Google Doc Chapter 11 HTH 354 and in class review/quizzes

True or False: Migrant workers are more likely to have a higher obesity rate.

True: The rate of obesity among migrant workers has risen to 81% of males and 76% of females (pg. 460).

True or false: there's a higher percentage of overweight white males than overweight black males ages 20 and older

True: in 2011-2014 the percentage of overweight white males ages 20 and older was 73.7 while the percentage of overweight black males ages 20 and older was 69.6 (pg. 447)

T/F An HIV infected woman has a 25% chance of having a child infected with HIV?

True: page 472

What are some of the barriers to receiving mental health care in the US?

The 2 main barriers are prohibitive costs of services and shortage of available mental health professionals. Mental health care is very costly. There are also many geographic barriers. Urban areas have more access to a wide variety of services whereas more rural areas do not. Therefore the mental health services are limited. There are also racial, ethnic, and religious barriers as well. In addition, the overall stigma for receiving mental health care may deter people from seeking the services that they need.

Generally, uninsured persons are in poorer health than the general population

T: Studies showed the uninsured use fewer health services than the insured. Decreased utilization of lower-cost preventative services (a quality of the uninsured population) results in an increased need for expensive emergency care later on.

All of these are individual barriers to healthcare for the homeless except: A)competing needs B)substance dependence C)convenience D)Mental illness

All of them are barriers to healthcare expect C. convenience because that is a system barrier.

What did Bill Clinton do in regard to healthcare

"Chip" -Children's health insurance program so he expanded health insurance for children, and he signed the mothers and newborn protection act

1. While you can buy 100 acetaminophen tablets (generic Tylenol) for 1.49 on amazon, MD Anderson charged ___ for one tablet.

$1.50

what was the salary of the CEO at MD Anderson (a non profit hospital)?

$1.8 million

1. Stamford Hospital charged $199.50 for a troponin test. Medicare reimburses Stamford ___ for that test.

$13.94

the heartburn bill in stamford connecticut cost about:

$21,000

1. Money in lobbying efforts from health care industries (hospitals, doctors, nursing homes, HMOs, etc) from a 1998-2012 was about

$5.36 billion

how much did MD Anderson charge for a package of gauze bandages?

$77

A typical piece of medical equipment will pay for itself in about

1 year

1. The president of MD Anderson (a nonprofit hospital) has an annual salary of about

1,845,000

1. How many administrators at New York city's memorial Sloan-Kettering cancer center make over 1 million dollars?

6

1. In the United States, what percentage of bankruptcies are health related?

62

What are the challenges faced in rural health?

Access to health care may be affected by poverty, long distances to service providers, rural topography, weather conditions, lack of transportation, and being uninsured. Many rural residents forgo or delay care due to cost They have lower levels of insurance coverage Geographic maldistribution creates a shortage of healthcare professionals which is a barrier Access to health care may be affected by poverty, long distances to service providers, weather conditions etc causing them to be less likely to utilize health services. This results in people being in poorer health than other urban areas and causes worse health outcomes.

Describe a health professional shortage area? What are some parts of Virginia that might meet this criteria?

A health professional shortage area was designated by the Health Professions Educational Assistance Act of 1976. This included geographic areas, population groups, and medical facilities. There are three different types of HPSAs designated by the Act which are geographic areas, population groups, and medical facilities. A health professional shortage area has to meet 3 criteria. The first is the geographic area involved must be rational for the delivery of health services. The second is it has to have a population to full-time PCP ratio of at least 3,500:1, or if the area has a ratio of less than 3,500:1 and more than 3,000:1 and an unusually high need for primary care. The third is the primary care professionals in contiguous areas are overutilized, excessively distant, or inaccessible to the population of the area under consideration. Some parts of Virginia that meet this criteria is the Western part of Virgina.

How does AIDS affect different population groups in the US?

