Midterm- Mikaella Cayanan
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School
California State University, Chico *
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Course
HCSV 435
Subject
Medicine
Date
Jan 9, 2024
Type
Pages
7
Uploaded by DoctorRose24659
1.
What are 6 basic characteristics that differentiate the U.S. health care delivery system
from that of other countries?
There is no central governing agency because healthcare is funded publicly and privately
by organizations, which leads to little integration and coordination. The U.S. focuses on
acute care and relies heavily on technology because it is the center of medical technology
innovation and much money is spent on research and development. Health care delivery
is largely in private hands, but it is only partially governed by free market forces, which
is why it is under imperfect market conditions. The American tradition of individual
responsibility and a commitment to minimizing government power has resulted in the
private sector playing a prominent role instead of the government in the country. The
presence of multiple players makes the system ineffective and disrupts the balance of
power, and that balance of power among the players prevents any single entity from
controlling the system. Access to health care services is selectively based on insurance
coverage; it is exclusive to individuals who have health insurance, are covered under a
government program, or can afford to pay for treatments privately.
2.
Most Western European countries have national health care programs that provide
universal access. How does the National Health Insurance system, such as the one
adopted by the country of Canada differ from the National Health system, such as the
one structured in Great Britain?
The majority of healthcare in Canada is provided by the private sector, with government
funding for health insurance. The provinces handle insurance. The employers of many
Canadians provide them with extra private insurance.
The National Health Service (NHS) in the United Kingdom is a fully socialized health
care system where the government not only finances but also provides care. Although
there is a private system that works alongside the public one, most services are provided
free of charge to individuals, and the system is supported by taxes.
3.
List the 4 health determinant categories and provide an example of how the
government is improving help in each determinant.
Environment
: The EPA is a federal agency responsible for protecting human health and
the environment. It sets and enforces regulations to reduce pollution, promote sustainable
practices, and ensure the safety of air, water, and land.
Behavior and Lifestyle
: Launches public health campaigns to raise awareness about the
importance of healthy behaviors such as regular exercise, a balanced diet, and tobacco
cessation. These campaigns provide information, resources, and support to encourage
individuals to adopt healthier lifestyles.
Heredity
: Supports programs that offer genetic testing and counseling services. These
services help individuals understand their genetic risks, identify potential hereditary
conditions, and make informed decisions about their health and family planning.
Medical Care
: Provides healthcare financing through programs such as Medicare and
Medicaid. These programs help ensure that individuals who qualify, such as the elderly,
low-income individuals, and people with disabilities, have access to necessary medical
care.
4.
Explain how the U.S. has both market & social justice aspects of healthcare.
While individuals in the U.S. have the freedom to choose their private health insurance
and pay out-of-pocket for services under market justice, there is also a social justice
component in which government programs such as Medicare and Medicaid ensure that
certain essential services are covered for those who cannot afford private insurance or
meet specific eligibility requirements.
5.
Describe what healthcare providers and institutions were like before the Industrial
Revolution.
Before the Industrial Revolution, hospitals were low in number and located only in big
cities. Few people were able to practice or pursue studies to become healthcare
practitioners due to the scarcity of medical schools. Many of the institutions were of poor
quality and were not properly sterilized. Anyone was allowed to practice medicine due to
the outdated processes, resulting in unprofessional practices. There was no systematic or
scientific medical education. Many asylums operated for patients who had untreatable,
chronic mental illnesses. Pesthouses also operated to isolate people with contagious
diseases.
6.
Discuss some of the advancements that changed healthcare and the switch from a
“traditions” approach to a scientific approach because of these groundbreaking
medical discoveries.
Ignaz Semmelweis implemented the policy of hand washing around 1847. Semmelweis
noticed the high puerperal fever mortality rate among postpartum women and concluded
that there was a link between the puerperal fever and the widespread practice among
medical students of not washing their hands prior to childbirth and immediately after
performing dissections.
Around 1860, Louis Pasteur is credited with inventing the germ theory of disease and
microbiology. Pasteur demonstrated various sterilizing methods, including boiling to
destroy bacteria and limiting air exposure to prevent contamination.
7.
Describe the differences between an allopathic physician (MD) and a holistic
physician (DO).
MDs and DOs mainly differ in their philosophies and approaches to treatment. Holistic
physicians practice osteopathic medicine, which focuses on the body's musculoskeletal
system. Allopathic physicians are trained as such, which means that their views include
medical treatment as an active intervention in treating or curing the effects of diseases.
8.
In the U.S. we have an imbalance of specialty care and primary care. What are the
major
medical care
distinctions between these two majors? Explain the negative
consequences of specialty maldistribution.
