HMGT 3301 EXAM 1 - Chapter 1, 2 & 3. Top Questions with accurate answers, graded A+

HMGT 3301 EXAM 1 - Chapter 1, 2 & 3. Top Questions with accurate answers, graded A+ Why did the professionalization of medicine start later in the U.S. than in some Western European nations? - -American medicine lagged behind the advances in medical science, experimental research and medical education and maintained a domestic character because... (i) Americans had a tendency to neglect research in basic sciences and placed more emphasis on applied sciences (ii) American attitudes about medical treatment placed emphasis on natural history and conservative common sense. Why did medicine have a domestic, rather than professional, character in the preindustrial era? How did urbanization change that? - -1) Medical Practice was in disarray- Anyone could practice without restriction or training 2) Medical procedures were primitive- no technical expertise 3) Missing institutional core- no widespread development of hospitals 4) Demand was unstable- low demand due to self-reliance (family folk-remedies), economic conditions (opportunity cost of transportation), and purchase costs (fee for service) 5) Medical education was substandard-apprenticeship, unrestricted entry, and deficient in science based training Urbanization increased reliance on specialized skills of paid professionals because.. a. Distanced people from families and neighborhoods- no more family-based remedies b. Women began working outside the home- no longer caring for the sick c. Physicians became less expensive and more accessible- telephones, cars, roadsreduced opp. cost of time and travel- more affordable d. Better geographic proximity of patients and physicians Which factors explain why the demand for the services of a professional physician was inadequate in the preindustrial era? How did scientific medicine and technology change that? - -Demand was low because: - Small rural communities were self-reliant: family care, home folk remedies. Most "physicians" had no expertise to offer - Not affordable - Indirect cost of transportation and opportunity cost of travel (time lost) - Costs doubled- 2 ppl (physician and emissary) had to make trip back and forth - Private funds, no insurance- personally pay for fee-for- service Science and technology led to.. - Increased demand for advanced services - specialized training became necessary and medicine practice became more professional- no longer provided by families - Legitimacy and complexity- effectiveness of scientific medicine became widely recognized - Cultural Authority- general acceptance of and reliance on the judgement of members of a profession because of superior knowledge and expertise - People's lives became increasingly governed by medical decisions made by physicians- admission to hospital, necessary treatment, prescriptions, granting medical leave, worker's compensation cases, pre-employment physicals, etc. How did the emergence of general hospitals strengthen the professional sovereignty of physicians? - -a. Hospitals were dependent on physicians to keep the beds filled- empowered physicians and enhanced their dominance because hospitals had to keep them satisfied even though they were not employed by the hospitals. They had enormous influence over hospital policy. Discuss the relationship of dependency within the context of the medical profession's cultural and legitimized authority. what role did medical education reform play in galvanizing professional authority? - -Dependency emerged because... a. Society expects a sick person to seek medical help and try to get well b. Cultural authority- medical judgements... i. Legitimize sickness ii. Exempt the individual from social role obligations i.e. school/work iii. Provide competent medical care so the person can get well and resume social role obligations c. Need for hospital services for critical illness and surgery d. Referral role, prescriptions Educational reform further legitimized the profession's authority and galvanized its sovereignty - upgrade of med-school standards, physicians clear monopoly on the practice of medicine How did the organized medical profession manage to remain free of control by business firms, insurance companies, and hospitals until the latter part of the 20 th century? - -Individual physicians who took up practice in corporate setting were castigated by the - medical profession and pressured to abandon such practices Legal doctrine in some states- "Corporate practice doctrine"- corporations could not employ licensed physicians w/o engaging in unlicensed practice of medicine AMA ("organized medicine")created in 1847-principal goal: advance professionalization, prestige, and financial well-being of members- o Strongly resisted national healthcare initiative- lobbying In general, discuss how technological, social, and economic factors created the need for health insurance. - -Scientific and tech. advances made health care more desirable, but less affordable Because of its well established healing values- medical care is individually and socially desirable growing demand for medical services Economic- ppl couldn't predict future needs for medical care or the costs o Great Depression- 1929- ppl needed protection from economic