Ch 18 Choosing Conventional and Complementary Health Care
board certified physicians
-board certified indicates that the physician has passed the national board examination for his or her specialty (ex: pediatrics) and has been certified as competent in that specialty
The federal program that covers people defined as poor is called: (a) Medicare; or (b) Medicaid.
The answer is B - Medicaid.
quality problem: life expectancy in the United States
-in 2011, life expectancy in the United States, at 78.49 years,was lower than that of 49 other nations of the world
reason to perform lasik
-reduce dependence on contact lenses or glasses
discussion regarding National Health Care is found _
*page 569* -national health insurance -system that Western countries (Canada, United Kingdom, France) that provide health care to all citizens through a national service funded through taxes
what HCFA did to control rising costs of health care?
--In 1998, the federal Health Care Financing Administration (HCFA) expanded the prospective payment system (diagnosis-related groups (DRGs) for Medicare) to include payments for outpatient surgery and skilled nursing care -HCFA (known as Center for Medicare and Medicaid services (CMS)) has encouraged to the growth of HMO plans for Medicare-eligible persons
use, example and potential side effects and hazards of common over-the-counter drugs: aspirin
-use: pain reliever; reduces fever and inflammation -examples: Bayer and Bufferin -potential hazards/common side effects: Stomach upset and vomiting; stomach bleeding; worsening of ulcers; enhancement of the action of anticlotting medications; hearing damage from loud noise; severe allergic reaction; association with Reye's syndrome in children and teenagers; prolonged bleeding when combined with alcohol
use, example and potential side effects and hazards of common over-the-counter drugs: decongestants
-use: reduce nasal stuffiness due to colds -examples: Sudafed, DayQuil, Allermed -potential hazards/common side effects: nervousness, restlessness, excitability, dizziness, drowsiness, headache, nausea, weakness, sleep problems
use, example and potential side effects and hazards of common over-the-counter drugs: antiacids
-use: relieve "heartburn" -examples:Tums and Maalox -potential hazards/common side effects: Reduced mineral absorption from food; possible concealment of ulcer; reduced effectiveness of anticlotting medications; interference with the function of certain antibiotics (for antacids that contain aluminum); worsened high blood pressure (for antacids that contain sodium); aggravated kidney problems
use, example and potential side effects and hazards of common over-the-counter drugs: laxatives
-use: relieve constipation -examples: ex-lax and citrucel -potential hazards/common side effects: reduced absorption of minerals from food; dehydration; dependency
explain the massage therapy type: Swedish massage
-uses long strokes, kneading, and friction on the muscles and moves the joints to aid flexibility
explain the massage therapy type: deep tissue massage
-uses patterns of strokes and deep finger pressure on parts of the body where muscles are tight or knotted, focusing on layers of muscle deep under the skin
allopathic medicine
-Conventional, traditional Western medical practice -mainstream medicine -dominant type of health care delivered in the United States, Canada, Europe, and much of the developed world -in theory, based on scientifically validated methods and procedures
as a cost problem, what is the problem with insurance of the US?
-Currently, more than 2,000 companies provide health insurance in the US, each with different coverage structures and administrative requirements -this lack of uniformity prevents our system from achieving the "economies of scale" (bulk purchasing at a reduce cost) and administrative efficiency realized in countries where there is a single payer delivery system
USP
-The USP (United States Pharmacopeia) is a nonprofit, scientific organization -it does not regulate or determine the safety of medications, foods, or dietary supplements, but it does offer verification services to manufactures of dietary supplement products
training for CAM practitioners (compare to conventional medicine practitioners)
-as with traditional Western medicine, practitioners of most complementary and alternative therapies spend years learning their practice -in addition, various forms of CAM are increasingly being taught in US medical schools -However, there is no national training, certification, or licensure standard for CAM practitioners and state regulations differ (this is also true for conventional medicine) -whereas practitioners of conventional medicine have graduated from US-sanctioned schools of medicine or are licensed medical practitioners recognized by the American Medical Association (AMA) (the governing body for all physicians) each CAM domain has different set of training standards, guidelines for practice, and licensure procedures
what concerns have risen about health maintenance organizations (HMOs)?
-as more and more people enroll in HMOs, concerns have arisen about care allocation and access to services, profit-motivated medical decisions making, and the degree of focus on prevention and intervention
how managed care plans are similar to other health insurance plans?
-as with other insurance plans, enrollees are members of a risk pool, and it is expected that some persons will use no services, some will use a modest amount, and others will have high-cost usage over a given year
why asking the right questions is important?
-asking the right questions at the right time may save you personal suffering and expense
diagnosis used in ayurveda
-ayurvedic practitioners use various techniques, including questioning, observation, and pulse palpation, to determine which of three vital energies, or doshas, is dominant in the particular patient
what should I consider when choosing health insurance?
-choosing health insurance plan can be confusing -some things to think about include how comprehensive your coverage needs to be, how convenient your care must be, how much you are willing to spend on premiums and co-payments, what the overall cost will be, and whether the services of the plan meet your needs
acupuncture is good for what things? (benefits of acupuncture)
-chronic pain -infertility -menopausal symptoms -chemotherapy patients that did acupuncture did not lose as much hair
what is the PCP of a college student? how reliable is?
-college students may opt to visit a PCP at their campus health center -the reputation of health care providers on college campuses is excellent -in survey, students have indicated that the health center medical staff is their most trusted source of health information
rhytidectomy
-commonly called a facelift -to improve signs of aging such as sagging skin in the face and neck
what approach complementary and alternative medicine (CAM) incorporate?
-complementary and alternative medical (CAM )therapies incorporate a holistic approach to medicine that focuses on treating the whole person, rather that just an isolated part of the body
altenrative (whole) medical systems
-complete systems of theory and practice that involve CAM domains -are therapies reflecting philosophies of health and balance. many have been practiced by various cultures throughout the world for centuries
EPA says _
-concern about growing pharmaceutical levels in water -American water is one of the safest in the world.
self-care (what consists of)
-consists of knowing your body, paying attention to its signals, and taking appropriate action to stop the progression of illness or injury
purpose of cosmetic surgery
-cosmetic surgery is performed to enhance appearance
Managed Care
-cost-control procedures used by health insurers to coordinate treatment -a network of physicians, hospitals, and other providers linked together to deliver health benefits.
what most people do when they are seek?
-deciding when to contact a physician can be difficult -most people first try to diagnose and treat a condition themselves
active participation in your treatment is the only sensible course in a health care environment that encourages _
-defensive medicine
list common nonherbal supplements
-dehydroepiandrosterone (DHEA)(hormone) -vitamin E -Glucosamine (biological substance that helps the body grow cartilage) -L-Carnitine (amino acid derivative) -Melatonin (hormone) -SAMe (pronounced "sammy")(biological compound that aids over 40 functions in the body) -Zinc (mineral) *for benefits, research findings and potential risks see page 561 table 18.3*
not all the supplements on the market today are directly derived from _. explain
-derived from plant sources -in recent years, there have been increasing reports in the media on the health benefits of various hormones, amino acids, and other biological compounds
problems with over-the-counter drugs
-despite a common belief that OTC products are safe and effective, indiscriminate use and abuse can occur with these drugs as with all others -ex: people who frequently drop medication into their eyes to "get the red out" or pop antacids after every meal are likely to become dependent -Many people also experience adverse side effects because they ignore the warnings on the label or simply do not read them
what people think about the efficiency of ACA? what is their solution?
-despite these provisions, many health experts feel that the ACA does not begin to go far enough in addressing the unequal access, high cost, and poor quality of our health care system -they assert that our system has failed, and an entirely new system must be put in its place: a system of national health insurance (or national health care) that advocates believe would addresses these key concerns
part of access problem, how managed care health plans determine access? problem with this?
-determine access on the basis of participating providers, health plan benefits, and administrative rules -Often this means that consumers do not have the freedom to choose specialists, facilities, or treatment options beyond those contracted with the health plan and recommended by their primary care provider
two types of saving accounts for health care spending? what they are?
-flexible spending account (FSA) for health care -health savings account (HSA) -they are saving plants that give you the opportunity to save money tax free to be used toward qualified health care expenses *more info in page 565*
Freeze-dried extracts
-form in which herbal remedies come -are very stable and offer good value for your money
tinctures
-form in which herbal remedies come -extracts of fresh or dried plants -usually contain a high precentage of grain alcohol to prevent spoilage and are among the best herbal options
standardized extracts
-form in which herbal remedies come -often available in pill or capsule form -are also among the more reliable forms of herbal preparations
two types of dietary products
-formulated foods -dietary supplements
antioxidants
-functional food contains them -chemicals that combat free radicals and oxidative damage in cells -they include vitamins C and E, the mineral selenium, and a variety of phytochemicals, naturally occurring compounds present in many whole and processed plant foods, from fruits and vegetables to coffee and tea
osteopath
-general practitioner who receives training similar to a medical doctor's but with an emphasis on the skeletal and muscular system -often uses spinal manipulation as part of treatment. their treatment may involve manipulation of the muscles and joints -osteopaths receive the degree of doctor of osteopathy (DO) rather than MD
This chapter will help you to become a better_
-health care consumer -learn to navigate the health care system is an important part of taking charge of your health
how health care providers strive to ensure the quality of care they provide? (in allopathic medicine)
-health care providers strive to ensure the quality of care they provide to their patients, and one of the ways they do this is by using evidence-based medicine
list types of managed care plans
-health maintenance organizations (HMOs) -preferred provider organizations (PPOs) -point service (POS)
what services health maintenance organizations (HMOs) provide?
-health maintenance organizations (HMOs) provide a wide range of covered health benefits for a fixed amount prepaid by the patient, the employer, medicaid, or medicare. -range of covered health benefits: physician visits, laboratory tests, surgery, and usually a prescription drug benefit
Echinacea
-herb -which has been widely praised for its ability to prevent colds although no research has proven its effectiveness in doing so
gingseng
-herb -which may or may not help its user handle stress better
green tea
-herb -green tea, said to potentially protect drinkers against heart attacks, a claim not yet been proven conclusively.
benefit of Ginkgo biloba
-herb -improve short-term memory and also be a blood thinner
problem with herbal remedies
-herbal remedies are not to be taken lightly -just because something is natural does not necessarily mean that it is safe ex: in recent years, the NCCAM has warned that certain herbal products containing kava may be associated with severe liver damage -Even rigorously tested products can be risky -many plants are poisonous, and some can be toxic if ingested in high doses. -others may be dangerous when combined with prescription or over-the-counter drugs, could disrupt the normal action of the drugs, or could cause unusual side effects
other than vitamin/mineral supplements, _, often referred to as_, are among the most common dietary supplements sold
-herbal remedies, often referred to as botanicals
how herbs were used in pharmaceutical drugs? how continue to improve pharmaceutical drugs?
-herbs were the original sources for compounds found in approximately 25% of the pharmaceutical drugs we use today, including aspirin (white willow bark), the heart medication digitalis (foxglove), and the cancer treatment Taxol (Pacific yew tree) -in addition, scientists continue to make pharmacological advances by studying the herbal remedies used in cultures throughout the world
reasons to not seek medical treatment or diagnosis, which can be very dangerous
-high costs -limited coverage -medicate yourself
training for Homeopathy
-homeopathic training varies considerably and is offered through diploma programs, certificate programs, short courses, and correspondence courses -laws that detail requirements to practice vary form state to state
function of part of over-the-counter medicine label (OTC): other information
-how to store the product properly and required information about certain ingredients (such as the amount of calcium, potassium, or sodium the product contains)
problem of elective surgeries? (think about costs)
-if a procedure is considered not medically necessary, it may not be covered by insurance. -in some cases, insurance companies may require a second opinion before approving payments on elective surgical procedures -if you are considering elective surgery, review your coverage requirements with your health insurance carrier before scheduling the procedure
what to look for if you are purchasing dietary supplements? how dietary supplements earn this?
