CHLH 101 Exam 3

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Almshouses

"poorhouses" that were run by the local government and provided some care

In 2014, how much did the US spend on health care

$3.1 Trillion!

Health Care - Today

-$2.6 million on health care (17+%) -Health care costs outpacing inflation for past few decades -2010 Affordable Care Act

3rd Party System

-1960s -Insurer pays physician and not the patient

Clinics

-2 or more physicians practicing as a group -no inpatient beds -For profit and not for profit

Allied Health Care Professionals

-Assist, facilitate, and complement work of physicians and health care specialists -Lab techs, support services, behavioral scientists, physical therapy, OT, social workers, dietitians

Accreditation of Health Care

-Assists in determining quality of health care facilities -Process by which agency evaluates and recognizes an institution as meeting certain predetermined standards -Usually through the Joint Commission (predominant accrediting org)

How much water do we use?

-Avergage US citizen uses 80-1000 gallons/day -only 6% of all water used is for domestic use

Car Insurance vs. Health Insurance

-Car: insurance protects you from unpredictable big, bad things; doesn't change how you access routine matenance -Health: without insurance, severely limited to how to access basics, prevention and higher level care

History on Health Care - Late 1800s and Early 1900s

-Care moved to physician's offices or hospitals -Science had a larger role in medical education -Mortality declined due to improved PH measures -1920s- Chronic diseases passed communicable as leading causes of death -New procedures available: X-ray, ECG, chemo -Doctors and nurses became more specialized

Regulating Water Quality

-Clean Water Act -Safe Drinking Water Act -Watershed- area of land where all of the water that is under it or drains off of it goes into the same place

Major issues of the US Health Care System

-Cost containment, access, and quality -All factors are equally important but expansion of one could compromise the two but doesn't have too

What is the greatest reason for lack of insurance?

-Cost!!!! -Most uninsured (80%) are from working families but they actually don't work one job, they work many different jobs which doesn't help them

Medicare

-Covers more than 48+ million people -Federal health insurance program for people 65+, certain disabilities/severe illnesses -SSA handles the enrollment -Contributory program through FICA tax (workmen people pay for part of it)

CHIP

-Created in 1997 for 10 years -funding assisted by increase in federal excise tax rate on tobacco -Targets low-income children ineligible for Medicaid -State/federal program

Exclusive Provider Organization

-EPO -Can only see certain providers

Affordable Care Act

-Extends coverage -Initiates improvements in quality of care -Sets base level of coverage/covered services

Managing solid waste

-Federal laws -Source reduction -composing -Sanitary landfills -combustion

FQHC and CHC

-Federally Qualified Health Center and Community Health Center -Public health clinics, community health centers, rural health centers, migrant health centers, -Over 1,100 community health centers -Support primary health care needs of underserved populations in the US

Health Maintenance Organization

-HMO -Staff model HMO: providers are salaried staff of the HMO who don't have private practices -Independent practice association (IPA): physicians as a group have contract with HMO and more common

World population growth

-Hazard -means expanded needs for food, clean water, safe housing, power -all have huge impact on environmental health

Medicaid

-Health insurance program for low-income, no age requirement -43+ million people covered -Eligibility determined by each state -Noncontributory program (no payroll tax

Long-Term Care

-Help with chronic illnesses and disabilities -Time-intensive skilled care to basic daily tasks -Found in inpatient and outpatient units, nursing homes, personal homes -Providers are physicians, nurses, PT, OT, ST

Medical Practice: Tertiary

-Highly specialized, technologically advanced care -Surgery and dialysis -Found in hospitals -providers are specialty physicians

Osteopathic Providers Historical

-Historical: Prevention focused, not overusing medicine -Doctors of Osteopathic Medicine (DOs)

Health Care History - 1960s

-Increased interest in health insurance -3rd party payment system -Cost of health insurance rose -increase access at little expense for those with insurance -those without insurance could not afford care

Population Based Practice (PH)

-Interventions aimed at disease prevention and health promotion -Health education and service provision (Sanitation, vaccines, disaster response)

Nurses: LPNs and RNs

-LPNs: 1-2 years of education in vocational program and pass licensure exam -RNs: completed accredited academic program and pass state licensure exam

Health Care History - 1990s

-Managed care becomes more prevalent -Achieved efficiency -Control utilization -CHIP developed -1996 - U.S. spent $1 trillion on health care (14%)

Government Health Insurance provided only to select groups:

-Medicare: 65+ -Medicaid: Low income -Children's Health Insurance Program (CHIP) -Veterans Administration benefits -Indian Health Services (IHS) -Federal employees -Prisoners

Long Term Care Options

-Mostly found via inpatient care (nursing homes, group homes, transitional care, day care) -Now being found in in-home health care (Growing due to restructuring of health care system, technology advances, and cost)

Examples of non-physician practitioners

-Nurse practitioners -Physician assistants

Preferred Provider Organization

-PPO -Get better pricing if you to preferred provider

Outpatient Care Facilites

-Patient receives care and does not stay overnight -clinic, dialysis center, urgent care, imaging centers

