurance programs constitute the largest category of social welfare spending (almost 50% of all social welfare expenditures); medical programs, the second largest, public aid, the third largest.