-if you are considering purchasing a dietary supplement, look for the USP Verified Mark on the label -dietary supplement products must meet stringent quality and manufacturing criteria to earn the USP Verified Mark
when need ophthalmologist?
-if you have an eye infection, glaucoma, or other eye condition needing diagnosis and treatment, you need to see an ophthalmologist
Patient Protection and Affordable Care Act (ACA)
-in 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) to provide a means for these and all Americans to obtain affordable health care -in addition to increasing access to care, the ACA is expected to address America's high cost of care and to improve overall quality of care
part of access problem, what kind of physicians are available?
-in 2012, there was almost 700,000 physicians in the US -however, there is an oversupply of higher-paid physicians (family practitioners, internists, pediatricians, etc)
how herbal medicines compare to chemical drugs in their effect? (how compare to pharmaceutical drugs)
-in general, herbal medicines tend to be milder than chemical drugs and produce their effects more slowly -they also are much less likely to cause toxicity because they are diluted rather than concentrated forms of drugs -but diluted or not, and no matter how natural they are, herbs still contain many of the same chemicals as synthetic prescription drugs
what kind of people health insurances prefer?
-in profit-oriented systems, insurers prefer to have healthy people in their plans who pour money into risk pools without taking money out
how many people are uninsured? (include percentages)
-in total, over 48 million Americans (16%) are uninsured -of these uninsured, 75% are workers or the dependents of workers -almost 12% of all the uninsured are children under age 18
nocebo effect
-in which a practitioner's negative assessment of a patient's symptoms leads to a worsening of the condition -Ethical considerations make the nocebo effect difficult to study; however, available experimental evidence links negative expectations with increased anxiety and pain
lasik (how done, what does, what corrects)
-in which a surgeon uses a razorlike instrument or laser to cut a flap in the cornea, the clear covering on the front of the eye, and then reshapes the exposed area using a laser -the surgery alters the way the eye focuses light, correcting nearsightedness, farsightedness, and some astigmatism -however, lasik is not effective at treating close-up vision problems in middle-aged adults -procedure usually takes less than 5 minutes, is painless, and the patient is awake the entire time
underinsurance
-inability to pay out-of-pocket expenses despite having insurance -people at risk of spending more than 10% of their income in medical care because their insurance is inadequate
changes to the diet are often part of the CAM therapies, and such changes commonly involve increased intake of _
-increased intake of certain functional foods
what to do to self-care?
-individuals can practice behaviors that promote health and reduce the risk of disease -We can also treat minor afflictions without seeking professional help
quality problem: infant mortality rate in the United States
-infant mortality rate, at 5.98 deaths per every 1,000 live births, is higher than that of 48 other nations
risk and complications of cosmetic surgery
-infection -bruising -numbness -bleeding -poor healing
part of access problem, what parts of cities experience high shortages of physicians?
-inner cities and some rural areas face constant shortages of physicians -similarly, of the nearly 5,000 non-federal hospitals in the US, over 60% serve urban areas, leaving many rural communities without readily accessible care
the ACA's provision for affordable Insurance Exchanges would increase bulk purchasing and reduce administrative costs, thus achieving some savings. Moreover, ACA mandates the following cost-control measures
-insurance companies that spend less than 80% of premium dollars on medical care in a given year now have to send enrollees a rebate -all insurance companies now have to publicly justify their actions if they plan to raise rates by 10% or more -Tougher screening procedures and penalties are helping to reduce health care fraud
how health insurance work?
-insurance pays for your care -Insurance typically allows you, the consumer, to pay into a pool of funds and then bill the insurance carrier for health care charges you incur
explain the the mechanism employed by private health insurance company: preexisting condition clauses
-limited the insurance company's liability for medical conditions that a consumer had before obtaining coverage ex: if a person applying for insurance had cancer, the insurer could deny the application entirely, or agree to cover the applicant but only for conditions unrelated to the cancer -under the 2010 Patient Protection and Affordable Care Act (ACA), starting in 2014, no one can be discriminated against due to a preexisting condition
problem of having drugs in water?
-long term effects -scientist have found effects in animals. -male fix, for example, have developed female traits and have reproductive problems because they were exposed to human birth control hormones. -there is no proof so far of harm to human health
training options for nurses (lower-level practical or vocational nurse)
-lower-level licensed practical or vocational nurses (LPN or LVN) complete a 1- to 2-year training program, which may be based in either a community college or a hospital, and take a licensing exam
explain the benefit of the functional food: garlic
-lowers cholesterol and reduces clotting tendency of blood -lowers blood pressure -may serve as form of antibiotic
how the use of managed care plans have changed? (compare with health insurance) why?
-managed care plans have grown steadily over the past decade with a proportionate decline of enrollment in traditional indemnity insurance plans -the reason for this shift is that indemnity insurance, which pays providers and hospitals on a fee-for-service basis with no built-in incentives to control costs, has become affordable or unavailable for most Americans
most forms of energy therapy _(what do?)
-manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields
chiropractic medicine
-manipulation of the spine to allow proper energy flow -has been practiced for more than 100 years and focuses on manipulation of the spine and other neuromuscular structures
what are the 5 general domains of practice to the many varies of CAM stated by NCCAM and recognizing that the domains may overlap? (domains of complementary and alternative medicine (CAM))
-manipulative and body-based practices -energy medicine -mind-body medicine -biologically based practices -whole medical systems the domains ovarlap. In particular, CAM whole medical system cut across all domains
explain the domain of complementary and alternative medicine (CAM): manipulative and body-based practices
-manipulative and body-based practices are based on manipulation or movement of one or more body parts
what you can do when going to ask questions to your health care practitioner?
-many patients find that writing their questions down before an appointment helps them get all the answers they need
why people prefer CAM therapies instead of conventional medicine?
-many people seek CAM therapies as alternative to the conventional Western system of medicine, which some people regard as too invasive, too high-tech, and too toxic in terms of laboratory-produced medications. CAM therapies are mild and less invasive. -some CAM patients believe that alternative practices will give them greater control over their health care
problems with self-care methods
-many people use self-care treatment methods inappropriately -taking prescription drugs used for a previous illness to treat your current illness -using unproven self-treatment -using other people's medications are examples of inappropriate self-care
food producers sometimes referred to their functional foods as _to emphasize their _
-nutraceuticals -to emphasize their nutritional and pharmaceutical benefits
dietary products, including specially formulated foods and dietary supplements, are perhaps the most controversial domain of CAM therapies because _
-of the sheer number of options available and the many claims that are made about their effects -many of these claims have not been investigated and many of the products are not currently regulated
on a personal level, what is the most important measurement?
-on a personal level, perhaps the most important measurement is how you and your loved ones experience the health care provided
two types of eye specialists
-ophthalmologist -optometrist
how health insurance has evolved? problems with this?
-originally, health insurance consisted solely of coverage for hospital costs (it was called major medical), but gradually it was extended to cover routine physicians' treatment and other services, such as dental and vision care and pharmaceuticals -These payment mechanisms laid the groundwork for today's steadily rising health care costs
types of dentistry specialities
-orthodontists -oral surgeons
orthodontist
-orthodontists specialize in the alignment of the teeth
how pharmaceuticals are getting into water supply? (drug flow cycle)
-our bodies do not absorb all medicines we take. So some of its is excreted and flushed into our sewers (excrete and flush drugs into sewers) -sewage treatment plants do not remove drugs. -treated water flows into lakes, rivers, and reservoirs -drinking water plants don't remove drugs -the drugs are in water flowing from our faucets
acupuncture has been very well proven in many areas and_in particularly. it has been well studied in that regard.
-pain relief
commonly used over-the-counter drugs (OTC) (categories)
-pain relievers -cold, cough, allergy and asthma medication -stimulants -sleeping aids and relaxants -dieting aids
too much of any herb, particularly one from _, can cause problems
-particularly one from nonstandardized extracts
premiums
-payment made to an insurance carrier, usually in monthly installments, that covers the cost of an insurance policy -payments made by the policyholders and/or their employer to the insurance company
why are so many people using alternative medicine?
-people use alternative medicine for multiple reasons, and many treatments can benefit a variety of physical and mental ailments ex: shirodhara (a traditional ayurvedic treatment in which warm herbalized oil is poured over the forehead in guided rhythmic patterns) is said to relieve stress and anxiety, treat insomnia and chronic headaches, and improve memory
how people that company does not cover health insurance pay their premiums? problem with this?
-people who are self-employed or work in companies that do not provide group health insurance must pay their premiums independently, and millions of employed but uninsured Americans do not find them affordable
problem of having uninsured people? (how affect society?)
-people without insurance cannot gain access to preventive care, so they seek care only in an emergency or crisis -because emergency care is extraordinarily expensive, they often are unable to pay, and the cost is absorbed by those who can pay: the insured or taxpayers
recent study found _in the water supply of more than 41 million Americans. concern about this?
-pharmaceuticals -when these medicine are antibiotics, there is a concern regarding antibiotic resistance
ophthalmologist
-physician who specializes in the medical and surgical care of the eyes, including prescriptions for glasses -holds a medical degree and can perform surgery and prescribe medications
naturopathy (naturopathic medicine)
-system of medicine originating form Europe that views disease as a manifestation of alterations in the body's natural self-healing process and that emphasizes health restoration as well as disease treatment -views disease as a manifestation of an alteration in the processes by which the body naturally heals itself -symptoms are a sign that our natural balance has been disturbed and must be re-established.
techniques used in traditional chinese medicine (TCM)
-techniques such as acupuncture, herbal medicine, massage, and qigong (a form of energy therapy) are among the TCM approaches to health and healing. -chiropractic, acupuncture, acupressure, tai chi, yoga and massage
function of part of over-the-counter medicine label (OTC): directions
-tells exactly how and when to take a medicine
nutraceuticals
-term often used interchangeably with functional foods -refers to the combined nutritional and pharmaceutical benefit derived through use of foods or food supplements
what pharmaceuticals were found in trace levels in lake mead (supply Nevada, California, and Arizona)?
-test have found trace levels of birth control, steroids, narcotics, and more
How ACA would help to reduce costs?
-the ACA's provision for affordable Insurance Exchanges would increase bulk purchasing and reduce administrative costs, thus achieving some savings
another concern about the health care system:
-the amount of waste it produces and its impact on the environment *for more info see page 566* includes medical waste and pharmaceutical waste
training for chiropractic medicine
-the average chiropractic training program includes intensive courses in biochemistry, anatomy, physiology, diagnostics, pathology, nutrition, and related topics, combined with hands-on clinical training -many chiropractors continue their training to obtain their specialized certification, for instance, in neurology, geriatrics, or pediatrics -most state licensing boards require a 4-year course of study after completing at least a 3-year undergraduate program -although states vary, increasing numbers require a 4-year undergraduate degree prior to entrance into chiropractic colleges -after completion of these requirements,applicants must pass an extensive examination given by the National Board of Chiropractic Examiners to obtain a license -the practice of chiropractic is licensed and regulated in all 50 states
negative things (problem) with health maintenance organizations (HMOs)
-the downside of health maintenance organizations (HMOs) is that patients are typically required to use the plan's doctors and hospitals -within an HMO, the PCP serves as a "gatekeeper,"coordinating the patient's care and providing referrals to specialists and other services
what is the fundamental principle of health insurance?
-the fundamental principle of insurance underwriting is that the cost of health care can be predicted for large populations -this is how premiums are calculated
example of nutraceutical
-the label on a bar of dark chocolate may state that modest consumption helps to reduce the risk of heart disease -the claim is backed up by research: plant compounds called flavonoids found in chocolate improve several risk factors for heart disease
most commonly advertised functional food?
-the most commonly advertised functional foods have been those containing antioxidants
who gives information about CAM practices?
-the national center for complementary and alternative medicine (NCCAM), part of the national institutes of health (NIH), provides a mechanism for reliable information about CAM practices -NCCAM serves as a clearinghouse for CAM information and a focal point for research initiatives, policy development, and general recommendations
how many people underinsured?
