HMGT Test 1, Questions and answers, 100% Accurate, rated A+

HMGT Test 1, Questions and answers, 100% Accurate, rated A+ ?!?!?!?!?!?!? HOW TO READ THE CARDS ?!?!?!?!?!?!? - -1.) CHAPTER 1 2.) CHAPTER 2 3.) CHAPTER 3 5.) CHAPTER 5 D.) DEFINITION (Everything was taken directly from slides and definitions are based on what Dr. Jim emphasized on in class) 1.) Why is cost containment an elusive goal of US health care delivery? - -- Size/Complexity - 16.4M Employees; 18% of GDP -Market-oriented/Free-market Economy - Private/Public Funding 1.) What are the two main theoretical objectives of a health care delivery system? - --All Citizens obtain Health Care Services when needed -Health Care Services should be cost effective & high quality 1.) What are the four basic theoretical functional components of the US health care delivery system? How do they interact with one another? - -better image page 6 in textbook 1.) What are the primary reasons employers provide health insurance for their employees? - --Employment Benefit in-lieu of salary - tax avoidance -Help maintain healthy work-force - i.e. Productivity/presenteeism -Reduce Turnover rate - Attraction/Retention of Talent 1.) Why do some US residents/citizens live without health insurance? - --Individual autonomy - choices of income allocation -Poverty & Low Healthcare Literacy -Not offered by Employer or High % Premium sharing 1.) How does the Affordable Care Act (ACA) impact US residents/citizens live without health insurance? - --Requires all Americans to have health insurance -Expansion of Medicaid Eligibility for coverage -Development of Subsidized Health Insurance Marketplace -Requirements for Health Insurers (lifetime limits, age limits) 1.) What is managed health care? What is a managed care organization (MCO)? - --Supporting Employer-sponsored Health Insurance to control utilization by employees -Employee/Enrollee Member Benefit Plan Design - includes Deductibles, Co-Pays, Benefits & Provider Network Limits -Negotiated Payments (Fee Structures) for Providers 1.) Why is the US heal1th care market called an "imperfect market"? - -In a Free (Perfect) Market: -Consumer Demand - sensitive to Price -Supply Levels - sensitive to Demand -Information & Transparency is Required 1.) What is the intermediary role of health insurance in the delivery of health care in the US? - --Negotiates the Rate of Fees (i.e. Provider Fee Schedule) that Employers will pay providers -No incentive to control costs or quality -Introduces the "Moral Hazard" -Delivery of health services can result in demand creation (self-assessed need) 1.) Name the major players in the US health care delivery system? - --Physicians & Hospitals -Business -Government -Labor -Consumers -Payers/Insurers -Pharma 1.) What are the key roles for government in the US health care delivery system? - --Purchase Health care services for elderly & poor -Public Health - domestic threats (i.e. Zika, Ebolz, W. Nile, TB, Syphilis, STDs, Measles, Mumps, Influenza, etc.) -Public Policy - Expansion of Coverage, Research, etc. -Regulation of Fee Market - Consumer Protection 1.) Why is it important for health care managers and policy makers to understand the intricacies of the US health care delivery system? - --Changes in one area inevitably impacts other areas - unintended consequences -Opportunities for synergies -The power of innovation, technology and research to structurally change the system 1.) Explain the difference between National Health Insurance and National Health System? - --National Health Insurance -National Health System D.) National Health System - -Government-controlled and managed health care delivery and payment D.) National Health Insurance - -Government-sponsored health insurance, but the delivery system is private 1.) Explain the definition of Socialized Health Insurance (SHI)? - -Government-mandated contributions by employers and employees, integrated by government mandates and regulations 2.) What are the main cultural beliefs and values of US society that have influenced health care delivery? - --Strong belief in Science's influence on Medical Care - i.e. Medical Model -Capitalism and Free Markets - Health Care Delivery System is Privatized -Entrepreneurialism & Self-determinism -Social Responsibility & Individual Responsibility 2.) What has been the role of health risk appraisal in defining the Basic Concepts of Health (i.e. health promotion and disease prevention? - --Science reveals HCD (Health Care Delivery) doesn't produce health (it mostly treats disease) -Economics reveals we can't afford