AIDS is a still a major health concern for blacks, Hispanics, and minority women. HIV is the leading cause of death only for African Americans, with an annual diagnosis that is eight times greater than the rate for whites. Racial differences in how AIDS affects different populations reflects social, economic, behavioral, and other factors associated with HIV transmission risks. Medicare and Medicaid become the primary payers for healthcare because of the onset of disability and depletion of personal funds. Approximately 70,000 previously uninsured people with HIV/AIDS were expected to gain coverage under the ACA. Males and African Americans have significantly higher rates of AIDS than females and whites in the United States. Individuals who have AIDS in rural communities are most likely to be young, non-white, and female. An infected woman has a 20% chance of having a child born with HIV, while 75% of all AIDS cases among US children are caused by mother-to-child transmission. These children suffer from failure to thrive, the inability to grow and develop as healthy children. HIV in Women- HIV in African American and Hispanic women range from 15-44 years old and was among the top 10 leading causes of death in 2010. Women AIDS is rapidly growing, and made up more than one-half of HIV/AIDS cases worldwide. Need for Research- Seeks to prevent HIV from infecting HIV negative people. Also, research is seeking to develop a therapeutic vaccine to prevent HIV from transitioning into AIDS. These vaccines are focused primarily on vulnerable populations. Public Health Concerns- Tuberculosis and HIV go hand-and-hand, because Tuberculosis, which is an opportunistic infection, is the worldwide leading cause of death among HIV infected persons. This causes a public health risk because these people are at a greater risk of developing multidrug-resistant tuberculosis, which is difficult to treat/fatal. Homophobia- Fear/hatred/prejudiced against gays and lesbians, which effects the policy related response to the HIV epidemic. Testing may not limit spread, for a lot of people don't change their behaviors. Discrimination- Disc in access to healthcare, HIV symptoms don't qualify for disability claims.

All of the following are criteria for designated primary care HPSA EXCEPT: a) area involved must be rational for delivery b) PCP in contagious areas are inaccessible c) the area has a population to full-time equivalent PCP ratio of at least 100:1 d) the area has a population to full-time equivalent PCP ratio of less than 3,500:1 but greater than 3,000:1

ANSWER: C Pg. 459 The ratio of population to full-time PCP needs to be 3,500:1.

Which of the following are different types of HPSA that the HPSA Act cover? a. Geographic areas b. Population groups c. Medical facilities d. All of the above

Answer: D

What is the impact of the ACA on vulnerable populations?

Approximately 70,000 previously uninsured people with HIV/AIDS were expected to gain coverage under the ACA, most of them would have gained insurance through medicaid expansion. The ACA made it so that health insurance companies could not deny patients based on preexisting conditions which could benefit people who previously didn't have health insurance for that reason. The ACA also makes healthcare more affordable for lower income individuals which allows more people to access the healthcare system.

Who are AA/PIs?

Asian Americans and Pacific Islanders: Constitute one of the fastest-growing population segments in the United States In education, income, and health, they are very diverse Children are more likely to be without contact with a health professional compared to White Americans Cultural attitudes and practices may prevent women from receiving adequate preventative care AAs are Asian Americans and PIs are Pacific Islanders. AA/PIs are the fastest growing population in the U.S. Compared to other ethnicities. Asian Americans are one of the fastest-growing populations in the United States. When it comes to education, health and income, Asian americans and Pacific Islanders are extremely diverse. AA/PIs had the lowest graduation rate from high school in 2013, but higher rates of graduating with a bachelor's degree or higher. Graduating rates vary among the different ethnicities within the AA/PIs population with Japanese students (94%) graduating with the highest rate between 2007-2009 with Vietnamese (72%) close behind and the the Hmong adults (61%) behind them. Median income for Asian Americans was higher compared to white non-hispanic counterparts. AA/PIs children are more likely to be without contact with a health professional. Cultural practices tend to prevent women from receiving preventive care like pap smears and breast cancer screenings. One common myth about AA/PI's is that the entire population is both healthy and economically successful, which is not true. The percentage of overweight and obesity varies within the Filipino adults, who are 70% more likely to be obese than the rest of the population. When compared to the United States population, overall smoking rates are the lowest with AA/PI populations. Additionally, compared to whites, Asian Indians twice as likely to have diabetes. Generally, Asian Americans and Pacific Islanders are seen small compared to the rest of the population, but they are extremely diverse when it comes to medical conditions and needs.

What is one of the most common childhood chronic diseases?

Asthma; The prevalence of children with asthma has consistently risen. More than 10 million US children younger than age 18 have ever been diagnosed. Second highest prevalence rate to unintentional injuries.