-the number of underinsured is not tracked, but a 2008 study estimated that 25 million Americans between the ages of 19 and 64 are underinsured (at risk of spending more than 10% of their income in medical care because their insurance is inadequate)
dietary supplement
-the office of dietary supplements, part of the national institute of health, defines a dietary supplement as a "product (other than tobacco) that is intended to supplement or add to the diet; contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents; is intended to be take by mouth as a pill, capsule, tablet, or liquid; and is labeled on the front panel as being a dietary supplement."
training for ayurveda
-training for ayuverdic practitioners varies -there is no national standard certification, although professional groups are working toward certain licensing guidelines
complementary medicine
-treatment used in conjunction with conventional medicine -used together with conventional medicine, as part of the modern integrative-medicine approach -complementary methods are used with traditional medicine
alternative medicine
-treatment used in place of conventional medicine ex: following a special diet or herbal remedy to treat cancer instead of using radiation, surgery, or other conventional treatments. Seeing an herbalist for stress or depression is an example of alternative treatment. -An alternative approach is one a person takes instead of seeing a conventional doctor
why people take dietary supplements?
-typically, people take dietary supplements (often without guidance from any CAM practitioner) to improve health, prevent disease, or enhance mood
how Point of Service (POS) plans work regarding doctors?
-under POS plan, members select an in-network PCP, but they can go to nonnetwork providers for care without a referral and must pay the extra cost
how works: HCFA (known as Center for Medicare and Medicaid services (CMS)) has encouraged to the growth of HMO plans for Medicare-eligible persons?
-under this system, commercial managed care insurance plans receive a fixed per capita premium from CMS and then offer more preventive services with lower out-of-pocket co-payments -these managed care plans encourage providers and patients to utilize health care resources under administrative rules similar to commercial HMO plans
Homeopathy (homeophatic medicine)
-unvonventional Western system of medicine based on the principle that "like cures like" -in other words, the same substance that in large doses produces symptoms of an illness will in highly diluted dosses prompt the body's own defenses to cure the illness
problem with defensive medicine
-unwarranted tests and treatments to protect against malpractice exposure are two significant factors driving up the cost of medicine -It is estimated that between $250 and $325 billion per year are spent on medical tests and procedures that do not improve health outcomes
use, example and potential side effects and hazards of common over-the-counter drugs: Expectorants
-use: Loosen phlegm, which allows the user to cough it up and clear congested respiratory passages -examples: Mucinex -potential hazards/common side effects: safety issues may arise when combined with other medications, particularly in frail or very ill individuals. effectiveness is sometimes in question
use, example and potential side effects and hazards of common over-the-counter drugs: diet pills, caffeine
-use: aid to weight loss -examples: Dexatrim -potential hazards/common side effects: organ damage or death from cerebral hemorrhage; nervousness; irritability; dehydration
use, example and potential side effects and hazards of common over-the-counter drugs: antihistamines
-use: central nervous system depressant that dry runner noses, clear postnasal drip and sinus congestion, and reduce tears -examples: Claritin, Benadryl, and Xyzal -potential hazards/common side effects: Drowsiness, sedation, dizziness, disturbed coordinations
use, example and potential side effects and hazards of common over-the-counter drugs: sleep aids and relaxants
-use: help relieve occasional sleeplessness -examples: Nytol, sleep-eze, sominex -potential hazards/common side effects: drowsiness the next day; dizziness; lack of coordination; reduced mental alertness; constipation; dry mouth and throat; dependency
use, example and potential side effects and hazards of common over-the-counter drugs: anticholinergics
-use: often added to cold preparations to reduce nasal secretions and tears -examples: atropine and scopolamine -potential hazards/common side effects: none of the preparations tested by the FDA have been found to be Generally Recognized as Effective (GRAE) or Generally Recognized as Safe (GRAS). some cold compounds contain alcohol concentrations greater than 40%
use, example and potential side effects and hazards of common over-the-counter drugs: acetaminophen
-use: pain reliever, fever reducer -examples: Tylenol -potential hazards/common side effects: Bloody urine, painful urination; sin rash; bleeding and bruising; yellowing of the eyes or skin; difficulty in diagnosing overdose because reaction may be delayed up to a week; liver damage from chronic low-level use
use, example and potential side effects and hazards of common over-the-counter drugs: ibuprofen
-use: pain reliever; reduces fever and inflammation -examples: Advil and Motrin -potential hazards/common side effects: Allergic reaction in some people with aspiring allergy; fluid retention or swelling (edema); liver damage similar to that from acetaminophen; enhancement of anticlotting medications; digestive disturbances
use, example and potential side effects and hazards of common over-the-counter drugs: Naproxen sodium
-use: pain reliever; reduces fever and inflammation -examples: Aleve and Naprosyn -potential hazards/common side effects: Potential bleeding in the digestive tract; possible stomach cramps or ulcers
benefit of health maintenance organizations (HMOs): how are health maintenance organizations (HMOs) premiums? problem with health maintenance organizations (HMOs)
-usually, health maintenance organizations (HMOs) premiums are the least expensive form of managed care (saving between 10% and 40% more than other plans), but they are also the most restrictive (offering little or no choice in doctors and certain services) -these premiums are 8% to 10% lower than for traditional plans, there are lower no deductibles or coinsurance payments, and co-payments are modest
why disease results in the perspective of naturopathy?
-views disease as a manifestation of an alteration in the processes by which the body naturally heals itself -disease results from the body's effort to ward off impurities and harmful substances from the environment
types of dietary supplements
-vitamin or mineral supplements -herbal supplements remedies -nonherbal supplements
The Children's Health Insurance Program (CHIP)
-was created in 1997 and reauthorized through new legislation in 2009 -it provides health insurance coverage to more than 5 million uninsured children -like Medicaid, it is jointly funded by federal and state funds and is administered by state governments
function of part of over-the-counter medicine label (OTC): warnings
-when not to use the product; conditions that may require advice from a doctor before taking the product; possible interactions or side effects; when to stop taking the product and when to contact a doctor
explain how qi works as stated by traditional chinese medicine (TCM)
-when qi is in balance, the person is in a state of health -imbalance of qi results in disease
when doctors accept alternative complementary techniques?
-when there is hard evidence that these techniques re not harmful and are effective -hard scientific evidence -more doctors will be welcoming to these techniques
types of functional foods
-whole foods: broccoli and nuts -modified foods: energy bar said to enhance memory
explain the domain of complementary and alternative medicine (CAM): whole medical systems
-whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States -in particular, CAM whole medical systems cut across all domains (overlaps all domains)
Reiki
-whose name derives from the Japanese words representing "universal" and "vital energy," or ki, is based on the belief that by channeling ki to the patient, the practitioner facilitates healing
why more people are turning to herbal remedies?
-with conventional scientists now recognizing the benefits of herbs, it is no wonder that more and more consumers are turning to herbal products
what is a less controversial way to consult a doctor?
-with telemedicine (by telephone) -doctor knows patients personally and requires a face-to-face exam before treating them remotely
explain the benefit of the functional food: yogurt
-yogurt is labeled as "Live and Active Cultures" contains active, friendly bacteria that can fight infections
explain right as patient: you are entitled to know whether the treatment you are receiving is standard or experimental
-you are entitled to know whether the treatment you are receiving is standard or experimental.In experimental conditions, you have the legal and ethical right to know if any drug is being used in the research project for a purpose not approved by the Food and Drug Administration (FDA) and whether the study is one in which some people receive treatment whereas others receive a placebo
why you can ask questions to your health care practitioner?
-you don't need to accept a defensive or hostile response -asking questions is your right as a patient
When deciding on a health insurance plan, you might consider the following questions:
1. How comprehensive do I want my coverage of health care to services to be? 2. How do I feel about limits on my choice of doctors or hospitals? 3. How convenient does my care need to be?
list your rights as a patient
1. the right of informed consent. 2. you are entitled to know whether the treatment you are receiving is standard or experimental 3. You have the right to privacy 4. You have the right to receive care, as well as to refuse treatment and to cease treatment any time 5. You are entitled to have access to all of your medical records and to have those records remain confidential 6. You have the right to seek the opinions of other health care professionals regarding your condition
In about _of doctor visits, the physician administers or prescribes at least one medication
2/3
Due to health care reform, by 2014, we should have _people who do not have insurance, who will have it
30 million people
_Americans are admitted to the hospital each year
35 million
_% of 18- to 29-year-olds report having used some form of CAM
36%
the federal government, through programs such as medicare and medicaid, currently funds _% of the total US health spending
45%
_% of Americans report taking at least one prescription drug in the past month; _% report taking three or more such drugs
45% 18%
have a glass of water in Philadelphia and you are drinking tiny amounts of at least _pharmaceuticals or their by-products
56
Medicaid covers approx _people
58 million
_% of US physicians admitted that they sometimes order unnecessary medical tests because they are concerned about being sued for malpracitce
91%
Under what type of managed care plan can patients go to providers outside their HMO network, but must pay for the extra cost. Is it: (a) independent practice association; or (b) point of service?
The answer is B - point of service or POS. POS is a hybrid of the HMO and PPO types providing a more acceptable form of managed care for those used to the traditional indemnity plan of insurance.
A concept of knowing your body and its signals and taking appropriate action to stop the progression of illness or injury or to improve your overall health is called: (a) health care; or (b) self care?
The answer is B - self care.
The common cold will improve with time, with or without treatment. This concept relates to: (a) the holistic approach; or (b) spontaneous remission?
The answer is B - spontaneous remission. This refers to the disappearance of symptoms without any apparent cause or treatment.
Joe has a suspicious growth on his back and his doctor wants him to have a biopsy. The ambulatory facility he will most likely go to for this type of procedure is a(n): (a) hospital; or (b) surgicenter?
The answer is B - surgicenter. A surgicenter is a place where minor, low-risk procedures such as tissue biopsies are performed.
Which form of body work involves gentle rocking and bouncing motions, a) rolfing or b) trager work?
The answer is B - trager work
Question #1: Going to see a chiropractor instead of visiting an orthopedist for relief of neck pain is an example of a) alternative or b) complementary medicine.
The answer is a - alternative, which is a treatment used in place of conventional medicine, while complementary medicine is a treatment used in conjunction with traditional approaches.
Beta-carotene, selenium, and vitamins C and E are all examples of a) anti-oxidants or b) nutraceuticals.
The answer is a - anti-oxidants, which are the most popular of all dietary supplements even though research isn't conclusive that all are effective in preventing heart disease.
Reiki is an example of a) biofield therapy or b) manipulative practices.
The answer is a - biofield therapy because although reiki is a type of massage, it is based on the belief that there is a universal life energy and that by channeling it through a person the spirit is healed, which in turn heals the person physically.
The herb which is thought to be both an anticoagulant and helpful in improving short-term memory is a) ginkgo biloba or b) Echinacea.
The answer is a - ginkgo biloba. Echinacea has been thought to help boost immune function and particularly to prevent against colds, although this has never been proven.
Tinctures are an example of an a) herbal or b) special dietary therapy.
The answer is a - herbal. They are extracts of dried or fresh plants, usually soaked in alcohol or vinegar, which are milder than chemical drugs and slower acting. They also tend to be less toxic to the body.
Is it a) true or b) false that androstenedione has been banned by several college and major league sports but is available over the counter?
The answer is a - true. The chemical structure of "andro" is similar to that of anabolic steroids. The FDA is requesting companies who distribute this substance to stop.
Traditional Chinese medicine emphasizes a) the need for proper balance of qi or b) classification of body type followed by herbal remedies.
The answer is a. Chinese medicine assesses the state of qi, or energy, in the body and balances it to ensure health.
Homeopathic medicine heals symptoms by prescribing a) minute doses of the substance causing symptoms or b) antidotes to the substance causing symptoms.
The answer is a. Homeopathic medicine, based on the law of similars, believes that the same substance that in large doses causes symptoms can be used in much smaller doses to cure it.