Inpatient Care Facilites

-Patient stays in overnight -Hospital, rehab, nursing home

4 types of Health Care Delivery

-Population-Based Practice (PH) -Medical Practice -Long-Term Practice -End of life Care

Types of Managed Care

-Preferred provider organization -Exclusive provider organization -Health maintenance organization

Restorative Care

-Provided after surgery (rehab, therapy, home care) -Found in inpatient and outpatient units, nursing homes, personal homes, -Providers are physicians, nurses, OT, PT, ST

Health Care History - 1980s

-Reagan and Congress eliminated Health Systems Agencies -Deregulation of health care delivery -Questions in medical ethics -Elaborate health insurance programs developed -Costs rose

Medical Practice: Primary

-Routine and preventive care -Annual physical, sore throat, pink eye, vaccines, basic chronic disease management -Found in outpatient -Providers: physicians, nurses, health educators

Early History of Health Care - Mid 1800s

-Self-care has been used -Anyone trained or not could practice medicine -Past medical education was not as rigorous as today (more about experience) -Barbers were usually the "doctors" because they had sharp tools and used leeches -Most care provided in patients' homes because hospitals found in large cities

End of Life Practice

-Services provided shortly before death -Hospice care

Superfund Sites

-Site needing significant clean up -Fund established in 1980 to clean up abandoned hazardous waste sites by taxes on chemical industries

Medical Practice: Secondary

-Specialized care and management -Chronic disease management, care for uncommon conditions -Found in outpatient and hospitals -Providers are usually physicians

National Health Insurance

-System where federal government assumes responsibility for health care costs of entire population, primarily paid for with tax dollars -U.S. is the only developed country without national health care plan -7 failed attempt at national health care in the last 70 years

History of Environmental Health

-Thought that unsanitary conditions caused disease -Lots of work on water, waste, living conditions -Focused on communicable/infectious illness -then on occupational based illness -now on chronic disease

Health Care History - 1940s and 1950s

-WWII impact where wage restrictions began and employers created health insurance to lure workers in -technical strides -Improved procedures, equipment, facilities meant rise in health care -Concept of health care as basic right or privilege

Public Health Professionals

-Work in PH organizations -usually financed by tax dollars -services available to everyone (primarily server the eco. disadvantaged) -PH physicians, dentists, MH providers, nurses, environmental health workers, health educators, health policy professionals

Limited or Restricted Care Providers

-advanced training in a health care speciality -provide care for a specific part of the body, but don't cover the entire body -dentists, optometrists, podiatrists, psychologists

Terrorism

-calculated use of violence or threat of violence against civilians to attain goals that are poetical or religious in nature -Socialogical hazard affect entire societies -Psychological hazard produces fear, stress, hysteria, -physical hazard leads to destruction of lives and property

Cost of Health Insurance in the US

-cost of insurance mirrors the cost of care -burden falls primarily on the employer, then on the employee (increased worker share of premium, raising deductibles, increasing Rx co-payments, increasing number of exclusions) -cost of insurance policy determined by risk of group, cost sharing and level of coverage provided

lead posioning

-found in soil, dust, air and paint -children at greatest risk -leads to anemia, birth defects, bone damages, learning disabilities

Natural environmental events/hazards

-geological activity and weather driven events -can result in physical and psychological health consequences -creates new variety of needs -Hurricane katrina, typhoon haiyan

Providers of population based practice

-have wide variety of skills and experiences -doctors, nurses, health educators, sanitation workers, epidemiologists

non-biological pollutants of water

-heat, inorganic chemicals, organic chemicals, radioactive pollutants -pharmaceuticals and personal care products

Allopathic Providers Historical

-historical: diagnose and treat disease based on science -Doctors of Medicine (MDs)

Causes of food borne disease

-inadequate cooking temperatures -unsanitary practices -contaminated equipment

Where is hospice care found and who are the providers

-inpatient units, outpatient units, nursing homes, personal homes, hospice specific homes -nurses, social workers, counselors, hospice volunteers

Heavy metals

-lead, mercury, chromium arsenic -occur naturally and also used by industry and in product

Regulation of OUTDOOR air quality

-many acts/policies have been established in the 1960/70s

Non-Allopathic Providers

-nontraditional means of health care -complementary and alternative medicine (CAM) was used together with conventional medicine, therapy is considered "complementary" -chiropractors, acupuncturists, naturopaths -natural products, mind-body medicine, manipulation

Protecting indoor air

-people spend 50-90% of time indoors -NO FEDERAL INDOOR CLEAN AIR ACT

Radiation

-process in which energy is emitted as particles or waves -heat, sounds, visible light are long-wavelength, low-energy radiation -high energy ionizing radiation -can lead to skin cancer

Problems with Medicare and Medicaid

-programs created to help provide health care to those who might have impossibilities of obtaining health insurance -some providers do not accept Medicare or Medicaid as forms of payment because of Medicare and Medicaid fraud -Very small problem compared with number of people enrolled