conseq. of sickness and hospitals needed protection from economic instability Which conditions during the WWII period lent support to employer-based health insurance in the US? - -1) To control high inflation in the economy during WWII, congress imposed wage freezes Employers started offering health insurance in the place of wage increases - National healthcare=communism (More of a Cold-war influence) Other reasons (not really WWII related): 2) 1948- supreme court ruled employee benefits (including health insurance) as legitimate part of union management negotiations-- -- health insurance=employee benefits in postwar era 3) 1954-Congress made employer paid health coverage non-taxable Discuss why reform efforts to bring in national health insurance have historically failed in U.S. - -a. Organized Medicine i. AMA and AHA strongly opposed plans for national health care- felt that their sovereignty was threatened ii. AMA launched massive campaigns against it- hired public relations firm of Whitaker and Baxter to launch very expensive lobbying effort-- -- campaign directly linked national health insurance with communism b. The Middle Class i. Beliefs and values (summarized below) represented sentiments of American Middle class- support was necessary for any broad-based health care reform c. American Beliefs and values i. Market justice ii. Individualism and self-determination iii. Distrust of government iv. Reliance on private sector v. Anti-German and anti-communism feelings: national health insurance= "socialized medicine" Which particular factors that earlier may have been somewhat weak in bringing about national health insurance later led to passage of Medicare and Medicaid? - -Government intervention was not desired when it came to health care for most Americans Mecidare and Medicaid met less opposition because reform was proposed for the underprivileged and vulnerable classes - Poor and elderly: special class(not for the stongly opposed working-middle class with private health insurance) It became clear that market alone could not ensure access for vulnerable population groups Growing elderly middle class was becoming politically active force On what basis were the elderly and the poor regarded as vulnerable groups for whom the special government-sponsored programs needed to be created? - -On their own, most elderly and poor could not afford increasing health care costs Health status of these groups was significantly worse than that of general population- required higher level of health care services Less than half of the elderly population were covered by private insurance-- - had to rely on own resources, public programs, charity Discuss the governments role in the delivery and financing of health care, with specific reference to the dichotomy between public health and private medicine. - -Government provides financing for Medicare and Medicaid, but services are delivered by private sector. -Publicly Financed, Privately delivered Expansion of Medicare and Medicaid gov's regulatory powers increasingly encroached upon private sector Government's Regulatory powers/ authority were give to state public health agencies which monitor compliance of private health care delivery institutions. Explain how contract practice and prepaid group practice were the prototypes of todays managed care plans. - -Contract Practice o inducements- guaranteed salary for physicians or contract with independent physicians and hospitals at flat rate fee per worker per month- capitation o Utilization was managed by requiring second opinions for major surgery and by reviewing length of hospital stays Prepaid Group Plan: enrolled population received comprehensive services for a capitated fee- Kaiser Discuss the main ways in which current delivery of health care has become corporatized. - -Corporatization: Growth and consolidation of large business corporations/organizations Managed care has emerged as dominant force and primary vehicle for insuring and delivering health care (demand side empowerment) Larger, integrated health care organizations (supply side empowerment) o expansion of alternative settings (outpatient surgery, home health care, long- term care, specialized rehabilitation) to make up for losses in acute inpatient sector o Physicians becoming employees of large clinics, hospitals, and other medical corporations In the context of globalization in health services, what main economic activities are discussed in this chapter? - -1) Advanced telecommunication in telemedicine cross border transfer of info 2) Medical tourism- travel abroad to receive elective, nonemergency medical care 3) Foreign direct investment in health services enterprises- providing medical equipment, supplies and services in another country 4) Immigration of health professionals- to countries with higher demands for their services and better economic conditions 5) US Corporations expanding operations overseas- health plans for expatriates 6) Medical care delivery by US providers is in demand overseas What were the two main aspects of the Supreme court's ruling in lawsuits filed against the ACA? - -1) majority of ACA provisions- including the individual mandate- are constitutional under Congress's power to tax 2) Federal government could not coerce states to expand their state Medicaid programs by threatening to eliminate funding for the existing Medicaid programs in states tht choose not to expand Medicaid coverage-- -- expansion became a state by state choice 1. What is the role of health risk appraisal in health promotion and disease prevention? - -a. It is the evaluation of risk factors and their health consequences for individuals. Only when the risks factors and their health consequences are known can interventions be developed to help individuals adopt healthier lifestyles. 