A naturopathic healer believes that a) the body can naturally heal itself or b) symptoms must be diagnosed and eliminated.
The answer is a. Naturopathic medicine feels that the body can heal itself and that symptoms result from assaults from the environment, and signal an imbalance within the body's systems.
The drug commonly used in Europe for treatment of mild depression is a) ephedra or b) St. John's Wort.
The answer is b - St. John's Wort. While used in this country, too, it is more popular in Europe. Study results on its effectiveness as an anti-depressant have been inconclusive.
Which therapy's effectiveness has been so well proven that it is no longer considered to be alternative, a) alternating current fields or b) biofeedback?
The answer is b - biofeedback, a method designed to help the mind to affect body function and symptoms which has been so fully investigated that it is considered to be beyond question.
Vitamins, minerals and amino acids are all examples of ingredients which are found in a) ergogenic drugs or b) dietary supplements.
The answer is b - dietary supplements. People take these to improve health, prevent disease, or enhance mood.
The food that fights motion sickness, stomach pain and upset and discourages blood clots is a) garlic or b) ginger.
The answer is b - ginger, popular with pregnant women experiencing morning sickness as well.
The energy therapy derived from the ancient technique of "laying on" of hands is a) reiki or b) therapeutic touch.
The answer is b - therapeutic touch, based on the idea that the therapist's healing force helps the patient's energies become balanced.
Most CAM products a) are or b) are not regulated in the United States as strictly as food and drugs are.
The answer is b - they are not regulated as strictly as food and drugs are in this country, in sharp contrast to some European countries which impose high standards both for ingredients and manufacturing.
Roughly a) 15% or b) 35% of all Americans have used some form of complementary or alternative medicines.
The answer is b. About 36% of Americans have used some form of CAM.
The CAM domain that might recommend meditation as a healing approach is a) energy medicine or b) mind-body medicine.
The answer is b. Mind-body medicine uses several techniques to help the mind to affect body functions.
What is the name of the federal insurance program that covers 99 percent of the elderly over 65 years of age? Is it: (a) Medicaid; or (b) Medicare?
The correct answer is B - Medicare.
What mechanism used by private insurance companies limits the insurance company's liability for medical conditions that a consumer had before obtaining coverage? Is it: (a) waiting period clauses; or (b) preexisting condition clauses?
The correct answer is B preexisting condition clauses.
Of evidence-based practice explain: clinical expertise
clinical expertise refers to the clinician's cumulative experience, education, and clinical skills
what also is also to blame for the cost problems?
insurance system is also to blame
benefit of herb St. John's Wort
is used extensively in Europe as a mild anti-depressant, and should never be used by individuals taking these by prescription
oral surgeon
oral surgeon perform surgical procedures to correct problems of the mouth, face, and jaw
Of evidence-based practice explain:current best scientific evidence
the best evidence is usually found in clinically relevant research that has been conducted using methodology
Of evidence-based practice explain: patient value
the patient brings his or her own personal and unique concerns, expectations, and values
explain the the mechanism employed by private health insurance company: deductibles
-are payments (commonly $250 to $1,000) you make for health care before insurance coverage kicks in to pay for eligible services
energy medicine
--CAM domain -therapies using energy fields, such as magnetic field or biofields -is a general term for therapies that focus either on energy fields thought to originate within the body (biofields) or on fields from other sources (electromagnetic fields) -the existence of these fields have not been experimentally proven
rhinoplasty
-correction and reconstruction of the nose
using self-care methods appropriately takes_
-education and effort
dentist
-specialist who diagnoses and treats diseases of the teeth, gums, and oral cavity
treatment used in allopathic medicine
-the prevention of disease and the restoration of health involve vaccines, drugs, surgery, and other treatments
treatment in acupuncture
-the therapist stimulates various points on the body with a series of precisely placed and extremely fine, long, and thin needles. -the stimulation of these acupuncture points is thought to increase the flow of qi (life-force energy) through the meridians, or energy pathways, in the body
function of part of over-the-counter medicine label (OTC): active ingredient
-therapeutic substance in product; it can always be found first on the label
_% of college students without a health insurance
20%
_% of all trips to the doctor are believed to be unnecessary and potentially harmful
70%
how many people have Medicare?
It currently serves over 39 million people.
Medicaid is funded by _. what this causes regarding how Medicaid works?
Medicaid relies on funds provided by both federal and state sources -Because each state determine income eligibility, covered services, and payments to providers, there are vast differences in the way Medicaid operates from state to state
why people are uninsured?
One of the problems with health insurance for the uninsured is that health care may not be affordable.
Acupuncture is a technique used in a) Traditional Chinese or b) Ayurvedic medicine.
The answer is A - Traditional Chinese medicine.
explain right as patient: You have the right to privacy
You have the right to privacy. this means that you do not have an obligation to reveal the source of payment for your treatment. It also means you have the right to make personal decisions concerning all reproductive matters
conventional health care is called_
allopathic medicine
although the terms_are often used interchangeably when referring to therapies, there is a distinction between them
although the terms complementary and alternative are often used interchangeably when referring to therapies, there is a distinction between them
what is the most common type of managed care?
approx 66 million Americans are enrolled in HMOs, the most common type
Yoga, meditation and visualization are all examples of a) massage or b) relaxation techniques.
b - relaxation techniques, one of several popular complementary techniques along with aromatherapy, food therapy, massage, and megavitamins.
massage therapy can be used for _
can be using for aching back
how many people have Medicaid?
covers approximately 40 million people
lack of health insurance (uninsured) has been associated with_
delayed health care and increased mortality
what act used to aid with insurance coverage for employees who change jobs?
even before passage of the ACA, Congress provided assistance with insurance coverage for employees who change jobs -under the Consolidated Omnibus Budget Reconciliation Act (COBRA) passed in 1986, Congress provided for former employees, retirees, spouses, and dependents to continue their insurance for up to 18 months at group rates -people who enroll in COBRA pay a higher amount than they did when they were employed, as they are covering both the personal premium and the amount previously covered by the employer
functional foods
foods said to improve some specific aspect of physical and mental functioning beyond the contribution of their specific nutrients
do herbal remedies have any risks or side effects?
herbs do have the potential to cause negative side effects ex: St. John's wort has potentially dangerous interactions with some prescription antidepressants and should never be taken with them -other herbs, such as kava, can have negative effects even when taken alone
function of part of over-the-counter medicine label (OTC): uses
symptoms or illnesses for which the product will be used
explain right as patient: right of informed consent
the right of informed consent means that before receiving any care, you should be fully informed of what is being planned; the risks and potential benefits; and possible alternative forms of treatment, including the option to refuse treatment. Your consent must be voluntary and without any form of coercion. It is critical that you read any consent forms carefully and amend them as necessary before signing
explain the massage therapy type: trigger point massage
trigger point massage (also called pressure point massage) uses a variety of strokes but applies deeper, more focused pressure on myofascial trigger points (nots that can form int eh muscles, are painful when pressed, and cause symptoms elsewhere in the body as well)
function of part of over-the-counter medicine label (OTC): purpose
what type of medicine it is (such as antihistamine, acid reducer, or cough suppressant)
_Americans are uninsured
42 million
function of part of over-the-counter medicine label (OTC): inactive ingredients
-substances such as colors or flavors
optometrist
-eye specialist whose practice is limited to prescribing and fitting lenses -typically evaluates visual problems and fits glasses but is not a trained physician
access to health care is determined by numerous factors, the most significant of which are _
-supply and proximity of providers and facilities and insurance coverage
breast augmentation
-surgical placement of an implant behind each breast to increase breast volume and enhance shape
treatment of acupressure
--is based on the same knowledge of energy flow as acupuncture -instead of needles, pressure is applied to points critical to balancing yin and yang, the two complementary principles that influence overall harmony (health) of the body -acupressure practitioners must have the same basic training and understanding of energy pathways as do acupuncturists
how are going to pay for health care reform?
--new medicare tax on wealthy (the top 2% of this country, are going to pay more taxes) -taxes on high cost plans -employers will pay higher taxes on what are called the Cadillac plans, the very, very expensive health care plans that are out there. -penalties for not offering insurance (bussiness with 50 employees that do not offer heath care insurance; $2,000 per person cost as an incentive to extend insurance coverage) -Fees from the health sector: corporations in the health care industry will pay higher fees: medical device manufacturers, pharmaceutical companies, insurers, they are going to pay higher fees in corporate taxes that, again, may potentially be passed on to consumers. -exemption for mandatory coverage: for businesses that have 25 employees or less and that earn $5,000 or less, they can get a waiver where they are not mandated to offer coverage. -Tax credits for employees' insurance: But those small companies that do are going to get some great tax incentives that will cover up to 50% of the cost -New insurance exchanges: employers that have 100 employees or less are going to be able to participate in state insurance exchanges, where they get the benefit of group rates and they also get some choices of insurers
among young adult ages 18 to 24, _% do not have health insurance coverage. how this compares to college students?
-31% -however, for young adults who are college students, the statistics are different -in a 2011 national survey of college students, 7% of respondents said they did not have health insurance -however, those who are covered only under their school's health care plan, almost 15% according to the survey, may not realize that such plans are usually short term and have a low upper limit of benefits, which would be problematic of the student were to have a severe illness or injury. Few students buy higher-level catastrophic plans however
_points along _meridians exists on the human body, according to classic _
-361 points -14 meridians -acupuncture theory
a survey conducted by the NCCAM and the National Center for Health Statistics (NCHS; part of the Centers for Disease Control and Prevention) revealed that _% of adults use some form of CAM
-38%
according to the Institute of Medicine, as many as_people die in US hospitals each year as the result of medical errors
-44,000 to 98,000
Medicare covers _% of Americans over age 65, all totally and permanently _, and all people with _. together, these groups comprise over_.BY 2030, it is estimated that _Americans will be insured by Medicare
-99% -permanently disabled people (after a waiting period) -end-stage kidney failure -these groups comprise over 45 million people, or 1 in 7 Americans -1 in 5 or 7 million Americans will be insured by Medicare
how ACA will help quality problems?
-ACA is intended to improve the quality of health care in the United States -As a first step, in 2011, the Department of Health and Human Services released to Congress a National Strategy for Quality Improvement in Health Care -Its priorities include a new emphasis on promoting the safest, most preventive, and most effective care, increased communication and coordination among providers, and ensuring that patients and families are engaged as partner in their care
explain regarding how racial and ethnic minorities are overly represented in the number of uninsured Americans. what contributes to this?
-Almost a 1/3 of all Hispanic Americans are uninsured compared to 18.7% of African Americans and 11.5% of whites -issues such as citizenship and language barriers contribute to some of the disparities in access to health insurance for many in our country
how often is allopathic medicine used?
-Among the US health care providers, the majority currently receives conventional medical training and treats patients using conventional medicine
mind-body medicine
-CAM domain -techniques designed to enhance the mind's ability to affect bodily functions and symptoms
manipulative and body-based practices
-CAM domain -treatments involving manipulation or movement of one or more body parts -includes methods that are based on manipulation or movement of the body
practices of CAM are under the different _
-CAM domains
how CAM therapies vary?
-CAM therapies vary widely in terms of the nature and extent of the treatment and the types of problems for which they offer help -they also vary in effectiveness -research has shown some to be ineffective, whereas others simply have not been studied, and others have limited research evidence supporting their effectiveness. a search of the NCCAM website reveals that, even for some of the most mainstream CAM therapies, such as acupuncture, message therapy, and yoga, the studies of effectiveness for pain and other conditions are, as yet, inconclusive
assessing health professionals. when evaluating health care providers, consider the following questions:
-Do they listen to you, respect you as an individual, and give you time to ask questions? Do they return your calls, and are they available to answer questions between visits? -what professional education and training have they had? what license or board certification(s) do they hold? Note that there is a difference between "board certified" and "board eligible" physicians -Are they affiliated with an accredited medical facility or institution? (ex: The Joint Commission) Accreditation requires that these institutions verify all education, licensing, and training claims of their affiliated practitioners -Are they open to complementary or alternative strategies? Would they refer you for different treatments if appropriate? -Do they indicate clearly how long a given treatment may last, what side effects you might expect, and what problems you should watch for? -Who will be responsible for your care when your physician is on vacation or off call? -Are there professional reviews and information on any lawsuit against them available online?
list common herbs and herbal supplements
-Echinacea -Flaxseed -Ginkgo -Ginseng -Green tea *for benefits, research findings, and potential risks see page 560 table 18.2*
who regulates food labels? when test foods?