to treat all diseases -Health Promotion & Disease Prevention science reveals we can decrease disease burden within a population 2.) How does the definition of "health" influence the health care delivery system? - --Health redefined = The absence of disease + presence of function/joy -Define a NEW program for health promotion + disease prevention -Government Policy/Regulation + Investment 2.) How can behavioral modification & therapeutic intervention be combined to influence health promotion and disease prevention? - --Case Example: Alcohol-induced Liver Toxicity/Cirrhosis (Education) -Case Example: Family History of Breast Cancer (Screening) -Case Example: HPV Immunization & Cervical Cancer (Public Health) Categories of Disease: (1)Acute; (2)Subacute (3)Chronic -Chronic Disease Prevalence D.) BioMedical Model - --Diseases occur in People & health is when person is free of diease. -Medical Science's role is to treat Disease. -Medication & Surgery developed to ease disease burden or eliminate disease. -Focus on Quantity of Life Years -Physicians are the source of truth. D.) Biopsychosocial Model: Holistic Health Model - --People are a combination of Mental, Spiritual, Emotional (Social) and Physical Health balance. -Medical Science's role is to address the balance of these factors while also treating diseases. -Focus on Quality of Life Years -Patients with Physician input is the source of truth. 2.) What is the significance of an individual's quality of life (QOL) and how does it influence health care delivery? - -Consumerism - Need-based consumption (not price-sensitive except in the uninsured) Wellness Behavior - Activity/Inactivity End of Life - Palliative Medicine/Hospice Self-perception of Health - Responses to potential threats Expectations - Comfort, Respect, Privacy, Security, Independence, Autonomy, Personal Preferences 2.) What "are the four determinants of health" as outlined by Blum (i.e. Blum's Force Fields")? (Page 52-53) - --Environment -Lifestyle -Heredity -Medical Care 2.) The Force Fields are surrounded by National/International Factors: - --Population Characteristics -Natural Resources -Ecological Balance -Human Satisfaction -Cultural Systems -Health Care Delivery Type 2.) World Health Organization (WHO) - Commission on Social Determinants of Health Conceptual Framework (Page 55) - -Commission on Social Determinants of Health Conceptual Framework (Page 55 2.) What are the main objectives of Public Health? - --Focus on Populations (not individuals) -Focus on Environment, Social and Behavioral Risks to Populations -Implement Population-level interventions (i.e. Water, Air, Seat Belts, etc.) -Design efforts to prevent diseases & threats 2.) What "preparedness" related measures have been taken to respond to potential natural and man-made disasters since 9/11? - -Infrastructure - Vaccine Manufacturers; Hospitals; Public Response Agencies Surge Capacity Planning - Regional Planning amongst competitors Example of Communitarianism vs. Individualism/Free-market Economy U.S. Healthcare Delivery Development - influenced by externalities 2.) Application of Theory: If the U.S. spends $1.7 Trillion a year and continues to have health disparities - where is the problem? Solution? (Pages 62-73) - --Study Anthro-cultural Beliefs and Values of the population -Equitably distribute Health Care Resources -Integrate Individual and Population Health Care Improvement strategies -Perform Community Health Assessments -Learn from Healthy People Initiatives & Carefully Measure Progress 2.) What are the concepts of market justice and social justice? - --Market Justice -Social Justice Market Justice (Chapter 2 Part 2) - -power point slide 26 & 27 Social Justice (Chapter 2 Part 2) - -power point slide 28 2.) How has health care delivery been rationed in the market justice and social justice systems? - -Market Justice = demand-side rationing (price rationing) Social Justice = supply-side rationing (non-price rationing) Quasi- or Imperfect Market = U.S. Health Care Delivery - -Elements of both Market & Social Justice exist and complement each other in many ways (Page 67) Example: Employer-based health insurance (Market) + Government-sponsored health insurance (Social) Also conflicting with each other in many ways Example: Medicaid covered patients can't find physicians, use Hospital EDs 2.) How can the Healthy People objectives achieve the vision of an integration of health care delivery in the US? (part 1) - -Medical model integration with: -Disease Prevention -Health Promotion -Primary Care-based care delivery model