CHLH 101 Exam 3
Almshouses
"poorhouses" that were run by the local government and provided some care
In 2014, how much did the US spend on health care
$3.1 Trillion!
Health Care - Today
-$2.6 million on health care (17+%) -Health care costs outpacing inflation for past few decades -2010 Affordable Care Act
3rd Party System
-1960s -Insurer pays physician and not the patient
Clinics
-2 or more physicians practicing as a group -no inpatient beds -For profit and not for profit
Allied Health Care Professionals
-Assist, facilitate, and complement work of physicians and health care specialists -Lab techs, support services, behavioral scientists, physical therapy, OT, social workers, dietitians
Accreditation of Health Care
-Assists in determining quality of health care facilities -Process by which agency evaluates and recognizes an institution as meeting certain predetermined standards -Usually through the Joint Commission (predominant accrediting org)
How much water do we use?
-Avergage US citizen uses 80-1000 gallons/day -only 6% of all water used is for domestic use
Car Insurance vs. Health Insurance
-Car: insurance protects you from unpredictable big, bad things; doesn't change how you access routine matenance -Health: without insurance, severely limited to how to access basics, prevention and higher level care
History on Health Care - Late 1800s and Early 1900s
-Care moved to physician's offices or hospitals -Science had a larger role in medical education -Mortality declined due to improved PH measures -1920s- Chronic diseases passed communicable as leading causes of death -New procedures available: X-ray, ECG, chemo -Doctors and nurses became more specialized
Regulating Water Quality
-Clean Water Act -Safe Drinking Water Act -Watershed- area of land where all of the water that is under it or drains off of it goes into the same place
Major issues of the US Health Care System
-Cost containment, access, and quality -All factors are equally important but expansion of one could compromise the two but doesn't have too
What is the greatest reason for lack of insurance?
-Cost!!!! -Most uninsured (80%) are from working families but they actually don't work one job, they work many different jobs which doesn't help them
Medicare
-Covers more than 48+ million people -Federal health insurance program for people 65+, certain disabilities/severe illnesses -SSA handles the enrollment -Contributory program through FICA tax (workmen people pay for part of it)
CHIP
-Created in 1997 for 10 years -funding assisted by increase in federal excise tax rate on tobacco -Targets low-income children ineligible for Medicaid -State/federal program
Exclusive Provider Organization
-EPO -Can only see certain providers
Affordable Care Act
-Extends coverage -Initiates improvements in quality of care -Sets base level of coverage/covered services
Managing solid waste
-Federal laws -Source reduction -composing -Sanitary landfills -combustion
FQHC and CHC
-Federally Qualified Health Center and Community Health Center -Public health clinics, community health centers, rural health centers, migrant health centers, -Over 1,100 community health centers -Support primary health care needs of underserved populations in the US
Health Maintenance Organization
-HMO -Staff model HMO: providers are salaried staff of the HMO who don't have private practices -Independent practice association (IPA): physicians as a group have contract with HMO and more common
World population growth
-Hazard -means expanded needs for food, clean water, safe housing, power -all have huge impact on environmental health
Medicaid
-Health insurance program for low-income, no age requirement -43+ million people covered -Eligibility determined by each state -Noncontributory program (no payroll tax
Long-Term Care
-Help with chronic illnesses and disabilities -Time-intensive skilled care to basic daily tasks -Found in inpatient and outpatient units, nursing homes, personal homes -Providers are physicians, nurses, PT, OT, ST
Medical Practice: Tertiary
-Highly specialized, technologically advanced care -Surgery and dialysis -Found in hospitals -providers are specialty physicians
Osteopathic Providers Historical
-Historical: Prevention focused, not overusing medicine -Doctors of Osteopathic Medicine (DOs)
Health Care History - 1960s
-Increased interest in health insurance -3rd party payment system -Cost of health insurance rose -increase access at little expense for those with insurance -those without insurance could not afford care
Population Based Practice (PH)
-Interventions aimed at disease prevention and health promotion -Health education and service provision (Sanitation, vaccines, disaster response)
Nurses: LPNs and RNs
-LPNs: 1-2 years of education in vocational program and pass licensure exam -RNs: completed accredited academic program and pass state licensure exam
Health Care History - 1990s
-Managed care becomes more prevalent -Achieved efficiency -Control utilization -CHIP developed -1996 - U.S. spent $1 trillion on health care (14%)
Government Health Insurance provided only to select groups:
-Medicare: 65+ -Medicaid: Low income -Children's Health Insurance Program (CHIP) -Veterans Administration benefits -Indian Health Services (IHS) -Federal employees -Prisoners
Long Term Care Options
-Mostly found via inpatient care (nursing homes, group homes, transitional care, day care) -Now being found in in-home health care (Growing due to restructuring of health care system, technology advances, and cost)
Examples of non-physician practitioners
-Nurse practitioners -Physician assistants
Preferred Provider Organization
-PPO -Get better pricing if you to preferred provider
Outpatient Care Facilites
-Patient receives care and does not stay overnight -clinic, dialysis center, urgent care, imaging centers
Inpatient Care Facilites
-Patient stays in overnight -Hospital, rehab, nursing home
4 types of Health Care Delivery
-Population-Based Practice (PH) -Medical Practice -Long-Term Practice -End of life Care
Types of Managed Care
-Preferred provider organization -Exclusive provider organization -Health maintenance organization
Restorative Care
-Provided after surgery (rehab, therapy, home care) -Found in inpatient and outpatient units, nursing homes, personal homes, -Providers are physicians, nurses, OT, PT, ST
Health Care History - 1980s
-Reagan and Congress eliminated Health Systems Agencies -Deregulation of health care delivery -Questions in medical ethics -Elaborate health insurance programs developed -Costs rose