-FDA regulates claims on food labels; however, the FDA does not test functional foods prior to their coming to the marker and can only remove a product from the market if it is found to be unsafe
how employed workers in companies that pay their health insurance pay their premiums?
-For workers employed in organizations that offer health care insurance, most of this cost (in premiums) is hidden: the worker pays 15% to 25% of the full premium, usually as a deduction from his or her paycheck, and earns lower wages in return for the remaining cost of the coverage
how number of Americans uninsured have changed? why?
-In recent decades, the number of Americans without health insurance rose dramatically as people with preexisting conditions, self-employed, and low-wage workers in businesses that don't offer group plans found themselves unable to obtain or afford coverage
precautions to take about consumer protection of food and dietary supplements? (how you can get informed)
-It is important to gather whatever information you can on both the safety and efficacy of any CAM treatments you are considering -in the case of functional foods and dietary supplements, start your own research with NCCAM and the Cochrane Collaboration's review on complementary and alternative medicine
As the costs of medical care have continued to increase, Medicare has _. As a result, some providers_
-Medicare has placed limits on the amount of reimbursement to providers -As a result, some providers no longer accept Medicare patients
examples of placebos experiments
-One study involved patients with Parkinson's disease. The patients who thought that they were receiving a placebo had the same changes in their brains on PET scans as those who received medication -similar chemical changes on brain imaging tests were seen with placebos in studies of pain and depression -a sample of alcohol-dependent patients received either the drugs naltrexone or acamprosate, or a placebo, for a period of 12 weeks. They were also asked whether they thought they were receiving active medication or a placebo. Those who believed they had been taking medication consumed fewer alcoholic drinks and reported less alcohol dependence and cravings, regardless of whether they really were receiving the drug
wallet biopsy (access problem)
-Otis W. Brawley, Chief Medical Officer for the American Cancer Society, uses the term "wallet biopsy" to describe the assessment a physician makes of a patient's (or his or her insurance complany's) ability to pay for prescribed tests and procedures -patients with excellent insurance coverage may then be encouraged to undergo expensive tests and treatments (a practice that can lead to useless or even harmful overtreatment), whereas patients with poor insurance may not be informed of the full variety of diagnostic and treatment options
why should all Americans be concerned about those who are uninsured and underinsured?
-People without adequate health care coverage are less likely than other Americans to have their children immunized, seek early prenatal care, obtain annual blood pressure checks and other screenings, and seek attention for symptoms of health problems -experts believe that this ultimately leads to higher system costs because their conditions go undetected at their earliest, most treatable stage, deteriorating to a more debilitating and costly stage before they are forced to seek help, often in an emergency room -because emergency care is far more expensive than clinic care, uninsured and underinsured patients are often unable to pay, and the cost is absorbed by "the system" in the form of higher hospital costs, insurance premiums, and taxes
types of massage therapy
-Swedish massage -deep tissue massage -sport massage -trigger point massage (also called pressure point massage) -shiatsu massage -other varieties include massage of specific body parts, such as the feet or fingers, application of hot rocks, water massage, or other techniques. -reiki, shiatsu, qi gong, and therapeutic touch
who was Marcus Welby MD?
-TV doctor was famous for taking a personal interest in his patients
To avoid problems with over-the-counter medication (OTC) what FDA developed?
-The FDA has developed a standard label that appears on most OTC products -it includes directions for use, active and inactive ingredients, warnings, and other useful information
what a primary care practitioner (PCP) can be for some people?
-The PCP for most people is a family practitioner, an internist, or for women, an obstetrician-gynecologist (ob-gyn) -many people routinely see nurse practitioners or physician assistants who work for an individual doctor or a medical group, and others use nontraditional providers as their primary source of care
problem of including more things within insurances? solution?
-These payment mechanisms laid the groundwork for today's steadily rising health care costs -Hospitals were reimbursed for the costs of providing care plus and amount for profit -this system provided no incentive to contain costs, limit the number of procedures, or curtail capital investment in redundant equipment and facilities -physicians were reimbursed on a fee-for-service (indemnity) basis determined by "usual, customary, and reasonable" fees -this system encouraged physicians to charge high fees, raise them often, and perform as many procedures as possible -until the mid to late twentieth century, most insurance did not cover routine or preventive services, and consumers generally waited until illness developed to see a doctor instead of seeking preventive care -consumers were also free to choose any provider or service they wished, including even inappropriate (and often very expensive) levels of care -solution: private insurance companies
what diagnosis-related groups (DRGs) for Medicare motivates the hospitals to do?
-This system motivates hospitals to discharge patients quickly, to provide ambulatory care, and to admit patients classified into the most favorable (profitable) DRGs
training for acupuncture
-US acupuncturists are state licensed, and most have completed a 2- to 3- year postgraduate program to obtain a master of traditional Oriental medicine (MTOM) degree
how allopathic medicine related to chiropractic medicine. how this applies to insurance?
-a century ago, allopathic medicine and chiropractic medicine were in direct competition -today, however, many health care organizations work closely with chiropractors, and many insurance companies will pay for chiropractic treatment, particularly if it is recommended by a medical doctor
qigong
-a component of traditional Chinese medicine -combines movements, meditation, and regulation of breathing to enhance the flow of vital energy (qi), improve blood circulation, and enhance immune function
medicare
-a federal health insurance program that covers people age 65 and older, the permanently disabled, and people with end-stage kidney disease -federal insurance program that covers a broad range of services except long-term care
Medicaid
-a federal-state matching funds program that provides health insurance to low-income people -gives aid to people who are defined as poor. -provides health insurance for people defined as low-income, including many who are blind, disabled, elderly, pregnant, or eligible for Temporary Assistance for Needy Families (TANF)
Point of Service (POS) plans
-a hybrid of HMO and PPO plans -provide a more familiar form of managed care for people used to traditional indemnity insurance, which may explain why it is among the fastest growing of managed care plans
Even if care providers and facilities are only a few miles away, not all Americans have equal access to them. a key disparity is _
-a key disparity is the quality of the patient's health insurance plan
primary care practitioner (PCP)
-a medical practitioner who treats routine ailments, advises on preventive care, gives central medical advice, and make appropriate referrals when necessary
Physician assistants (PAs)
-a midlevel practitioner trained to handle most standard cases of care under the supervision of a physician -are licensed to examine and diagnose patients, offer treatment, and write prescriptions under a physician's supervision - are practitioners that competently care for patients seeking primary care.
managed care describes a health care delivery system consisting of the following elements:
-a network of physicians, hospitals, and other providers and facilities linked contractually to deliver comprehensive health benefits within a predetermined budget, sharing economic risk for any budget deficit or surplus -a budget based on an estimate of the annual cost of delivering health care for a given population -an established set of administrative rules requiring patients to follow the advice of participating health care providers in order to have their health care paid for under the terms of the health plan
when to seek help. You should consult a physician if you experience any of the following:
-a serious accident or injury -sudden or severe chest pains, especially if they cause breathing difficulties -trauma to the head or spine accompanied by persistent headache, blurred vision, loss of consciousness, vomiting, convulsions, or paralysis -Sudden high fever or recurring high temperature (over 102 degree F for children and 103 degree F for adults) and/or sweats -tingling sensation in the arm accompanied by slurred speech or impaired thought processes -Adverse reactions to a drug or insect bit (shortness of breath, severe swelling, dizziness) -Unexplained sudden weight loss -Persistent or recurrent diarrhea or vomiting -Blue-colored lips, eyelids, or nail beds -Any lump, swelling, thickness, or sore that does not subside or that grows for over a month -Any blood in the stool or urine, or significant pain or marked, persistent change in bowel or bladder habits -Yellowing of the skin or the whites of the eyes -Any symptoms that is unusual and recurs over time -Pregnancy
dermabrasion
-a surgical scraping of the top layers of the skin to remove fine wrinkles, acne scars, and skin growths
Within self-care, what are some at-home tests?
-a vast array of at-home kits are now available to test for pregnancy, allergies, HIV, genetic disorders, and many other conditions
three key issues facing today's health care system
-access: access to providers, facilities, and treatments; access to quality of health insurance. -cost -quality
explain the the mechanism employed by private health insurance company: co-payments
-are set amounts that you pay per service or product received, regardless of the total cost (ex:$20 per doctor visit or per prescription filled)
how can you open a FSA or an HSA?
-as long as you are not claimed as a dependent on someone else's tax return, you can open one, either an FSA through your employer or an HSA through your bank
how much cost in insurance companies vs medicare? what this causes?
-according to the health insurance association of America, commercial insurance companies commonly experience administrative costs greater than 10% of the total health care insurance premium, whereas the administrative cost of the government's medicare programs less than 4% -these administrative expenses contribute to the high cost of health care and force companies to require employees to share more of the costs, cut back on benefits, and drop some benefits altogether -these costs are largely passed on to consumers in the form of higher prices for goods and services
list name of drug of common over-the-counter drugs
-acetaminophen -antacids -anticholinergics -antihistamines -aspirin -decongestants -diet pills, caffeine -expectorants -ibuprofen -laxatives -naproxen sodium -sleep aids and relaxants
_are two therapies within traditional Chinese medicine based on the belief that _
-acupuncture and acupressure -based on the belief that vital energy flow through meridian channels in the body
what is one of the most popular traditional Chinese medicine (TCM) therapies?
-acupuncture is one of the oldest and most popular TCM therapies
problems with prescription drugs
-adverse effects and complications arising from the use of prescription drugs are common, as is failure to respond to a medication
list types of bodywork
-alexander technique -feldenkrais method -rolfing structural integration -pilates -trager approach
explain the the mechanism employed by private health insurance company: exclusions
-all insurers set some limits on the type of covered services (ex: most exclude cosmetic surgery, private rooms, and experimental procedures)
what is allopathic medicine based on?
-allopathic medicine is based on the premise that illness is a result of exposure to pathogens, such as bacteria and viruses, or organic changes in the body
diagnosis in Homeopathy
-although homeopathic physicians do use certain standard remedies for certain conditions, they also classify patients by type and work within eahc patient's type to heal ever-deeper layers of disturbance
many consumers choose to have prescriptions filled online. problem with this? precautions?
-although many websites are operating legally and observe the safeguards of traditional procedures for dispensing drugs, some sell counterfeit drugs of inconsistent quality or sidestep required consumer protection -if you buy medications online, buy only from state-licensed pharmacy sites based in the United States. -Look for sites with the Verified Internet Pharmacy Practice Sites (VIPPS) seal, awarded by the National Association of Boards of Pharmacy (NABP) to Internet pharmacy sites that meet their criteria -Don't provide any personal health or financial information, including a Social Security number, unless you are sure the website will keep your information safe and private
why people are worried about consumer protection regarding food and dietary supplements?
-although particular products, such as chocolate or zinc lozengers, have been widely studied, there is little quality research to support the claims of many others -dietary supplements can currently be sold without FDA approval. this raises issues of consumer safety. even when products are dispensed by CAM practitioners, the situation can be risky -some homeopaths and herbalists who mix their own tonics may not use standardized measures. lack of standard regulation means that some unskilled and untrained people may be treating patients without fully understanding the potential chemical interactions of their preparations -products sold in "health food" stores and over the Internet may have varying levels of the active ingredient or may contain additives to which the consumer may have an adverse reaction
how over-the-counter drugs are used?