2. Health promotion and disease prevention may require both behavioral modification and therapeutic intervention. Discuss. - -a. Behavior can be modified through educational programs and incentives directed at a specific high-risk populations. b. Therapeutic interventions fall into 3 categories: i. Primary prevention—activities undertaken to reduce the probability that a disease will develop in the future ii. Secondary prevention—early detection and treatment of disease, main objective is to block the progression of a disease or an injury from developing into an impairment or disability iii. Tertiary prevention—interventions that could prevent complications from chronic conditions and prevent further illness, injury, or disability 3. Discuss the definitions of health presented in this chapter in terms of their implications for the health care delivery system. - -a. Health has been defined as the absence of illness or disease and the implication is that the health care delivery system emphasizes diagnosis and treatment of disease rather that prevention of disease. 4. What are the main objectives of public health? - -a. The main objectives are to promote optimum health for society as a whole and to protect the health and safety of populations from a variety of old and new threats. 5. Discuss the significance of an individual's quality of life from the health care delivery perspective. - -a. Specific life domains, such as comfort of factors, respect, privacy, security, degree of independence, decision-making autonomy, and attention to personal preferences, are significant to most people. These factors are now regarded as rights that patients can demand during any type of heath care encounter. 6. What "preparedness"-related measures have been taken to cope with potential natural and man-made disasters since the tragic events of 9/11? - -a. Former President George W. Bush signed into law the Public Health Security and Bioterrorism Preparedness Response Act of 2002. Right after, the Homeland Security Act of 2002 created the Department of Homeland Security (DHS) can called for a major restructuring of the nation's resources with the primary mission of helping prevent, protect against, and respond to any acts of terrorism in the US. b. One of the key concepts of preparedness in surge capacity which is the ability of a healthcare facility or system to expand its operations to safely treat an abnormally large influx of patients. 7. The Blum model points four key determinants of health. Discuss their implications for health care delivery. - -a. The four key determinants of health environment, lifestyle, heredity, and medical care. These four elements are interactive. The most important force is environment and the least important force is medical care. b. Many costly diseases can be avoided by lifestyle changes, which include healthy diets, exercise, smoking cessation, and abstinence from drugs. One of the problems with the healthcare delivery system is the importance of healthcare expenditures are devoted to the treatment of medical conditions rather than to the prevention and control of factors that produce those medical conditions. 8. What has been the main cause of the dichotomy in the way physical and mental health issues have traditionally been addressed by the health care delivery system? - -a. Diagnosis and categorization of mental distress have not always been as clear-cut. Difficulties in identifying certain behaviors as indicative of mental disorders, the predominance of the medical model that has focused on the physical aspects of health care, while mental health has been relegated to a secondary status. 9. Discuss the main cultural beliefs and values in American society that have influenced health care delivery and how they have shaped the health care delivery system. - -a. The medical model of healthcare delivery is founded on advances in science and technology. The holistic aspects of health and use of alternative therapies have been deemphasized. Health care has largely been viewed as an economic good (or service), not as a public resource. b. There is a clear distinction in the types of services between poor and affluent communities, and between rural and urban locations. Medical practice has emphasized treatment rather than health education. In contrast, commitment of resources to the preservation and enhancement of health and well-being have lagged far behind. 