Medical Practice: Primary
-Routine and preventive care -Annual physical, sore throat, pink eye, vaccines, basic chronic disease management -Found in outpatient -Providers: physicians, nurses, health educators
Early History of Health Care - Mid 1800s
-Self-care has been used -Anyone trained or not could practice medicine -Past medical education was not as rigorous as today (more about experience) -Barbers were usually the "doctors" because they had sharp tools and used leeches -Most care provided in patients' homes because hospitals found in large cities
End of Life Practice
-Services provided shortly before death -Hospice care
Superfund Sites
-Site needing significant clean up -Fund established in 1980 to clean up abandoned hazardous waste sites by taxes on chemical industries
Medical Practice: Secondary
-Specialized care and management -Chronic disease management, care for uncommon conditions -Found in outpatient and hospitals -Providers are usually physicians
National Health Insurance
-System where federal government assumes responsibility for health care costs of entire population, primarily paid for with tax dollars -U.S. is the only developed country without national health care plan -7 failed attempt at national health care in the last 70 years
History of Environmental Health
-Thought that unsanitary conditions caused disease -Lots of work on water, waste, living conditions -Focused on communicable/infectious illness -then on occupational based illness -now on chronic disease
Health Care History - 1940s and 1950s
-WWII impact where wage restrictions began and employers created health insurance to lure workers in -technical strides -Improved procedures, equipment, facilities meant rise in health care -Concept of health care as basic right or privilege
Public Health Professionals
-Work in PH organizations -usually financed by tax dollars -services available to everyone (primarily server the eco. disadvantaged) -PH physicians, dentists, MH providers, nurses, environmental health workers, health educators, health policy professionals
Limited or Restricted Care Providers
-advanced training in a health care speciality -provide care for a specific part of the body, but don't cover the entire body -dentists, optometrists, podiatrists, psychologists
Terrorism
-calculated use of violence or threat of violence against civilians to attain goals that are poetical or religious in nature -Socialogical hazard affect entire societies -Psychological hazard produces fear, stress, hysteria, -physical hazard leads to destruction of lives and property
Cost of Health Insurance in the US
-cost of insurance mirrors the cost of care -burden falls primarily on the employer, then on the employee (increased worker share of premium, raising deductibles, increasing Rx co-payments, increasing number of exclusions) -cost of insurance policy determined by risk of group, cost sharing and level of coverage provided
lead posioning
-found in soil, dust, air and paint -children at greatest risk -leads to anemia, birth defects, bone damages, learning disabilities
Natural environmental events/hazards
-geological activity and weather driven events -can result in physical and psychological health consequences -creates new variety of needs -Hurricane katrina, typhoon haiyan
Providers of population based practice
-have wide variety of skills and experiences -doctors, nurses, health educators, sanitation workers, epidemiologists
non-biological pollutants of water
-heat, inorganic chemicals, organic chemicals, radioactive pollutants -pharmaceuticals and personal care products
Allopathic Providers Historical
-historical: diagnose and treat disease based on science -Doctors of Medicine (MDs)
Causes of food borne disease
-inadequate cooking temperatures -unsanitary practices -contaminated equipment
Where is hospice care found and who are the providers
-inpatient units, outpatient units, nursing homes, personal homes, hospice specific homes -nurses, social workers, counselors, hospice volunteers
Heavy metals
-lead, mercury, chromium arsenic -occur naturally and also used by industry and in product
Regulation of OUTDOOR air quality
-many acts/policies have been established in the 1960/70s
Non-Allopathic Providers
-nontraditional means of health care -complementary and alternative medicine (CAM) was used together with conventional medicine, therapy is considered "complementary" -chiropractors, acupuncturists, naturopaths -natural products, mind-body medicine, manipulation
Protecting indoor air
-people spend 50-90% of time indoors -NO FEDERAL INDOOR CLEAN AIR ACT
Radiation
-process in which energy is emitted as particles or waves -heat, sounds, visible light are long-wavelength, low-energy radiation -high energy ionizing radiation -can lead to skin cancer
Problems with Medicare and Medicaid
-programs created to help provide health care to those who might have impossibilities of obtaining health insurance -some providers do not accept Medicare or Medicaid as forms of payment because of Medicare and Medicaid fraud -Very small problem compared with number of people enrolled
Brownfields
-property where reuse is complicated by the presence of hazardous substances from prior use -EPA works to help these lands be cleaned for re-use
Regulating Food Safety
-regulated by federal and state authorities -FDA ensure safety all of food except meat and dairy -USDA does meat and dairy -Enforced locally registered environmental health specialists
Vector borne disease outbreaks
-rising -#1 is lyme disease -have federal, state and local efforts for prevention
Allopathic and Osteopathic Providers Today
-similar education, training, perspective -Most DOs work in primary care and MDs work in primary and specialties
Independent Providers
-specialized education and legal authority to treat any health problem/disesase -allopathic and osteopathic providers -non-allopathic providers
Two Party System
-used in the early 1900s -Patients and physicians -Physicians collected own bills, set and adjusted prices based on ability to pay
Non point source pollution
-water -all pollution that occurs through runoff, seepage, or falling of pollutants into water
point source pollution
-water -pollution that can be traced to a single source
Radiation form Human made sources
-x-rays, nuclear medicine diagnoses, radiation therapy, nuclear energy and weaponry
Who are more likely to be uninsured?