Brownfields

-property where reuse is complicated by the presence of hazardous substances from prior use -EPA works to help these lands be cleaned for re-use

Regulating Food Safety

-regulated by federal and state authorities -FDA ensure safety all of food except meat and dairy -USDA does meat and dairy -Enforced locally registered environmental health specialists

Vector borne disease outbreaks

-rising -#1 is lyme disease -have federal, state and local efforts for prevention

Allopathic and Osteopathic Providers Today

-similar education, training, perspective -Most DOs work in primary care and MDs work in primary and specialties

Independent Providers

-specialized education and legal authority to treat any health problem/disesase -allopathic and osteopathic providers -non-allopathic providers

Two Party System

-used in the early 1900s -Patients and physicians -Physicians collected own bills, set and adjusted prices based on ability to pay

Non point source pollution

-water -all pollution that occurs through runoff, seepage, or falling of pollutants into water

point source pollution

-water -pollution that can be traced to a single source

Radiation form Human made sources

-x-rays, nuclear medicine diagnoses, radiation therapy, nuclear energy and weaponry

Who are more likely to be uninsured?

-young -less education -low income -non-white

4 Parts of Medicare

1. Hospital Insurance (Part A) 2. Medical Insurance (Part B) 3. Managed Care Plans (Part C - optional, insurance companies) 4. Prescription Drug plans (part D - optional, insurance companies)

Third-party system/payment

1. Patient/insured 2. medical provider 3. insurer

Types of hospitals

1. Private - profit making, specialty hospitals 2. Public - Supported and managed by the government jurisdictions 3. Non-Profit- 1/2 of the hospitals; still business oriented 3. Teaching and non-teaching hospitals 4. Full-service or limited-service hospitals

Two Types of Long-Term Practice

1. Restorative Care 2. Long-Term Care

When were Medicare and Medicaid formed?

1965

West Nile virus

Caused by mosquitos passing infection to humans; mosquitos thrive in standing water

Because Lars broke his arm in 17 places, he has to stay in the hospital for a few days. He will be paying 20% of the inpatient stay costs, which is his....

Co-Insurance

Lars broke his arm during frisbee competition with friends. He has a flat fee of $250 for ER services, which is....

Co-payment

Recycling

Collecting, sorting, processing materials that would be otherwise considered waste

Air pollution

Contamination of air by substances in great enough amounts to harm living organisms Ex: transportation, electrical power plants fueled by coal and oil

Solid waste

Garbage, refuse, sludge, discarded solid material -95% traced to ag, mining and gas/oil production

Where is population based practice found?

Governmental health agencies

Natural Hazards

Naturally occurring phenomenon or event that produces or releases energy in amounts that exceed human endurance, causing injury, disease or death

Pesthouses

Places to isolate infectious disease

Lars has health insurance, for which he pays $200/year....

Premium

How do most people in the US get health insurance?

Through their employer

Hazardous waste

Waste dangerous to human health and/or environment

Copayment

a set amount you pay for certain services Ex: $20 for a physician visit

Phytochemical smog

air pollutants + sunlight

Greenhouse gases

air pollutants tied to global climate change

Deductible

among you must pay before your insurance will kick in

Sources of indoor air pollution

asbestos, biogenic pollutants, radon, environmental tobacco smoke, formaldehyde

Exclusion

care not covered by insurance policy Ex: cosmetic surgery, dental work usually

Waterborne disease examples

cholera, typhoid fever, dysentery

Pre-Existing Condition

condition diagnosed/treated before the coverage starts

National Ambient Air Quality Standards

created by amendment to CAA -emission standards for cars, for new industries, and ambient air standards for urban areas

Quality health care should be

effective, safe, timely, patient centers, efficient, patient centered

Environmental Protection Agency

federal agency responsible for setting, maintaining, and enforcing environmental standards

Municipal solid waste

generated by households, businesses, institutions -Avg: 4.3 pounds per person/day

Ozone

harmful in the atmosphere because it harms human tissue; useful in stratosphere to screen out radiation

Air Quality Index

index indicating level of pollution in the air and associated health risk

Vector

living organisms that can transmit communicable disease Ex: mosquito, rat, tick

Criteria pollutants

most pervasive pollutants, of greatest concern ex: Lead, NO2, CO

Primary pollutants

pollutant coming directly from transportation, power plants, industrial plants, refineries

Clean Air Act

provided the federal gov. with authority to address interstate pollution

Industrial smog

sulfur dioxide + air pollutants from burning coal

Co-Insurance

the amount you pay of a service you use in a percent Ex: For any inpatient care you pay 20% and insurer pays 80%

Biological pollutants of water

viruses, bacteria, parasites,

Runoff

water that flows over land surfaces, typically from precipitation

secondary pollutants

when primary pollutants react with sunlight and other chemicals

thermal inversion

when warm air traps cooler air at the surface of the earth

Policy

your contract with the insurer

Premium

your regular payment for coverage, whether you use it or not


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