10. Briefly describe the concepts of market and social justice. In what way do the two principles complement each other and in what do they conflict each other? - -a. Market justice—a distributional principle which says that health care is most equitably distributed through the market forces of supply and demand rather than gov't interventions b. Social justice—a distribution principle that says heath care is most equitably distributed by gov't-run national health care program c. The two principles conflict in regard to the large number of uninsured who cannot afford to purchase private health insurance and do not meet the eligibility criteria for Medicaid or Medicare. d. The two principles complement each other when private and government health insurance programs enable the covered populations to have access to health care services delivered by private practitioners and private institutions (market justice). Tax-supported county hospitals or city hospitals in large cities, public health clinics, and community health centers can be accessed by the uninsured in areas where such services are available (social justice) 11. Describe how health care is rationed in the market justice and social justice systems. - -a. In the market justice system, healthcare services are rationed through prices and the ability to pay (ex: demand-side rationing, or price-rationing). Under social justice, the government makes attempts, to limit the supply of healthcare services (planned rationing, supply-side rationing, or non-price rationing). 12. To what extent do you think the objectives set forth in Healthy People initiatives can achieve the vision of an integrated approach to health delivery in the US? - -a. For an integrated approach to become reality, resource limitations make it necessary to deploy the best American ingenuity toward health-spending reduction, elimination of wasteful care, promotion of individual responsibility and accountability for one's health, and improved access to basic services. An integrated approach also necessitates creation of a new model for training health care professionals by forming partnerships with the community. 13. What are the major differences of Healthy People 2020 and from the previous Healthy People initiatives? - -a. Healthy People 2020 is differentiated from previous Healthy People initiatives by including multiple new topic areas to its objective list, such as adolescent health, genomics, global health, health communication and health information technology, and social determinants of health. 14. How can heath care administrators and policymakers use the various measures of health status and service utilization? - -a. Quantified measures of health status and utilization can be used by managers and policymakers to evaluate the adequacy and effectiveness of existing programs, plan new strategies, measure progress, and discontinue ineffective services 1. Why does cost containment remain an elusive goal in US health services delivery? - -Limited resources, health insurance premiums costs are increasing faster than inflation, rising costs limit the ability to offer health benefits, rising costs takes toll on the lower-income households, taxes are already high 2. What are two main objectives of a health care delivery system? - -a. Enabling all citizens to obtain needed health care services b. Services must be cost effective and meet certain established standards of quality 3. Name the four basic functional components of the US health care delivery system and what role they play. (Quad-function model) - -a. Financing—necessary to obtain health insurance to pay for health care services b. Insurance—protects the insured against catastrophic risks when needing expensive health care services; determines the package of health services the insured individual is entitles to receive c. Delivery—the provision of health care services by various providers (entities that deliver health care services and can either independently bill for those services or is tax-supported d. Payment—deals with reimbursement (the amount insurers pay to a provider, the payment may only be a portion of the actual charge) 4. What is the primary reason for employers to purchase insurance programs to provide health benefits to their employees? - -a. Employers don't have to pay 100% of the premiums, so they require their employees to pay a portion of the cost (premium cost sharing) 5. Why are there some US citizens without health care coverage and how will ACA change this? - -a. Some employers can't afford to buy group insurance, so their employees don't receive the health benefits b. Some employees can't afford the cost of the premiums and those who are self-employed pay higher premiums c. ACA makes it mandatory for all US citizens to have health insurance 6. What is managed care? - -a. Def: a system of healthcare delivery that seeks to achieve efficiencies using the quad-model functions, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid 7. Why is US healthcare market referred to as "imperfect"? - -a. Prices are not feely governed by the demand, but rather for monetary reasons 8. Discuss the intermediary role of insurance in the delivery of health care. - -a. It describes how and where health care services may be received b. When delivering services, providers send the bill to an agency of the gov't that subsequently sends payment to each provider 9. Who are the major players in the US health services system? What are the positives and negatives of the often conflicting self-interests of these players? - -a.