-young -less education -low income -non-white
4 Parts of Medicare
1. Hospital Insurance (Part A) 2. Medical Insurance (Part B) 3. Managed Care Plans (Part C - optional, insurance companies) 4. Prescription Drug plans (part D - optional, insurance companies)
Third-party system/payment
1. Patient/insured 2. medical provider 3. insurer
Types of hospitals
1. Private - profit making, specialty hospitals 2. Public - Supported and managed by the government jurisdictions 3. Non-Profit- 1/2 of the hospitals; still business oriented 3. Teaching and non-teaching hospitals 4. Full-service or limited-service hospitals
Two Types of Long-Term Practice
1. Restorative Care 2. Long-Term Care
When were Medicare and Medicaid formed?
1965
West Nile virus
Caused by mosquitos passing infection to humans; mosquitos thrive in standing water
Because Lars broke his arm in 17 places, he has to stay in the hospital for a few days. He will be paying 20% of the inpatient stay costs, which is his....
Co-Insurance
Lars broke his arm during frisbee competition with friends. He has a flat fee of $250 for ER services, which is....
Co-payment
Recycling
Collecting, sorting, processing materials that would be otherwise considered waste
Air pollution
Contamination of air by substances in great enough amounts to harm living organisms Ex: transportation, electrical power plants fueled by coal and oil
Solid waste
Garbage, refuse, sludge, discarded solid material -95% traced to ag, mining and gas/oil production
Where is population based practice found?
Governmental health agencies
Natural Hazards
Naturally occurring phenomenon or event that produces or releases energy in amounts that exceed human endurance, causing injury, disease or death
Pesthouses
Places to isolate infectious disease
Lars has health insurance, for which he pays $200/year....
Premium
How do most people in the US get health insurance?
Through their employer
Hazardous waste
Waste dangerous to human health and/or environment
Copayment
a set amount you pay for certain services Ex: $20 for a physician visit
Phytochemical smog
air pollutants + sunlight
Greenhouse gases
air pollutants tied to global climate change
Deductible
among you must pay before your insurance will kick in
Sources of indoor air pollution
asbestos, biogenic pollutants, radon, environmental tobacco smoke, formaldehyde
Exclusion
care not covered by insurance policy Ex: cosmetic surgery, dental work usually
Waterborne disease examples
cholera, typhoid fever, dysentery
Pre-Existing Condition
condition diagnosed/treated before the coverage starts
National Ambient Air Quality Standards
created by amendment to CAA -emission standards for cars, for new industries, and ambient air standards for urban areas
Quality health care should be
effective, safe, timely, patient centers, efficient, patient centered
Environmental Protection Agency
federal agency responsible for setting, maintaining, and enforcing environmental standards
Municipal solid waste
generated by households, businesses, institutions -Avg: 4.3 pounds per person/day
Ozone
harmful in the atmosphere because it harms human tissue; useful in stratosphere to screen out radiation
Air Quality Index
index indicating level of pollution in the air and associated health risk
Vector
living organisms that can transmit communicable disease Ex: mosquito, rat, tick
Criteria pollutants
most pervasive pollutants, of greatest concern ex: Lead, NO2, CO
Primary pollutants
pollutant coming directly from transportation, power plants, industrial plants, refineries
Clean Air Act
provided the federal gov. with authority to address interstate pollution
Industrial smog
sulfur dioxide + air pollutants from burning coal
Co-Insurance
the amount you pay of a service you use in a percent Ex: For any inpatient care you pay 20% and insurer pays 80%
Biological pollutants of water
viruses, bacteria, parasites,
Runoff
water that flows over land surfaces, typically from precipitation
secondary pollutants
when primary pollutants react with sunlight and other chemicals
thermal inversion
when warm air traps cooler air at the surface of the earth
Policy
your contract with the insurer
Premium
your regular payment for coverage, whether you use it or not