True or False: The FDA required private insurance to cover preventive services and additional services for women

False: The ACA required private insurance to cover preventive services and additional services for women including the FDA. The FDA approved prescription contraceptives, domestic violence screenings, breastfeeding support systems, and HPV testing.

(T/F) The homeless utilize outpatient care more than inpatient care.

False: The homeless have a high use of inpatient services to account for lack of access to outpatient services.

In a population based program, which of the following is not part of the population based services for children? a. Immunizations b. Referral programs c. Child abuse and neglect prevention d. Rehabilitative services

B is the answer. A, C, and D are all included in the population based services for children. The community based programs deal with referral programs for children with chronic diseases, etc.

Making sure children are up to date on immunizations, and monitoring child abuse is an example of which health service? a. Personal medical and preventative services b. Population-based community health services c. Health related support services

B: focuses on all children and not just children who lack access to health care services (pg.455)

What are the roles of the Office on Women's Health?

Breast cancer research, service delivery, and education through the National Action Plan on Breast Cancer (NAPBC) Help prevent physical and sexual abuse through the Violence Against Women Act of 1994 Promotes breastfeeding, women's health education, girls/adolescent health, and heart health Substance Abuse and Mental Health Services Administration targets 6 areas for special attention: Physical and sexual abuse of women Women as caregivers Women with mental/addictive disorders Women with HIV/AIDS, STIs, Tuberculosis Older women Women detained in criminal justice system The roles of the Office on Women's Health include the promotion of research, health service delivery, and education in various government settings. The OWH also serves to prevent physical and sexual abuse against women; has goals that cover a variety of diseases and disabilities. Women's services targets six main areas and we thought that this is important for women's overall health and wellbeing. These include physical and sexual abuse; women as caregivers; women with mental and addictive disorders; women with HIV/AIDS, sexually transmitted diseases, and or TB; elder women; and women detained in criminal justice system.

Research funding for HIV/AIDS is important. Currently what is research focusing on? a. More effective early HIV detection methods b. Public education c. A vaccine for HIV negative people from requiring HIV d. Oral medication to help reduce symptoms of HIV

C. A vaccine for HIV negative people from acquiring HIV (Page 473) Explanation: Research is focused on the prevention of HIV occurring in individuals to reduce the financial and emotional burden of the disease. Also to reduce the prevalence and spreading of HIV in the world.

Which category of disability is considered most severe? a. Emotional b. Mental c. Social d. Vocational

C. Social Social disabilities are considered the most severe because management of social rolls requires both physical and mental well being.

Describe the scope of chronic illness and disability in the US.

Chronic diseases are now the leading cause of death in the united states. 7 out of 10 deaths each year are from chronic diseases. Heart disease is the number one cause of death in the US. Chronic disease leads to limitations on ADLs. The cost is over $153 billion each year in productivity loss. Most of the burdens associated with chronic diseases result from four modifiable risk behaviors: physical activity, nutrition, smoking, and alcohol use. The prevalence of disability increases with age. 70.5% of adults 80+ years old have a disability. Disabled individuals tend to be covered by public insurance. The chronic diseases most responsible for disabilities are arthritis, heart disease, back problems, asthma, and diabetes. Chronic illnesses are the leading cause of death in the United States. Heart disease, cancer and stroke account for over 50% in the U.S. Roughly 7 out of 10 deaths result each year due to chronic diseases. More than 1 in 4 adults have more than one chronic disease. The total loss of productivity because of chronic illnesses is estimated to be greater than $153 billion dollars. Treatment of chronic disease accounts for 86% of US health care costs. Most of these chronic diseases are from preventable risk factors (physical activity, smoking, alcohol). 53 million people disabled, mostly elderly Disabilities result mainly from chronic conditions (arthritis, heart disease, asthma, back problems, diabetes) Disabled people are primarily covered by Medicare (30%) and Medicaid (10% Medicaid pays for most long term services (40%) Disability can be categorized as mental, physical, or social Physical disability: relates to person's mobility/basic activities Mental: relates to both cognitive and emotional state Social: Considered most severe because management of social roles requires both physical and mental well-being Disabilities are predominantly measured through ADL's and IADL's

All of the following are are considered to be the most common mental disorders in the United States except: a. Phobias b. Substance Abuse c. Affective Disorders d. Schizophrenia

D. According to National studies the most common mental disorders are phobias; substance abuse, including alcohol and drug dependence; and affective disorders, such as depression. Schizophrenia is much less common, affecting 0.6% of the population

Which childhood characteristics have important implications for health system design?