The major distinction between primary care and specialty care lies in the scope of care
and services provided to patients. The first point of contact for individuals seeking
medical attention is primary care, which focuses on treating the person as a whole. It
consists of a wide range of services such as disease prevention, health promotion,
diagnosis, and treatment for acute or chronic illnesses. On the other hand, specialty care
usually follows primary care and has a more narrowed focus. It may concentrate on
specific diseases, organ systems, or body parts. Specialty care tends to be more in-depth
due to its focused nature.
Specialty maldistribution causes a high volume of intensive, expensive, and invasive
medical services as well as to the rise in health care costs. The underprivileged
communities will suffer the most without primary care providers because they tend to
seek them out the most. Also, primary care plays a crucial role in disease prevention,
health promotion, and managing chronic conditions effectively. When there is an
imbalance between primary care providers and specialists, it can result in inadequate
attention being given to preventive measures or holistic approaches towards patient
well-being.
9.
Describe the training of and discuss the important role that advance practice nurses
and physician’s assistants (Non-Physician Practitioners) play in providing high
quality, cost effective medical care.
Advance practice nurses and physician's assistants play an important role in providing
high-quality, cost-effective medical care due to their extensive education and training.
Unlike the average nurse, these healthcare professionals have undergone additional
schooling and certification, which enables them to provide a wider range of services. This
expanded scope of practice allows them to deliver comprehensive care to patients,
addressing not only their immediate medical needs but also other aspects of their
well-being. NPPs work helps alleviate some problems created by the geographic
maldistribution of physicians. By leveraging their advanced knowledge and skills,
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advance practice nurses and physician's assistants contribute significantly to the overall
quality of healthcare delivery while also helping to control costs.
10. What impact does the growth of technology have on healthcare costs? How has
technology impacted access to medical care and why aren’t new treatments,
medications, modalities and machines available to everyone?
The rise in medical technology was a factor in rising healthcare costs. This is due to the
cost of both purchasing and maintaining technological equipment. Access to medical care
has been significantly impacted by technology. It has enhanced the effectiveness and
efficiency of the delivery of healthcare. However, despite the advancements in medical
technology, not everyone has equal access to new treatments because they come with a
high cost and limited availability.
11. What is HIPPA and what role does it play in protecting patient privacy when it comes
to electronic medical records?
It is a law that sets guidelines and regulations for the use and protection of personal
medical information. The main purpose of HIPPA is to ensure patient privacy and give
individuals more control over their health information. HIPPA plays a crucial role in
protecting patient privacy when it comes to electronic medical records by regulating their
usage and release, allowing patients more control over their health information.
12. Discuss some of the examples of new, cutting-edge medical technology and its
impact and implications for society, politics and religion.
Remote monitoring and telemedicine have a huge impact on society. It eliminates the
need for travel and shortens wait times by enabling people to obtain healthcare services
from the convenience of their own homes. People who reside in remote or underserved
locations with little access to medical services would especially benefit from this.
Telemedicine has the potential to address political concerns about healthcare access and
cost. The load on hospitals and clinics can be lessened by offering remote consultations,
thereby cutting healthcare expenses for both individuals and governments.
Telemedicine poses moral questions from a religious standpoint about the nature of
doctor-patient relationships. Some religious organizations could worry about whether or
not virtual consultations uphold a personal connection between doctors and patients or if
they compromise conventional conceptions of care.
13. Explain how public and private financing of health care affects the demand for
healthcare services and products.
The demand for health services and goods is shaped by both public and private health
care financing. Private finance gives consumers more freedom to make their own
decisions, which can increase demand. Public finance tries to increase access, cover
certain demographics, and possibly boost demand within those communities.
14. Explain the significance of Gatekeeping in regards to primary care and keeping
healthcare costs down.
Gatekeeping regarding primary care plays an important role in keeping healthcare costs
down by reducing unnecessary expensive specialist consultations, controlling
prescription costs, minimizing assessment expenses through streamlined evaluations, and
promoting improvements in the services provided by primary care physicians.
Additionally, primary care offers a more thorough picture of a patient's health, and more
visits encourage enhancements in the services they offer.
15. Discuss the four principles of insurance and the nature and purpose of cost sharing in
private health insurance.
The first principle states that risk is unpredictable for the insured individual. This means
that no one can predict with certainty when they will suffer a loss or need to use their
insurance policy.
The second principle states that risk can be predicted with a reasonable degree of
accuracy for a group or population. While predicting when a person will experience a
loss may be challenging, predictions about the chance of losses happening among a wider
group or population are possible.
The third principle explains that insurance provides a mechanism for transferring or
shifting risk from an individual to the group through the pooling of resources. Insurance
firms can distribute the cost of covering losses across all policyholders by combining the
premiums from numerous individuals.