-although physicians often recommend OTC remedies to patients for common conditions such as muscle pain or constipation, OTC drugs are also used in the course of self-diagnosis and self-treatment -American consumers spend billions of dollars yearly on OTC preparations for relief of everything from runny noses to ingrown toenails
how Preferred Provider Organizations (PPOs) are compared to HMOs?
-although they offer greater choices in doctors than HMOs do, they are less likely to coordinate a patient's care -members may choose to see doctors who are not on the preferred list, but this choice may involve having to pay a higher percentage of the cost of care
who and where elective surgeries are done?
-an elective surgical procedure is typically performed by a surgeon or qualified physician in either a hospital or an ambulatory center -some simple, minimally invasive procedures may even be performed in a doctor's office -the type of surgery will mandate the qualifications and background of the surgeon or physician who performs it
difference between physician assistant and nurse practitioner?
-an important difference between a PA and a NP is that the PA must practice under a physician's supervision
traditional chinese medicine (TCM)
-ancient comprehensive system of healing that uses herbs, acupuncture, and massage to bring the body into balance and to remove blockages of vital energy flow that lead to disease -the concept of qi, or vital energy, is foundational to it
types of prescription drugs
-antidepressants and antianxiety drugs -hormonal contraceptives -weight-loss aids -smoking-cessation aids -stimulants and sedatives -antibiotics -statins and other cholesterol-lowering drugs
The AP's investigated team found traces of drugs in 24 metropolitan areas out of 62 major water systems it checked, and we are talking about all kinds of medications:
-antidepressants, antibiotics, heart medicine
as a result of consumer safety concerns, pressure has mounted to establish an _
-approval process for dietary supplements similar to the process that FDA uses for drugs
Preferred Provider Organizations (PPOs)
-are networks of independent doctors and hospitals that contract to provide care at discounted rates
problem with treatment used in allopathic medicine
-be aware, however, that not all allopathic treatments have had the benefit of the extensive clinical trials and long-term studies of outcomes that would be necessary to conclusively prove effectiveness in different populations -even when studies appear to support the health benefits of a particular treatment or product, other studies with equal or better scientific validity often refute these claims -Also, today's recommended treatment may change dramatically in the future as new technologies and medical advances replace older practices
problems with generic drugs
-be aware, though, that there is some controversy about the effective of generic drugs, because substitutions sometimes are made in minor ingredients that can affect the way the drug is absorbed, potentially causing discomfort or even allergic reactions in some patients -always note any reactions you have to medications and tell your doctor about them
before considering CAM therapies, what you should do? precautions
-before considering any treatments, consult reliable resources to thoroughly evaluate risks, the scientific basis of claimed benefits, and any contraindications to using the product or service -Avoid practitioners who promote their treatments as a cure-all for every health problem or who seem to promise remedies for ailments that have thus far defied the best scientific efforts of mainstream medicine -in short, apply the same strategies to researching CAM as you wold to choosing allopathic care
what to do with old medicines?
-before used to say flush them in water -now they are saying to put them in a plastic bag or old jar or bottle, put some water, coffee grounds or used mulch. something to make it unappealing to animals, teenagers, etc, and then throw it in the trash.
many therapies fall under the mind-body medicine category, but some, such as _have been so well investigated that they are no longer considered alternative
-biofeedback and cognitive-behavioral tehcniques
explain the domain of complementary and alternative medicine (CAM): biologically based practices
-biologically based practices use substances found in nature (such as herbs), special diets, or vitamins (in dosses outside those used in conventional medicine)
board eligible physician
-board eligible merely means that the physician is eligible to take specialty board's exam, but not necessarily that he or she has passed it
benefits of yoga and meditation
-both of them decrease stress hormones, cortisol, and epinephrine. having these two hormones over time result in cellular inflammation, which is the beginning of most disease processes. -in the case of lung cancer, yoga helps you breath better and get more oxygen in -meditation, you realize you are not your pain. you are not even your body. you expand your consciousness and that changes you biochemically.
cost problem: how much we spend in health care? how this will change?
-both per capit a and as a percentage of gross domestic product (GDP), we spend more on health care than any other nation -In 2011, our national health expenditures reached $2.7 trillion, over $8,600 for every man, women, and child. This translates into 17.9% of our GDP -Consider that health care expenditures are projected to grow by 6.2% each year, reaching over $4.7 trillion annually by 2021, nearly 20% of our projected GDP
acupressure
-branch of traditional Chinese medicine related to acupuncture -uses application of pressure to selected body points to balance energy -the practitioner uses deep massage of particular points on the body that correspond with the organs or body systems that are not functioning properly.
acupuncture
-branch of traditional Chinese medicine that uses the insertion of long, thin needles to affect flow of energy (qi) along pathways (meridians) within the body
list common types of cosmetic surgery
-breast augmentation -liposuction -rhinoplasty -dermabrasion -rhytidectomy
explain the benefit of the functional food: plant stanols/sterols
-can lower "bad" (low-density lipoprotein (LDL)) cholesterol
explain the benefit of the functional food: oat fiber
-can lower LDL cholesterol -serves as a natural soother of nerves -stabilizes blood sugar levels
explain the benefit of the functional food: sunflower seeds and oil
-can lower risk of heart disease -may prevent angina
what hospitals have been using more alternative complementary techniques?
-cancer hospitals
many managed care plans pay their contracted health care providers through _. (list others)
-capitation -some plans pay health care providers a salary, and some are still fee-for-service plans
problems with at-home tests (self-care methods)
-caution is in order here: although many of these devices are valuable for making an initial diagnosis, others are not valid or reliable -moreover, home health tests are not substitutes for regular, complete examinations by a trained practitioner
list health care reform: what happens this year?
-children on family plan until 26 -cover kids with pre-existing conditions -insurance must cover preventive care -help seniors pay for prescription drugs -no drop from coverage when you get sick -no lifetime caps on coverage
list types of manipulative and body-based practices
-chiropractic medicine -massage therapy -bodywork
what idea chiropractic medicine is based?
-chiropractic medicine is based on the idea that a life-giving energy flows through the nervous system, including the spinal cord -if the spine is partly misaligned or dislocated, that force is disrupted
treatment in chiropractic medicine
-chiropractors use a variety of techniques to manipulate the spine back into proper alignment so the energy can flow unimpeded
Common forms (types) of self-care include the following
-diagnosing symptoms or conditions that occur frequently but may not require physician visits (ex: common cold, minor abrasions) -Using over-the-counter remedies to treat mild, infrequent, and unambiguous pain and other symptoms -Performing first aid for common, uncomplicated injuries and conditions -checking blood pressure, pulse, and temperature -performing monthly breast or testicular self-examinations -doing periodic checks for blood glucose, cholesterol, or other levels as prescribed by a physician -Learning from reliable self-help books, websites, and DVDs -Performing meditation and other relaxation techniques -Maintaining a healthful diet, getting adequate rest, and exercising
how diagnosis is done by traditional chinese medicine (TCM)
-diagnosis is based on personal history, observation of the body (especially the tongue), palpation, and pulse diagnosis, an elaborate procedure requiring considerable skill and experience by the practitioner
Assessing your health professional. Questions to ask yourself about the quality of care you are receiving include the following:
-did your health care provider take a throughout health history and ask for any recent updates to your health history? was your examination throughout? -Did your health care provider listen to you? -Did you feel comfortable asking questions? Did your health care provider answer thoroughly, in a way that was easy to understand? Did he or she admit to not knowing an answer to your question when appropriate? -Would you feel comfortable seeing the health care provider again?
techniques and treatment in ayurveda
-dietary modification and herbal remedies drawn from the botanical wealth of the Indian subcontinent are common -dietary changes and herbal remedies, including tinctures, which are mixtures of herbs in alcohol that tend to be milder than our prescription or over-the-counter drugs. -treatments may also include certain yoga postures, meditation, massage, steam baths, changes in sleep patterns and sun exposure, and controlling breath
what is part of the CAM domain of biologically based practices?
-dietary products -functional foods -herbal remedies and other dietary supplements
when not to try telemedicine or medical website?
-do not use them if you have a pressing condition that cannot wait 24 hours
what are incentives for doctors in managed care plans? what is capstone component of managed care plans?
-doctors have the incentive to keep their patient pool healthy and avoid catastrophic ailments that are preventable; usually such incentives come back in terms of increased salaries, bonuses, and other benefits -as such, prevention and health education to reduce risk and intervene early to avoid major problems are often capstone components of such plans
training of doctors
-doctors undergo rigorous training before they can begin practicing -after 4 years of undergraduate work, students typically spend 4 years studying for their medical degree (MD) -After this general training, some students choose a specialty, such as pediatrics, cardiology, cancer, radiology, or surgery, and spend 1 year in an internship and several years doing a residency -some doctors receive additional training in order to specialize in certain elective surgeries -some specialties also require a fellowship; in all, the time spent in additional training after receiving a medical degree can be up to 8 years
why was Patient Protection and Affordable Care Act (ACA) created?
-does not provide for a system of national health care but is merely a set of initial steps toward increasing the number of insured Americans -reforms mandated by ACA are currently being implemented
why are America's health care costs so high? list factors
-duplication of services -an aging population -growing rates of obesity, inactivity, and related health problems -demand for new diagnostic and treatment technologies -an emphasis on crisis-oriented care instead of prevention -physician overtreatment,whether to avoid malpractice suits or to increase income -inappropriate use of services by costumers, including use of emergency services for routine care, and family demands for futile and expensive procedures for patients who are dying
there is a website to consult doctors online, what is the name? how they did?
-eDocAmerica -LivePerson -JustAnswer -they fail to diagnose the correct illness because they lacked the physical examination
what are elective surgeries? why needed?
-elective medical procedures are surgeries and treatments that are planned, nonemergency procedures -although not considered medically necessary, many types of elective procedures, from musculoskeletal to weight loss surgeries, greatly improve people's health and functioning, and some can reduce the patient's risk for chronic disease -even purely cosmetic surgeries can enhance the patient's self-esteem
explain the domain of complementary and alternative medicine (CAM): energy medicine
-energy medicine involves the use of energy fields, such as magnetic fields or biofields (energy fields that some believe surround and penetrate the human body)
how wise consumer uses prescription drugs? what is a source of information for consumer?