Developmental vulnerability: refers to rapid and cumulative physical and emotional changes that characterize childhood and potential impact that illness, injury or disruptive family and social circumstances can have on a child's life-course trajectory. Dependency: refers to children's special circumstances that require adults - parents, school officials, caregivers, and sometimes neighbors - to recognize and respond to their health needs, seek health care services on their behalf, authorize treatment and comply with recommended treatment regimens. 20% of children require special health care( defined as having a chronic, medical,behavioral or developmental condition lasting 12+ months, childhood obesity is at 19% in the U.S. (obese children in poor families have less options for health care), programs designed to help children have eligibility/financing restrictions that make it difficut to gain access,l14% of children have been diagnosed with asthma, apprx 11% of children have depression, children are considered a Developmentally vulnerable population and have lead to the dramatic increase in family services

What is/are barrier(s) for mental health access? a.) shortage of mental health professionals b.) costs are inexpensive so there is overcrowding c.) prohibitive costs of services d.) both a and b are true e.) both a and c are true

E: both a and c are true Page 466 - Two main barriers to health care are prohibitive cost of services and shortage of available mental health professions. In 2013, 50.1% of those who needed mental health care, young adults stated that their failure to receive care was due to the high cost of treatment. There is 1 mental health professional to every 30,000 people.

in 2014, low birth weights in live births were most prominent among White Americans.

False Low birth weights were most prominent among Black Americans

T/F Asian Americans and Pacific Islanders are seen as relatively healthy and are less likely to get chronic diseases or conditions such as diabetes and obesity.

False They are more than twice as likely to develop diabetes

T/F The Indian Health Service mandate has been easy to implement because the location of Indian reservation communities are accessible in the United States?

False. Pg. 450 It has been difficult to implement because the reservation communities are geographically not accessible.

True or False: Women are more likely to experience a problem with binge drinking than men.

False. Pg. 456 In 2015, men were more likely to report binge drinking (29.9% men; 17.4% women)

True or False: People in Rural areas generally have better health than people in Urban areas.

False: People living in rural areas report lower health status than those living in urban areas (page 458).

(T/F) Psychologists interpret behavior change in people and can prescribe drugs

False: Psychologists DO interpret behavior change in people, but CANNOT prescribe drugs (pg. 467)

True or False: Community based programs include immunization delivery and monitoring programs and lead screening and abatement programs.

False: The ones listed are population based programs. Community based programs include case management and referral programs for children with chronic diseases. (pg. 454)

What is the Indian Health Service?

Federal program that ensures comprehensive and culturally acceptable health services to American Indians and Alaska Natives The purpose of the Indian Health Service is to ensure that comprehensive and culturally acceptable health services are available to American Indian and Alaska Natives (AIAN). It serves more than 560 tribes. Besides providing primary care, initiatives focus on alcoholism, diabetes, mental health, maternal and child health, domestic violence, and child abuse. More than half of low-income uninsured Indians do not have access to IHS.

Barriers to healthcare for homeless individuals include all EXCEPT: a. Accessible of transportation b. Competing needs c. Low cost d. Availability of healthcare

Health care is very costly and often deters those without insurance or employment as they will not be able to pay for it and may be turned away anyways or get in federal trouble for not paying off their debt.

What are health concerns of women?

Heart disease and stroke account for a higher percentage of deaths among women than among men. Binge drinking rates rose in women from 11.2% to 17.4% Chronic lower respiratory disease is third leading cause of death in women Obesity rates are rising, with an average of 38.8% of women being classified as obese in 2014 It is found that heart disease, stroke and cancer are higher in women than in men. Functional limitations due to health is greater in women than men. Additionally, women reported more physically and mentally unhealthy days than men. Women face a distinct disadvantage in obtaining employer-based health insurance coverage because they are more likely than men to work part-time, receive lower wages, and have interruptions in their work histories.

