NR605 Midterm Exam 2024/25 with correct answers
Managed Care - ans ----1) acts as the insurance company and the providers of care.
2) Employs mechanisms to control (manage) utilization of medical services.
3) Determines the price at which the services are purchased and how much the providers get paid.
4) Is the most dominant health care delivery system in the United States and available to most Americans. This is includes both Health Maintenance Organizations (HMO) and
Preferred Provider Organizations (PPO).
5) Employers and government are the primary financiers of managed care.
6) An MCO functions like an insurance company. - It promises to provide health care services contracted under the health plan to the enrollees of the plan.
Enrollee - ans ----a member; an individual covered under the plan
gatekeepers - ans ----a healthcare professional (primary care, general practitioner) who regulates access especially to hospitals and specialists
- managed care plans rely on gatekeepers to orchestrate and control the health care of enrollees
Health plan - ans -----a contractual arrangement between the MCO and the enrollee
-includes a list of covered health services to which enrollees are entitled -uses selected providers, usually primary care, general practitioners (the "gatekeepers")
Tricare - ans ----Financed by the military, and covers families, dependents or retired military
VA health care system - ans -----Is available to retired veterans
-Focuses on hospital, mental health and long-term care
-Is one of the largest and oldest (1946) organized health systems in the world
*provide medial care, education and training, research, contingency support and emergency management for the Department of Defense medical care system.
"safety net" providers - ans ----provide care and services to the poor, uninsured, minorities and immigrants living in disadvantaged communities
Croesus teacher cost shifting - ans -----Medicaid, the primary financial source for the safety net, does not allow much cost shifting
-charges an insured patient more than it does an uninsured patient for the same procedure. Those with health insurance pay for financial loss hospitals incur when providing services to those without insurance
Market justice - ans -----"assume free market", market based demands, peoples ability to pay, economic reward
-individual responsibility(pull up by boot straps)
-"freedom of individuals to be left alone"
-private solutions to social problems
Social Justice - ans -----social resource, active government involvement, ability to pay
inconsequential, equal access is viewed as basic right
-everyone entitled to basic package of benefits
-public solutions to social problems
-public health practitioners should work towards these social goals
National Health Insurance - ans -----Canada
-insures national population against the cost of health care
-private providers, coordinated by government
National Health Systems - ans -----Great Britain
-financed by tax supported national health insurance programs -government owns/runs everything
Socialized Health Insurance Systems - ans -----Germany
-healthcare is financed through government mandated contributions by employers, employees, and general taxed.
-private providers, government controll
Systems Framework - ans -----Organized approach to understanding the components
of the US health care delivery system.
- components designed to achieve common goals, organize approach
What Is Health? - ans -----It presupposes(precondition) the existence of illness or disease. -It emphasizes clinical diagnosis and medical interventions to: -Treat disease or its symptoms. -Have a clinical diagnosis and medical interventions.
Health - ans ----Health is not merely the absence of disease (or injury), but complete physical, mental, and social wellbeing.
bio-psycho-social model of health
Croesus teacher health care system - ans ----all the activities whose primary purpose is to promote, restore, or maintain health.
Holistic Health - ans -----Treats the whole person.
-Incorporates alternative therapies.
-Has physical, mental, social, and spiritual aspects.
Holistic concepts of health care, along with preventive and health promotional efforts, need to be adopted to significantly improve the health of Americans.
Illness - ans -----Identified by a person's perception and evaluation of how he/she is feeling. The hypochondriac is born.
-People are ill when they infer a diminished capacity to perform tasks and roles expected by society.
Disease - ans -----Based on a professional evaluation.
-Requires therapeutic intervention.
Overall satisfaction - ans -----Overall satisfaction with life during and following a person's encounter with the health care delivery system. -An indicator of how satisfied a person was with the experiences while receiving health care.
Goal: To have a positive effect on an individual's ability to function, meet obligations, feel self-worth.
Interventions - ans ----1) Social or medical care policy. - welfare of nation
2) Community-based interventions. -inequalities in a community
3) Health care interventions. - improve quality of services and reduce disparities across groups
4) Individual interventions. - minimize negative social determinants in health status
four distinct time periods: - ans -----Preindustrial era
-Postindustrial era
-Corporate era
-Era of health care reform (still in its infancy)
Preindustrial Medical Institutions - ans -----Almshouses (poorhouses) were run by the local government.
-Hospitals were few, and had deplorable sanitary conditions and poor ventilation.
-State governments operated asylums for patients with untreatable, chronic mental illness.
-Pesthouses were operated to isolate people.
-Dispensaries were staffed by medical students or apprentices.
institutionalization - ans -----growth of hospitals Croesus teacher -Advancements in medical science created the need to centralize expensive facilities and equipment in an institution.
"voluntary health insurance" - ans -----private health insurance
Workers' Compensation - ans -----originally designed to make cash payments to workers for wages lost because of job-related injuries and disease.
-Later became compensation for medical expenses, and death benefits for survivors were added.
-Was a trial balloon for the idea of government-sponsored health insurance.
hospital insurance plan for teachers - ans -----In 1929, Justin Kimball began a hospital insurance plan for teachers at Baylor University Hospital in Dallas, Texas. It became the model for Blue Cross plans around the country.
-The AHA supported group hospital plans and coordinated them into a Blue Cross network.
nontaxable employer provided health coverage - ans -----In 1954, Congress made employer-provided health coverage nontaxable.
-This was equivalent to getting more salary without having to pay taxes.
three-part program was adopted to serve two distinct populations: Medicare Parts A and
B, and Medicaid - ans -----Medicare Part A was designed to use Social Security funds
to finance hospital care. (Medicare payroll tax)
-Medicare Part B was designed to cover physicians' services Through government-
subsidized insurance. -The elderly would pay part of the premiums.
-Medicaid benefits vary from state to state. -It is means-tested, and confines eligibility to those below an income level.
-Medicare has uniform national standards for eligibility and benefits. -It covers anyone over the age of 65. -In 1972, the program was expanded to include the disabled on Social Security and those with ESRD, regardless of age.
Three main features of Corporate Era - ans ----1)Corporatization-Medical care has become the domain of large corporations
2)Information revolution-Telemedicine, e-health
3)Globalization-Various cross-border activities
Era of Health Care Reform - ans ----Major changes undertaken by the government to expand health insurance to the uninsured and regulate the financing and delivery of health care
Croesus teacher