-even though these drugs are administered under medical supervision, the wise consumer still takes precautions -consumers have a variety of resources available to determine the risks of various prescription medicines and to make educated decisions about whether to take a certain drug -one of the best resources is the FDA's Center for Drug Evaluation and research website. This consumer-specific section of the FDA website provides current information on risks and benefits of prescription drugs -being knowledgeable about what you are taking or thinking about taking is a sound strategy to ensure safety
evidence-based practice
-evidence-based medicine -decisions regarding patient care based on clinical expertise, patient values, and current best scientific evidence
Researchers are investigating how and why placebos work on some people. one theory is that _
-expecting a positive outcome activates the same natural pathways in the brain as some medications doo
Key provisions of ACA aim to increase access to quality health insurance among Americans. These include the following:
-insurers are now required to cover several preventive services, such as health screenings for cancer, blood glucose, and blood pressure -Insurers are required to cover young adults on a parent's plan through age 26 -As of 2014, Americans with preexisting conditions cannot be denied coverage -Both annual and lifetime limits on benefits will be phased out by 2014 -as of 2014, Affordable Insurance Exchanges (AIEs) will facilitate consumer shopping and enrollment in plans with the same kinds of choices that members of Congress have. ex: give New England States are currently working to create an AIE intended to use its buying power to increase access to affordable coverage to New England residents -Small businesses, which typically paid as much as 18% more than large businesses for health insurance coverage for their employees, now qualify for special tax credits to help fund insurance plans
rolfing structural integration
-is a form of bodywork that reorganizes the connective tissues to release tension , balance the body, and alleviate pain -the therapist applies firm-sometimes painful-pressure to different areas -this process can release repressed emotions as well as dissipate muscle tension
alexander technique
-is a movement education method designed to release harmful tension in the body to improve ease of movement, balance, and coordination
pilates
-is a popular exercise method focused on improving flexibility, strength, and body awareness -it involves a series of controlled movements,some of which are performed using special equipment
feldenkrais method
-is a system of gentle movements and exercises -it is designed to improve movement, flexibility, coordination, and overall functioning through techniques that enhance awareness and retrain the nervous system
explain the massage therapy type: shiatsu massage
-is a traditional healing art from Japan that applies firm finger pressure to specified points on the body that are believed to be important for the flow of vital energy
trager approach
-is also known as psychophysical integration or mind.body integration -one aspect employs gentle, shaking motions of the patient's limbs in a rhytmic fashion to induce states of deep, pleasant relaxation
placebo effect
-is an apparent cure or improved state of health brought about by a substance, product, or procedure that has no generally recognized therapeutic value -patients often report improvements in a condition based on what they expect, desire, or were told would happen after receiving a treatment, even though the treatment was, for example, simple sugar pills instead of powerful drugs
therapeutic touch
-is based on the premise that the therapist has the ability to perceive, through his or her hands held just above the patient's body, imbalances in the patient's energy -The therapist promotes healing by increasing the flow of the body's energies and bringing them to balance
explain the massage therapy type: sport massage
-is performed to prevent athletic injury and keep the body flexible -ti is also used to help athletes recover from injuries
message therapy
-is soft tissue manipulation by trained therapist for relaxation and healing
explain the the mechanism employed by private health insurance company: coinsurance
-is the percentage of costs that you must pay based on the terms of the policy (ex: 20% of the total bill)
how patients react to acupuncture? (benefits of acupuncture)
-is used to relieve a wide variety of health conditions, from musculoskeletal dysfunction to depression -following acupuncture, most participants in clinical studies report high levels of satisfaction with the treatment, improved quality of life, improvement in or cure of the condition, and reduced reliance on prescription drugs and surgery -results have been promising in the treatment of nausea associated with chemotherapy, headaches, fibromyalgia, and low back pain
chiropractic medicine treatment is effective for _
-it has been established that chiropractic treatment can be effective for back pain, neck pain, and headaches
massage benefits
-it has been shown to increase immunity in a study of breast cancer patients -helps with sleep -decreases stress hormones -relaxes muscles -balances the sympathetic and parasympathetic nervous systems so that the healing response, which is innate, can come to the surface
what questions should I ask my health care provider about proposed tests, treatments, or medications?
-it is important to understand recommendations that your health care provider makes -Questions to ask include how often the practitioner has performed the procedure, the proportion of successful outcomes for the treatment or procedure, any side effects and whether they can be treated or reduced, whether a hospital stay will be required, and why a test has been ordered
who developed Homeopathy?
-it was developed in the late 1700s by Samuel Hahnemann, a German physician, as an approach to medicine that was not as harsh as other treatments of the time, such as bloodletting and blistering
critical for responsible consumerism (health care consumer) responsible health care
-knowing the benefits and limits of self-care -making wise decisions about providers -making wise decisions about medications
what lasik stands for?
-laser-assisted in situ keratomileusis
list common elective surgeries
-lasik -cosmetic surgery
list key indicators of quality
-life expectancy -infant mortality rate
training of physician assistant
-like other health care providers, PAs are licensed by state boards of medicine
how good are medical doctors that use allopathic medicine?
-like other professionals, medical doctors are only as good as their training, continued acquisition of knowledge, and resources
explain the the mechanism employed by private health insurance company: upper limits on payments
-some insurance plans also imposed an annual upper limit or lifetime limit, after which coverage would end -the ACA makes this practice illegal as of 2014
what actions produce an immune system dysfunction? how solve this?
-many researchers have postulated that excessive stress and maladaptive coping can lead to immune system dysfunction and increase the risk of disease -scientists are exploring ways in which relaxation, biofeedback, meditation, yoga, tai chi, and activities that involve either conscious or unconscious mind "quieting" may counteract negative stressors -ex: a recent revie of PNI found that psychological support (including relaxation therapies) can improve wound healing, whereas inflammatory molecules such as C-reactive protein, which is a risk factor for heart disease, were found to be reduced in olrder adults after 16 weeks of tai chi -studies have also shown promising positive effects of mind-body techniques that encourage relaxation and other stress-reduction strategies for people with cancer
where massage therapists work?
-massage therapists work in an array of settings both private and public: medical and chiropractic offices, studios, hospitals, nursing homes, fitness centers, and sports medicine facilities
massage techniques are important for what whole medical systems or alternative medical systems?
-massage therapy techniques are important aspect of both traditional chinese medicine and ayurvedic medicine
explain the benefit of the functional food: soy protein
-may lower heart disease risk by reducing LDL cholesterol and triglycerides
explain the benefit of the functional food: ginger
-may prevent motion sickness, stomach pain, and stomach upset -discourages blood clots -may relieve rheumatism
list government-funded programs
-medicare -medicaid
over-the-counter drugs (OTC)
-medications available without a prescription
generic drugs
-medications marketed by chemical names rather than brand names -sold under a chemical name rather than brand name, contain the same active ingredients as brand-name drugs but are less expensive
types of mind-body medicine
-meditation -yoga -tai chi -certain uses of hypnosis -dance, music, and art therapies -prayer
In case of yoga and meditation, we are in embryonic stage of the understanding of the connection between _, but these techniques do cause_. the original study of the relaxation response demonstrated _. Thus, there are connection between_
-mind and body -physiological changes. -demonstrated lower blood pressure -between what we think of as mind or mental and body or physiological
explain the domain of complementary and alternative medicine (CAM): mind-body medicine
-mind-body medicine uses a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms
In 2010, the average family's annual health insurance premium was more _
-more than $13,000
what groups are more likely to have used CAM?
-more women than men -people with higher educational levels -people who have been hospitalized in the past year -former smokers (compared with current smokers or those who have never smoked) -people with back, neck, head, or joint aches or other painful conditions -people with gastrointestinal disorders or sleeping problems
10 most common CAM therapies
-natural products (17.7%) -deep breathing -meditation -chiropractic and osteopathic -massage -yoga -diet based therapies -progressive relaxation -guided imagery -homeopathic treatment *to see percentages see page 554 figure 18.3*
treatment in naturopathy
-naturopathy physicians emphasize restoring health rather than curing disease -They employ an array of healing practices, including diet and clinical nutrition; homeopathy; acupuncture; herbal medicine; hydrotherapy (the use of water in a range of temperatures and methods of application); spinal and soft-tissue manipulation; physical therapies involving electric currents, ultrasound, and light therapy; therapuetic counseling; and pharmacology
explain how diagnosis-related groups (DRGs) works (Medicare)
-nearly 500 groupings were created to establish how much a hospital would be reimbursed for caring for a patient diagnosed with a particular condition or combination of conditions -DRGs are based on the assumption that patients with similar health status and conditions will require a similar amount of hospital resources -If the costs of treating a patient are less than the predetermined amount, the hospital can keep the difference. However, if a patient's care costs more than the set amount, the hospital must absorb the difference (with a few exceptions that must be reviewed by a panel)
does insurance cover CAM?
-nearly all health insurance providers cover at least one form of CAM, with acupuncture, chiropractic, and massage therapy being the most common -However, people who choose CAM often must pay the full cost of services themselves
major changes due to health care reform in 2014
-nearly all required to get insurance -new exchanges for businesses, uninsured (small businesses with 50 employees will have to get insurance or pay a fine) -coverage for pre-existing conditions -insurance tax credits for middle class
how the United States ranks in quality?
-nevertheless, although our health care spending far exceeds that of any other nation, we rank far below many other nations in key indicators of quality
what to do when a doctor prescribes a drug? (related to generic drugs)
-not all drugs are available as generics -If your doctor prescribes a drug, always ask if a generic equivalent exists and if it would be safe and effective for you to try
federal Health Care Financing Administration (HCFA)
-now known as the Center for Medicare and Medicaid Services (CMS)
what is the best characteristic of health professional?
-numerous studies document the importance of good communication skills: the most satisfied patients are those who feel their health care provider explains diagnosis and treatment options thoroughly and involves them in decisions regarding their own care
additional degrees that nurses and nurse practitioners can earn
-nurses and nurse practitioners may also earn the clinical doctor of nursing degree (ND), doctor of nursing science (DNS and DNSc degrees), or research-based PhD in nursing
how placebos are sued for clinical research studies?
-placebos are used in clinical research studies -patients with a particular condition are given either the treatment that is being tested or a placebo. If a significant greater number of patients receiving the treatment have a significantly more beneficial outcome than the patients receiving the placebo, then the treatment can be considered effective -Most such studies are double-blinded; that is, neither the patients nor the doctors involved in the study are told until the study ends who had the real treatment and who had the placebo
why pay a premium to insurance? how health insurance works?
-policyholders pay premiums into a pool of funds, from which insurance companies pay claims -when you are sick or injured, the insurance company pays your care provider out of the pool regardless of your total contribution -depending on circumstances, you may never pay for what your medical care costs, or you may pay much more for insurance than your medical bills ever total -the idea is that you pay affordable premiums so that you never have to face catastrophic bills
postoperative complications of lasik
-postoperative complications can include infection or night glare (starbusts or halos that appear when you are viewing lights at night)
capitation
-prepayment of a fixed monthly amount for each patient without regard to the type or number of services provided
how prescription drug use have changed?
-prescription drug use has rise by 25% over the past decade
list conventional health products
-prescription drugs -over-the-counter (OTC) drugs
difference between prescription drugs and over-the-counter (OTC) drugs
-prescription drugs can be obtained only with a written prescription from a physician, whereas over-the-counter drugs can be purchased without a prescription
List conventional health care practitioners (practice allopathic medicine)
-primary care practitioner (PCP) -doctors -osteopaths -ophthalmologist -optometrist -dentist -nurses -nurse practitioners (NPs) -physician assitants (PAs)
nurse practitioners (NPs)
-professional nurse with advanced training obtained through either a master's degree program or a specialized nurse practitioner program -nurse practitioners have the training and authority to conduct diagnostic tests and prescribe medications (in some states)
The United States has several mechanisms for ensuring quality services:
-providers are assessed according to education, licensure, certification/registration, accreditation, peer review, and the legal system of malpractice litigation -over-the-counter (OTC) and prescription medications, as well as medical devices, must be approved by the Food and Drug Administration -Insurance companies and government payers may also require a higher level of quality by linking payment to whether a practitioner is board certified, a facility is accredited, or a treatment is an approved therapy -In addition, most insurance plans now require prior authorization and/or second opinions, not only to reduce costs but also to improve quality of care
parts of over-the-counter medicine label (OTC)
-purpose -active ingredients -uses -warnings -directions -other information -inactive ingredients
list popular types of biofield therapy (energy medicine)
-qigong -Reiki -therapeutic touch -acupuncture -acupressure
_are overly represented in the number of uninsured Americans
-racial and ethnic minorities
references to massage have been found in what cultures?
-references to massage have been found in ancient writing from many cultures, including those of ancient Greece, ancient Rome, Japan, China, Egypt, and the Indian subcontinent
types of nurses
-registered nurses (RNs) -Lower-level licensed practical or vocational nurses (LPN or LVN) -nurse practitioners
many private health insurance companies have also adopted _
-reimbursement rates based on diagnosis-related groups (DRGs)
holistic
-relating to or concerned with the whole body and the interactions of systems, rather than treatment of individual parts -CAM therapies uses holistic approach to medicine that focuses on treating the whole person, rather than just an isolated part of the body -From the holistic point of view, disease itself is believed to be the result of the body's effort to protect itself from the environment, and a signal to us that we need to make changes in our lifestyle and coping mechanisms to genuinely recover.
psychoneuroimmunology (PNI)
-relative new field of study -the PNI research society defines it as the "study of interrelationships among behavioral, neural, endocrine, and immune processes" -That there is a clear link between how we feel emotionally and how well our immune system functions.
what process could help to reduce amount of pharmaceuticals in water supply?