Which of the following is not a predisposing characteristic? Racial/ Ethnic characteristics Gender and age Geographic location Homelessness

Homelessness. Homelessness is an enabling characteristic, not a predisposing characteristic.

The percentage of a population diagnosed with chronic illness is NOT a variable for designating medically underserved areas. The following are variables of medically underserved areas:

Infant mortality rate Percentage of population below poverty income levels Percentage of population 65 years of age and older Number of primary care practitioners per 1,000 population

Which services and policies currently combat AIDS in the US?

Medicaid waiver program: states may design packages of services to specific populations, such as elderly, the disabled, and persons who test HIV positive. Ryan White Care act: Passed in 1990, provided federal funds to develop treatment and care options for person with HIV/AIDS. Title 2 is administered by states and has been used to establish HIV clinics and related services in areas lacking the resources needed to offer specialty care. Medicaid waiver program- packages of services to specific populations and people who test positive for HIV Ryan White CARE Act (1990)- federal funds to develop treatment and care options for HIV/AIDS patients Social Security Disability Income Supplemental Security Income Program Medicare and medicaid- primary payers for health care because of the onset of disability and depletion of personal funds linked with the development and progression of AIDS

Describe the scope of mental health issues in the US.

Mental health disorders are among the leading cause of disability in the US, and major risk factors for suicide, CVD, and cancer. They can be psychological or biological in nature, with the most common including phobias, substance abuse (drug and alcohol dependence), affective disorders (ex. depression). In the US, 45.1 million adults are diagnosed with a mental illness, with 11 million of those being severe mental illnesses (SMI). Prevalence of SMI is higher in Medicaid recipients, women, and individuals 18-25 in age. Of adults with a diagnosable mental disorder, 62.1% did not receive treatment. In children, 1 in 5 have a mental disorder and only half of those diagnosed receive mental health services. Mental disorders are the leading cause of disability for people in the United States. Almost ⅕ of adults experience a mental disorder every year and more than ⅕ of children in the United States experience a mental disorder. There is a higher prevalence of severe mental illness among Medicaid recipients, women, and individuals from 18-25 years of age. The tenth leading cause of death in the United States is suicide. Mental disorder affect people of all races, age groups, and incomes.

Describe migrant workers and their health needs.

Migrant workers are farm workers who travel long distances from their primary residence or lack a primary residence entirely, due to season crop changes or work availability. There are at least 3 million in the United States. As of 2013-2014, 84% were uninsured Obesity rate: 81% for males, 75% for females Greater risk for developing infectious diseases, especially tuberculosis (48.8 cases per 100,000 population) HIV/AIDS rate considerably higher Community and Migrant Health Centers provide services to these populations Rural Health Clinics Act, 1977: responded to concern that isolated rural communities could not generate sufficient revenue to support services of a physician. Permits physician assistants, nurse practitioners, and certified nurse-midwives to practice without direct supervision of a physician; be reimbursed by Medicare and Medicaid; tied level of Medicaid payment to level established by Medicare. They are farmworkers who travel long distances from their primary residence or lack a primary residence entirely, either due to seasonal crop changes or work availability. Their health care needs include prenatal care, obesity, chronic conditions, infectious diseases, and HIV/AIDS care. Due to the rising health needs amongst the migrant workers, services are being provided to the workers and their families through state programs and federally through HRSA's Migrant Health Program.

Compared with White Americans, what health challenges do minorities face?

