U.S. Health Care System Final
10 characteristics that differentiate the U.S. health care system - ANSWER 1. no central
agency governs a system
2. access is selective based on insurance
3. health care offered under imperfect market activity
4. third party insurers are intermediaries between finance and delivery
5. multiple payers are cumbersome
6. balance of power, no domination, fragmented self-interests
7. legal risk affects practice behavior
8. new technology creates demands for its use
9. new service settings along a continuum
10. quality is achievable
4 principles of insurance - ANSWER risk is unpredictable, risk can be predicted with some
accuracy in a large group, insurance can transfer risk from the individual to group through pooling of
resources, losses are shared by all members
8 forces of future change in health care - ANSWER social and demographic
economic
political-ecucation and immigration policies impact health care workforce, divided on health care
issues
technological
informational
ecological-new diseases, natural disasters, bioterrorism
global-globalization
anthro-cultural-beliefs, values, ethos, and traditions
access to care - ANSWER ability to obtain needed, affordable, convenient, acceptable, and
effective personal health services timely
accountable care organizations - ANSWER ACOs, integrated group of providers who take
responsibility for delivering services to a defined population, use mechanisms already used by MCOs
and IDSs (disease management, care coordination, sharing cost savings with providers, etc.) to
improve cost, quality, and population health
,U.S. Health Care System Final
could possibly dominate a market, reduce competition, and harm consumers through higher prices
and lower quality
acquisition - ANSWER acquired organization ceases to exist as a separate entity
activities of daily living (ADL) - ANSWER evaluates seven activities of self care and mobility-
feeding, bathing, dressing, using the toilet, transferring, grooming, walking 8 feet
acute conditions - ANSWER relatively severe, episodic (of short duration) and often
treatable
advance directives - ANSWER patient's wishes regarding continuation or withdrawal of
treatment when patient lacks capacity to make end-of-life decisions
Agency for Healthcare Research and Quality (AHRQ) - ANSWER focus on quality, cost
reduction, and better access, technology assessmetns
alliances, networks - ANSWER sharing of existing resources
allocative tools - ANSWER health policies which involve the direct provision of income,
services, or goods to certain groups of individuals or institutions
Americans' beliefs and values which influence U.S. health care - ANSWER the advancement
of science, a champion of capitalism, entrepreneurial spirit and self-determination, a concern for the
underprivileged, free enterprise and distrust of government
Amy Forand's bill (1957) - ANSWER expand Social Security to include hospital and nursing
home care
areas of concern for the future of long-term care - ANSWER financing, resources,
infrastructure, workforce, regulation, information technology
asynchronous telemedicine - ANSWER use of store-and-forward technology, recipient
reviews information later
, U.S. Health Care System Final
average daily census - ANSWER average number of bed occupied per day, equals days of
care/number of days
average length of stay (ALOS) - ANSWER days of care/discharges
an indicator of severity of illness and resource use, highest in federal hospitals, followed by state and
local government hospitals
Baylor Plan - ANSWER created in 1929 by J.F. Kimball at Baylor University Hospital in Texas
for school teachers, prepaid plan, employer paid so much money per person to the hospital and the
teachers could seek care when needed, became the model for Blue Cross
Biologics and Price Competition and Innovation Act of 2009 - ANSWER authorizes the FDA
to regulate biosimilars (parallel to generic drugs)
Biosimilar User Fee Act of 2002 - ANSWER authorizes the FDA to charge a user fee for the
premarketing review of biosimilars
Blum's Force Field and Well-Being Paradigms of health - ANSWER environment, lifestyle,
heredity, and medical care
bundled payments (package pricing) - ANSWER number of related services in one price,
reduces provider-induced demand because fees are inclusive of all bundled services, evidence that
prospectively set bundled fees reduce health care spending without compromising quality of care
capacity - ANSWER size is determined by number of beds set up and staffed
case management - ANSWER coordination of care for complex and potentially costly cases
case-mix methods - ANSWER case mix-aggregate severity of conditions
resource utilization groups (RUGs)-used to determine per-diem reimbursement for skilled nursing
facilities
case-mix groups (CMGs)-used to reimburse inpatient rehabilitation facilities