The fourth principle states that actual losses are shared on an equitable basis by all
members of the insured group. This means that the cost of a claim made by an insured
member for a loss is split among all other members in the form of premiums.
Due to the nature of insurance, cost sharing is necessary. The purpose of cost sharing is to
decrease the misuse of insurance benefits.
16. Discuss Medicare; when and how it was developed (parts A and B) and, how it has
changed since its inception, i.e., Part C and D, managed care and the Affordable Care
Act
Medicare covers medical expenses for the elderly. In Medicare Part A, Hospital insurance
is paid for by taxes that employers pay and withheld from employees' paychecks; this
allows the use of Social Security money to pay for hospital care. Services that physicians
determine to be medically necessary may be covered by Medicare Part B. Part C lowers a
beneficiary's expense while providing coverage that goes beyond that of parts A and B.
Medicare Part D requires individuals to pay an extra premium but provides coverage for
prescription drugs. The implementation of the Affordable Care Act has also had an
impact on Medicare. The ACA has allowed more people to acquire healthcare insurance
overall, including those who are eligible for Medicare.
17. What are Diagnostic-Related groups (DRG’s), Ambulatory Payment Classification
(APC), Outpatient Prospective Payment System (OPPS), Resource Utilization
Groups (RUG), and Home Health Resources Groups (HHRG) and how are “codes”
like this utilized to try to control cost?
DRG’s are used to pay for inpatient services, and it was created to ensure that people
receive the services they require and that their bill isn't bloated with extra charges. APC is
associated with Medicare's Outpatient Prospective Payment System and is a payment
method for services provided by hospital outpatient departments, and it helps determine
how much to pay healthcare providers for outpatient services under the Medicare
program. The OPPS was implemented to pay for facility services such as nursing,
anesthetics, etc. RUG is a system used to categorize nursing home patients into groups
based on their clinical and functional state as determined by a facility's minimal data set.
HHRG runs Medicare Certified Home Health, Hospice, and Home Care organizations.
All of the codes are used to maintain stability between providers and patients on the costs
of services delivered.
18. Based on the information in your text, how were the National Health Expenditures
were spent and what impact did this have on the Gross Domestic Product (GDP) and
the Consumer Price Index (CPI)?
The National Health Expenditures were spent on health services, supplies, health-related
research, and construction activities in a country during a calendar year. In 2015, the U.S.
GDP was a little more than $18 trillion. Thus, 17.8% of the total economic output in the
United States in 2015 was consumed by health care. The rapid rise in health care
expenditure and cost inflation exceeded the growth in GDP and CPI.
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19. Describe the types of Outpatient Care, and discuss why it has grown so quickly the
impact this has had on society.
Clinical services include regular check-ups, screens for chronic conditions, diagnostic
procedures, and treatment for such conditions. Primary care doctors or specialists may
offer these at outpatient clinics or private offices.
Surgical services comprise procedures that can be carried out without a hospital stay on
an outpatient basis. Examples include simple procedures like minor surgery or the
excision of moles.
Acute care emergency services are accessible in outpatient settings like urgent care
facilities. These institutions offer fast medical care for non-life-threatening conditions
that need to be treated right away but do not necessitate a trip to the emergency room.
Home health care entails offering medical support and help to patients in their own
homes. People who have trouble getting to medical facilities owing to mobility problems
or chronic illnesses can benefit greatly from this kind of outpatient therapy.
Community health clinics provide comprehensive primary healthcare services to
marginalized people as outpatient facilities. They frequently offer free or inexpensive
medical and dental care, mental health counseling, testing for early disease, and other
crucial healthcare resources.
Several variables have fueled the expansion of outpatient treatment. First of all, it enables
patients to receive required medical care without the hassle and expense of overnight
hospital stays. For people without insurance or who are unable to pay for conventional
hospital-based treatments, it also offers more affordable primary healthcare options.
20. Distinguish between primary, secondary, and tertiary care.
Primary care is the initial level of medical attention that people receive for routine medical
conditions. It focuses on providing general medical services and preventive care, such as routine
check-ups, vaccinations, and screenings. Primary care is typically provided by general
practitioners or family physicians.
Secondary care is the next level of healthcare that involves specialized medical services provided
by healthcare professionals who have expertise in a specific area. For additional assessment or
treatment, primary care professionals frequently refer patients to secondary care. This level of
care includes services like hospitalization, routine surgeries, and rehabilitation.
Tertiary care is the most complex level of care and is required for relatively uncommon
conditions. It often involves highly specialized medical teams and facilities, such as trauma
centers or transplant units. These services may include complex surgeries, long-term management
of chronic conditions, and intensive rehabilitation programs.