Minorities are more likely to be economically disadvantaged, which majorly affects the healthcare quality they receive, including lower rates of prenatal care. Black Americans are more likely to be economically disadvantaged, fall behind in health status, have a shorter life expectancy, higher age-adjusted death rates for a majority of leading causes of death, higher age-adjusted maternal mortality rates, and higher infant, neonatal, and postneonatal mortality rates than whites. Hispanic Americans experience significant barriers accessing medical care, which is made even more difficult by the inability of some to speak English. Hispanic Americans have lower education levels, higher unemployment rates, higher uninsured rates, are less likely to take advantage of preventative care, and experience greater behavioral risks than White Americans. In 2014, low birth weights in live births were most prominent among blacks (pg.438 & 440). Black Americans are more economically disadvantaged than White Americans. American Indian/Alaskan Native are the least likely race to begin prenatal care in the first trimester (pg. 439). Individuals of Hispanic origin are least likely to have mothers who are educated past 16 years of age (pg. 439). Percentage of mothers who smoked during pregnancy was highest among the American Indian or Alaskan Native race. Black Americans: Overall, black Americans are more economically disadvantaged than White Americans. Do not have as great of health statuses Shorter life expectancies Higher age-adjusted death rates. Higher maternal mortality rates. Black males are reported to smoke cigarettes more often than white males. Black Americans have higher neonatal, infant, and postneonatal death rates. Highest rates of heart disease, strokes, and hypertension are most prominent among Hispanic blacks. Diabetes is most prominent in Hispanic/Non-Hispanic blacks when compared to non-Hispanic white individuals. American Indians and Alaska Natives: Diabetes, hypertension, infant mortality and morbidity, chemical dependency, and AIDS and HIV related morbidity are high. Higher death rates from alcoholism, tuberculosis, diabetes, injuries, suicide, and homicide. Twice as likely to be poor and unemployed as other Americans. Hispanic Americans: More economically disadvantaged than White Americans (25.6% lived below the federal poverty level) Many experience barriers in accessing medical care, due to language barrier Low education levels, create higher unemployment rates More likely to be uninsured because they are unemployed Less likely to take advantage of preventative care than non-Hispanic whites Asian Americans: Chinese, Asian Indian and Filipino children were more likely to be without contact with a health professional compared to non-Hispanic White children. Cultural practices and attitudes may prevent AA/PI women from receiving adequate preventative care, such as pap smears and breast cancer screenings. Asian Indians are more than twice as likely to have diabetes than White americans.

How is mental health provided in the US?

Most mental health services are provided in the general medical sectorector, a concept first described by Regier and colleagues (1988) as the de facto mental health service system - rather than formal mental health specialist services. The de facto system combines specialty mental health services with general counseling services, such as those provided in primary care settings (nursing homes, community health centers by ministers, counselors, self-help groups, families, and friends). Mental health services are provided through public and private resources in both inpatient and outpatient facilities ( State/county mental hospitals, private psychiatric hospitals, nonfederal general hospital psychiatric services, VA psychiatric services, residential treatment centers, and freestanding psychiatric outpatient clinics). Most mental health services are provided in the general medical sector rather than through formal mental health services through a de facto system. This system combines specialty mental health services with general counseling services, such as those provided in primary care settings and nursing homes. Services are provided through public and private resources in both inpatient and outpatient facilities. Two barriers to mental health are prohibitive cost of treatment and shortage of available mental health professionals. Those who are not insured are treated in state and county mental health hospitals. Care is also provided in short term acute hospitals and emergency departments. For patients who have insurance or who have a personal ability to pay, availability is provided through psychiatric hospitals. Managed care and HMOs have expanded its services to include mental health care.

Who did billy towson represent?

Pharmaceutical companies

Which health services are currently available for children?

Population based community health services: Immunization delivery and monitoring programs, lead screening and abatement programs and rehabilitative services for children with complex congenital conditions or other chronic and debilitating disease. Community based programs: Provide assurance and coordination functions, such as case management and referral programs for children with chronic disease and early interventions and monitoring for infants at risk for developmental disabilities. Personal, medical, and preventative health services include primary and specialty medical services. Health related support services include nutrition education, early intervention, rehabilitation, disease prevention service, and family support programs. Population based community health services include community wide health promotion and disease prevention services such as immunizations, child abuse and neglect prevention, special child abuse treatment programs, and rehabilitative services for children with complex congenital conditions or chronic or debilitative diseases. Community based programs provide assurance and coordination functions, such as case management and referral programs, for children with chronic diseases and early interventions and monitoring for early interventions and monitoring for infants at risk for developmental disabilities.

Describe the different types of mental health professionals.