-reverse osmosis but it is very expensive
In addition to asking the suggested questions above, being proactive in your health care also means that you should be aware of your _
-right as a patient
example of complementary medicine
-seeing a doctor for a pinched nerve who also recommends that you get chiropractic treatment is complimentary treatment. -use massage therapy along with prescription medicine to treat anxiety
what is bodywork?
-several body-covered modalities fall into the category of bodywork
training in naturopathy
-several major naturopathic schools in the US and Canada provide training, conferring the naturopathic doctor (ND) degree on students who have completed a 4-year graduate program that emphasizes humanistically oriented family medicine
list diseases ad conditions for which CAM is most frequently used among adults
-severe headache or migraine -neck pain -back pain (17.1%) -joint pain -insomnia -head or chest cold -cholesterol -anxiety -arthritis -other musculoskeletal *to see percentages see page 553 figure 18.2*
no matter what type of plan you are in, a _could save you money
-special savings account for health-related expenses could save you money
ayurveda (ayurvedic medicine)
-the science of life -a comprehensive system of medicine, derived largely from ancient India, that places equal emphasis on the body, mind, and spirit, and strives to restore the body's inhate harmony through diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing -alternative medical system that has evolved over thousands of years in India -seeks to integrate and balance the body, mind, and spirit, and to restore harmony in the individual -Ayurvedic medicine analyzes your body type, then makes certain recommendations regarding what you should and shouldn't eat.
why should I care about alternative methods?
-the ultimate choice about health care remains with you -in order to make sound decisions about what is best for your health, you need to understand as much as you can about your options
defensive medicine
-the use of medical practices designed to avert the possibility of malpractice suits in the future -an approach to health care in which the practitioner orders tests or treatments, or avoid high-risk patients or procedures, largely to reduce their liability to malpractice suits
training for massage therapy
-there are about 1,500 massage therapy schools, college programs, and training programs in the US -The course of study typically covers subjects such as anatomy and physiology, kinesiology, therapeutic evaluation. massage techniques, first aid, business, ethical, and legal issues, and hands-on-practice -these educational programs vary in length, quality, and whether they are accredited -many require 500 hours of training, which is the same number of hours that many states require for certification -some therapists also pursue specialty or advanced training
what doctor websites say?
-they are not responsible for the advice their experts give -say they are not intended to be substitutes for people's personal doctors -they all recommended testing, which would have resulted in a doctor's visit
how dentists get their certification? (dental degrees)
-they attend dental school for 4 years and receive the title of doctor of dental surgery (DDS) or doctor of medical surgery (DMD) -they must also pass both state and national board examinations before receiving a license to practice
uninsured
-they have no private health insurance and are not eligible for Medicare, Medicaid, or other government health programs
training options for registered nurses (registered nurse degrees)
-they may choose from several training options -registered nurses (RNs) in the United States complete either a 4-year program leading to a bachelor of science in nursing (BSN) degree or a 2-year associate degree program -They must then pass a national certification exam
after diagnosis , what do in ayurveda and goal?
-they then establish a treatment plan, the goal of which is not to cure a specific disorder, but to bring the doshas into balance, thereby reducing the patient's symptoms
works for nurse precitioners
-they work in a variety of settings, particularly in HMOs (health maintenance organizations), clinics, and student health centers
treatment in massage therapy
-this is accomplished by manipulating the muscles and connective tissues to loosen the fibers and break up adhesion, improve the body's circulation, and remove waste products
list common functional foods
-those that contain antioxidants -plant stanols/sterols -oat fiber -sunflower seeds and oil -soy protein -garlic -ginger -yogurt
people have been using herbal remedies for _
-thousands of years
herbal remedies come in several different forms. list them
-tinctures -freeze-dried extracts -standardized extracts
to control hospital costs, what government implemented for Medicare?
-to control hospital costs, in 1983 the federal government set up a prospective payment system based on diagnosis-related groups (DRGs)for medicare -HCFA (known as Center for Medicare and Medicaid services (CMS)) has encouraged to the growth of HMO plans for Medicare-eligible persons
how private insurance companies solved the problem of high health care costs mentioned in the previous flashcard?
-to limit potential losses, private insurance companies began increasingly employing several mechanisms: cost sharing (in the form of deductibles, co-payments, and coinsurance), waiting periods, exclusions, "preexisting condition" clauses, and upper limits on payments
how massage therapy is used today?
-today, massage therapy is used as a means of treating painful conditions, relaxing tired and overworked muscles, reducing stress and anxiety, rehabilitating sport injuries, and promoting general health
where do we spend our health care dollars?
-total expenditures=$2.2 trillion 31.3% of professional services 30.7% hospital care 16.5% government administration and other 12.8% drugs and other medical products 8.7% nursing home and home care
list alternative medical systems (whole medical systems)
-traditional Chinese medicine (TCM) -ayurveda (ayurvedic medicine) -Homeopathy or homeopathic medicine -Naturopathy or naturopathic medicine -Native American, Aboriginal, African, Middle Eastern, and South American cultures also have their own unique alternative medical systems. As the number of alternative therapists grows and systems become intertwined, so do the number of options available to consumers
training for traditional chinese medicine (TCM)
-traditional chinese medicine practitioners within the US must complete a graduate program at a college or university approved by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) -graduate programs vary based on the specific area of concentration within TCM but usually involve an extensive 3- to 4-year clinical internship -in addition, an examination by the National Commission for the Certification of Acupuncture and Oriental Medicine, a standard for licensing in the US, must be completed
nurse
-trained health care professional who provides many services for patients and who may work in a variety of settings -trained health care professionals who provide a wide range of services for patients and their families, including patient education, counseling, community health and disease prevention information, and administration of medications
what accreditation means?
Accreditation requires that these institutions verify all education, licensing, and training claims of their affiliated practitioners
how Affordable Care Act (ACA) will affect Medicaid?
Beginning 2014, the ACA will provide generous federal subsidies to states that expand Medicaid coverage to all Americans living below 133% of the federal poverty level (in 2012, the poverty level was $19,090 for a three-person household) -although states would be responsible for only a small percentage of the funding, some have refused any expansion to their Medicaid programs
CAM
Complementary and alternative medicine (CAM)
briefly describe health maintenance organizations (HMOs)
HMOs provide a wide range of covered health benefits for a fixed amount prepaid by you, the employer, Medicaid, or Medicare. Usually, HMO premiums are the least expensive form of managed care, but also the most restrictive, offering little or not choice of doctors and services. The copayments are usually $10 to $20 per office visit. If there is a downside to HMOs, it is that patients are required to get approval from a "gatekeeper", or primary care physician, for treatment.
Key provisions of ACA aim to _
Key provisions of ACA aim to increase access to quality health insurance among Americans
Perhaps the single greatest difficulty that we face as health care consumers is_
Perhaps the single greatest difficulty that we face as health care consumers is the sheer magnitude of choices available to us.
What is the most restrictive type of managed care? Is it: (a) preferred provider organizations; or (b) health maintenance organizations?
The answer is B - health maintenance organizations. Health maintenance organizations are also the least expensive form of managed care.
Green tea drinkers appear to have lower rates of a) colon cancer or b) heart attacks.
The answer is B - heart attacks.
What is the breakdown of the light sensitive part of the eye called? Is it: (a) clouding of the eye; or (b) macular degeneration?
The answer is B - macular degeneration.
Both chiropractors and osteopaths work primarily with the a) respiratory system or b) musculoskeletal system.
The answer is B - musculoskeletal system.
Who should treat a scratched eyeball? Is it a: (a) optometrist; or (b) ophthalmologist?
The answer is B - ophthalmologist.
example of accredited medical facility or institution?
The Joint Commission is an independent nonprofit organization that evaluates and accredits more than 15,000 health care organizations and programs in the United States.
what nation spends more in health care than any other nation?
The United States
What percent of the population is believed to be exceptionally susceptible to the power of suggestion and may be easy targets for aggressive health marketing? Is it: (a) 10 percent; or (b) 20 percent?
The answer is A - 10 percent. This process uses the placebo effect that offers a cure with a product or procedure that has no recognized therapeutic value.
What is the number of people in the United States without health insurance? Is it: (a) 40 million; or (b) 20 million?
The answer is A - 40 million.
Which of these specialists are state licensed, usually earning at least two years post-graduate credit, a) acupuncturists or b) practitioners of acupressure?
The answer is A - acupuncturists.
Food therapy is based on the belief that many disorders are the result of a) allergies or b) poor nutrition.
The answer is A - allergies.
What medical practice is based on scientifically validated methods and procedures whose objective is to heal by countering the patient's symptoms? Is it: (a) allopathic medicine; or (b) osteopathic medicine?
The answer is A - allopathic medicine. While allopathic medicine is based on scientifically validated methods, we must remember that not all allopathic treatments have had the benefit of extensive clinical trials and long-term studies.
"Allopathic" means a) conventional or b) alternative medicine.
The answer is A - conventional.
"Biofields" are energy fields originating a) in the body or b) outside the body.
The answer is A - in the body
Creatine a) does b) doesn't naturally occur in the body.
The answer is A - it does naturally occur in the body, primarily in skeletal tissue.
What is the phenomenon called when a person keeps a job in order to keep health insurance? Is it: (a) job lock; or (b) health freeze?
The answer is A - job lock.
Jack evaluates visual problems and fits glasses but is not a trained physician. Jack is an: (a) optometrist; or (b) ophthalmologist?
The answer is A - optometrist. An ophthalmologist holds a medical degree and can perform surgery and prescribe medications.
The midlevel specialist with advanced training who handles most standard cases of care is a(n): (a) physician assistant; or (b) oncologist.
The answer is A - physician assistant.
Most users of CAM a) use it with conventional therapy or b) use it because they don't believe conventional medicine will help them.
The answer is A - use it with conventional therapy.
Traditional, scientifically based medicine is called: (a) medipatic; or (b) allopathic?
The answer is B - allopathic.
When being proactive in your healthcare, you should: (a) depend upon your physician's office to call and remind you of appointments needed; or (b) ask for a written summary of your lab results.
The answer is B - ask for a written summary of your lab results.
Paying a set fee for each office visit is called a: (a) coinsurance; or (b) copayment?
The answer is B - copayment.
A specialist who diagnoses and treats diseases of the teeth, gums, and oral cavity is a(n): (a) oral surgeon; or (b) dentist?
The answer is B - dentist. Dentists must attend dental school for four ears and earn the title of doctor of dental surgery or doctor of medical dentistry.
strategies to take an active role in your own health care
The more you know about your body and the factors that can affect your health, the better you will be at communicating with health care providers. The following points can help: -Know your own and your family's medical history -Research your condition: causes, physiological effects, possible treatments, and prognosis. Don't rely on the health care provider for this information -If you are concerned about an upcoming medical visit, bring a friend or relative along to help you review what the doctor says. If you go alone, take notes -ask the practitioner to explain the problem and possible tests, treatments, and medications in a clear and understandable way. If you don't understand something, ask for clarification -If the health care provider prescribes any medications, ask whether you can take generic equivalents that cost less -Ask for a written summary of the results of your visit and any lab tests -If you have any doubt about recommended tests or treatments, seek a second opinion -After seeing a health care professional, write down an accurate account of what happened and what was said. Be sure to include the names of the provider and all other people involved in your care, the date, and the place -When filling prescriptions, make sure the pharmacist provides you with a drug information sheet that lists medical considerations and details about potential drug and food interactions
what part of Americans have tried Alternative and complementary medicine (CAM)?
more than 1/3 of the American population has also done so (try an alternative method).
liposuction
removal of pockets of fatty tissue with a vacuumlike device, to slim the hips, thighs, abdomen, or other areas
possible reasons acupuncture is beneficial in body?
some Western researchers are looking at potential biomechanisms to understand how acupuncture may work to relieve pain, such as activating opioids in the brain
explain the the mechanism employed by private health insurance company: waiting period
some plans specify a waiting period (ex: 6 months) before they will provide coverage