10 characteristics that differentiate the U.S. health care system - ANSWER 1. no central
agency governs a system
2. access is selective based on insurance
3. health care offered under imperfect market activity
4. third party insurers are intermediaries between finance and delivery
5. multiple payers are cumbersome
6. balance of power, no domination, fragmented self-interests
7. legal risk affects practice behavior
8. new technology creates demands for its use
9. new service settings along a continuum
10. quality is achievable
4 principles of insurance - ANSWER risk is unpredictable, risk can be predicted with some
accuracy in a large group, insurance can transfer risk from the individual to group through pooling of
resources, losses are shared by all members
8 forces of future change in health care - ANSWER social and demographic
economic
political-ecucation and immigration policies impact health care workforce, divided on health care
issues
technological
informational
ecological-new diseases, natural disasters, bioterrorism
global-globalization
anthro-cultural-beliefs, values, ethos, and traditions
access to care - ANSWER ability to obtain needed, affordable, convenient, acceptable, and
effective personal health services timely
accountable care organizations - ANSWER ACOs, integrated group of providers who take
responsibility for delivering services to a defined population, use mechanisms already used by MCOs
and IDSs (disease management, care coordination, sharing cost savings with providers, etc.) to
improve cost, quality, and population health
,U.S. Health Care System Final
could possibly dominate a market, reduce competition, and harm consumers through higher prices
and lower quality
acquisition - ANSWER acquired organization ceases to exist as a separate entity
activities of daily living (ADL) - ANSWER evaluates seven activities of self care and mobility-
feeding, bathing, dressing, using the toilet, transferring, grooming, walking 8 feet
acute conditions - ANSWER relatively severe, episodic (of short duration) and often
treatable
advance directives - ANSWER patient's wishes regarding continuation or withdrawal of
treatment when patient lacks capacity to make end-of-life decisions
Agency for Healthcare Research and Quality (AHRQ) - ANSWER focus on quality, cost
reduction, and better access, technology assessmetns
alliances, networks - ANSWER sharing of existing resources
allocative tools - ANSWER health policies which involve the direct provision of income,
services, or goods to certain groups of individuals or institutions
Americans' beliefs and values which influence U.S. health care - ANSWER the advancement
of science, a champion of capitalism, entrepreneurial spirit and self-determination, a concern for the
underprivileged, free enterprise and distrust of government
Amy Forand's bill (1957) - ANSWER expand Social Security to include hospital and nursing
home care
areas of concern for the future of long-term care - ANSWER financing, resources,
infrastructure, workforce, regulation, information technology
asynchronous telemedicine - ANSWER use of store-and-forward technology, recipient
reviews information later
, U.S. Health Care System Final
average daily census - ANSWER average number of bed occupied per day, equals days of
care/number of days
average length of stay (ALOS) - ANSWER days of care/discharges
an indicator of severity of illness and resource use, highest in federal hospitals, followed by state and
local government hospitals
Baylor Plan - ANSWER created in 1929 by J.F. Kimball at Baylor University Hospital in Texas
for school teachers, prepaid plan, employer paid so much money per person to the hospital and the
teachers could seek care when needed, became the model for Blue Cross
Biologics and Price Competition and Innovation Act of 2009 - ANSWER authorizes the FDA
to regulate biosimilars (parallel to generic drugs)
Biosimilar User Fee Act of 2002 - ANSWER authorizes the FDA to charge a user fee for the
premarketing review of biosimilars
Blum's Force Field and Well-Being Paradigms of health - ANSWER environment, lifestyle,
heredity, and medical care
bundled payments (package pricing) - ANSWER number of related services in one price,
reduces provider-induced demand because fees are inclusive of all bundled services, evidence that
prospectively set bundled fees reduce health care spending without compromising quality of care
capacity - ANSWER size is determined by number of beds set up and staffed
case management - ANSWER coordination of care for complex and potentially costly cases
case-mix methods - ANSWER case mix-aggregate severity of conditions
resource utilization groups (RUGs)-used to determine per-diem reimbursement for skilled nursing
facilities
case-mix groups (CMGs)-used to reimburse inpatient rehabilitation facilities