Psychiatrists are physicians who specialize in the diagnosis and treatment of mental health disorders. Psychologists interpret and change the behavior of people, but can not prescribe drugs to patients. Social workers are trained in counseling for mental health patients and compete with psychologists for patients. Nurses provide a wide range of mental health services through the subspecialty of psychiatric nursing. Therapists and counselors contribute to available services for mental health patients. Psychologists: trained in interpreting and changing the behavior of people, can not prescribe medicine. Therapists: clinicians who actively give treatment to patients with mental disorders. Counselors: type of psychologist. Psychiatrists: Physicians who specialize in the diagnosis and treatment of mental disorders. Social Workers: receive training in various aspects of mental health services, particularly counseling. Masters degree level, they also compete psychologists for patients.

during the affordable care act and health care reform, who was president obama's chief of staff?

Rahm Emmanuel

The governor of VA is who?

Ralph Northam (he is a physician-his big platform was healthcare and expanding Medicaid across the state)

What measures are taken to improve access to care in rural areas?

The Rural Health Clinics Act of 1977: allowed physician assistants, nurse practitioners and certified nurse-midwives associated with rural clinics to practice without direct supervision of a physician. Community and Migrant Health Centers: address both geographic and financial barriers to access by providing services to low-income populations on a sliding-fee scale. The promotion of National Health Service Corps, the designation of HPSAs and medically underserved areas, the development of community and migrant health centers, and establishment of the Rural Health Clinic Acts are all measures that have been taken to encourage better health outcomes in rural settings. In addition, the U.S. Department of Health and Human Services was created in 1987 in order to help create better health outcomes in rural areas. There has been increased funding to improve EMS in rural areas, provide better health jobs in rural areas, and to develop behavior health capacity in rural areas

How can the framework of vulnerability be used to study vulnerable populations in the US?

The framework of vulnerability is an integrated approach to studying vulnerability, vulnerability is determined by a convergence of predisposing, enabling, and need characteristics at both individual and ecological levels. They also ultimately influence individuals' risk of contracting illness, or for those recovering from illness. Identifying individuals that fit within this framework allow us to study and better understand the conditions that lead to a state of vulnerability. Vulnerability refers to the population with poor health or illness. The framework of vulnerability can be used to study vulnerable populations in the U.S. by assessing ecological factors. These factors can be determined through a convergence of 1) predisposing characteristics (racial/ethnicity, gender/age, geographic location) 2) enabling characteristics (insurance status, homelessness) and 3) need characteristics at both individual and ecological levels (mental health, chronic illness, HIV/AIDS) (pg. 437). Ultimately, these factors determine an individual's degree of vulnerability and their quality or access to healthcare. This is important as the access and quality of health care determine their health status as well as their probability of contracting an illness. An individual's vulnerability status ultimately affects the whole population's health outcomes.

What are the barriers to receiving health care for individuals who are homeless?

The homeless face barriers to obtaining ambulatory services, but incur high rates of hospitalization due to lack of access to outpatient services. Other barriers include lack of accessible transportation to medical care providers and competing needs for basic food, shelter, and income which take precedence over obtaining health services and taking care of one's health. Walk-in appointment services decrease access barriers. barriers that make it difficult for the homeless to receive healthcare is the inability for the government to provide public benefits to individuals without a physical street address. The shortage of adequate housing for these individuals also provides a barrier to the individuals achieving a place of residency. Other barriers to the homeless receiving health care include individual factors (mental illness or competing needs,) system factors (availability and cost of healthcare) as well as lack of accessible transportation

What are characteristics and health concerns of the homeless population?

The homeless population lack financial as well as educational resources to obtain health care. There are also a lot of federal restrictions that don't allow persons lacking a home address to receive public benefits. Some overall health concerns of the homeless population include undiagnosed chronic diseases, mental health issues and substance abuse problems. Lack of transportation and competition for basic food and shelter plays a large role in accessing health care. Homeless women: 1 in 4 are homeless because of violence, the economic standing of women is more unstable than men, 18% of homeless families are homeless because of domestic violence. Homeless women face economic and housing needs and special gender-related issues including; pregnancy, childcare responsibilities, domestic violence, fragmented family support, and discrimination. A lot of homeless people do not receive public benefits because there are restrictions for people without an actual street address. Among the homeless there is a high percentage dealing with untreated acute and chronic medical, mental health, and substance abuse problems. Homeless people typically have eight to nine medical conditions or illnesses. They are at a greater risk for assault and victimization regardless if they live on the streets or in a shelter. Many homeless people fall victim to being over heater or too cold and experience overcrowding in shelter or on the streets which leads to communal diseases.

What are the racial/ethnic minority categories in the US?

The racial/ethnic minorities in the United States make up 38% of the US population and are categorized as Black Americans (13.3%), Hispanic or Latino Americans (17.6%), Asians (5.6%), Native Hawaiian and other Pacific Islanders (.2%), American Indian/Alaska Natives (1.2%) and (2.6%) are self-identified as two or more races. White, Black, American Indian/alaska Native, Asian Indian Chinese, Filipino, Japanese, Korean, Vietnamese (other asian), Native Hawaiian, Guamanian or Chamorro, Samoan, other Pacific Islander

What are the health concerns of children?

Three sectors that address health concerns of children include: Personal medical and preventative services: When children have inadequate access to health care, their overall health is diminished Population-based community health services: Making sure children are up to date on immunizations, monitoring child abuse Health related support services: proper nutrition and family support programs Childhood obesity is linked to excess mortality rates 20% of children have chronic medical conditions (asthma most common) Unintentional injuries are the #1 cause of death for children (motor vehicle crashes being #1) Depression also has a huge impact on adolescent development and well being Vaccination rates are varied for children based on race and ethnicity

there are 2 us senators from the commonwealth of Virginia, who are they (remember, the US healthcare system is very political)

Tim Caine, and Mark Warner

True or False "Chronic diseases are now the leading cause of death in the United States?"

True: next to heart disease and cancer. Page 468. 7-10 deaths in the United States each year are from chronic diseases.

True or false: vulnerable populations are likely to be considered economically disadvantaged, suffering the worst under economic downturn.

True: vulnerable populations experience significant barriers in access to quality health care, as well as economically disadvantaged compared to white Americans (pg. 438)

What is the number 1 leading cause of death in children and adolescents?

Unintentional injuries are the leading cause of death for children and adolescents. In 2014 35% of deaths among adolescents age 15-19 and 30% of deaths among children age 1-14 were due to unintentional injuries.

Which of the following is not a targeted area for women's services? A. physical and sexual abuse B. women as caregivers C. women in the workforce D. women with mental and addictive disorder

Women's services is targeting six main areas and we thought that this is important for women's overall health and wellbeing. These include physical and sexual abuse; women as caregivers; women with mental and addictive disorders; women with HIV/AIDS, sexually transmitted diseases, and or TB; elder women; and women detained in criminal justice system. C is the correct answer

What's the goal of the US department of Health and Human Services? a)build more hospitals in rural areas b) promote better health care in rural areas c)Improve preventative care in America d) incentives for physicians to work in rural areas

b

Mental health services are provided through ________ resources in both inpatient and outpatient facilities? a.) private b.) public c.) private & public d.) state

c.) private & public (p.442) These facilities include state and county mental hospitals, private psychiatric hospitals, nonfederal general hospital psychiatric services, VA psychiatric services, residential treatment centers, and freestanding psychiatric outpatient clinics.

1. Brill compares the hospital industry to

colleges and universities

what is a part of the structure part?

facilities

Harry truman did what?

first one to campaigned for universal healthcare, and first one enrolled in medicare

what did lyndon b johnson do?

he signed medicare and medicaid into law and signed the older americans act which funds meals on wheels, senior centers

who did Karen ignani represent?

insurance companies

what is the fastest growing minority group in the US?

latinos

what did george w bush do?

medicare part D (prescription drug coverage) in 2004

what did FDR do?

new deal, social security

chargemaster facts:

not consistent, and theres no real reason for the prices

what is a part of the outcome part?

patient satisfaction

Congress 3 responsibilities:

power to tax, making laws, power to spend

what is respite care?

provides relief for caregivers, older American act sometimes helps to fund this

what are the three parts to the donabedian model?

structure, process, outcomes

Vulnerability can be determined through ecological and individual characteristics.

true

What is a part of the process part?

waiting time, delivery of care

1. Which statement is true in regards to a hospital chargemaster?

• Chargemaster prices are generally much higher than Medicare reimbursement

why does healthcare cost so much?

• The charge master is part of it, and we always talk about who should be paying for healthcare instead of "why is it costing so much." Healthcare costs so much money because we are not controlling the prices, and they mark up the prices because they know we are going to pay for it.