N473 Final

Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?

$2,000 You pay the first $1,000 of the discounted (or allowed) charge because of the deductible, plus 4 copays of $250 per day, or another $1,000. That comes to $1,000 + $1,000, for a total of $2,000 that you pay out of pocket.

Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go out of network. You forget to check and go get your blood test at a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?

$88 Your health plan will pay 60% of the $20 allowed charge, or $12. Because the lab is not in network, it is not required to accept the health insurance's discounted price, which is also called the allowed charge. The lab can bill you for the balance, which is $88.

Descriptive epidemiology can answer which of the following questions? (select all that apply) a. Which municipalities in Puerto Rico (PR) have been most severely affected by Zika virus infections? b. What percent of the lab confirmed cases of Zika virus in PR were in women? c. How does sexual transmission effect the gender disparity in Zika virus transmission? d. Why is Zika virus emerging now in PR?

A, B

Climate-related Processes - define deforestation and desertification Climate Change - _____ effect: climate change has resulted from _____ in the release of ____ gases (CO2, methane, NO), changes in land cover because of human ____, and changes in solar ___ that have altered the energy ____ of the climate system - depletion of ____ layer - overexposure to UV radiation can lead to ____ ____ and ____

Deforestation: the permanent removal of trees to make room for something besides forest. Desertification: the process by which fertile land becomes desert, typically as a result of drought, deforestation, or inappropriate agriculture. Climate change - Greenhouse effect: climate change has resulted from increases in the release of greenhouse gases (CO2, methane, NO), changes in land cover because of human activity, and changes in solar radiance that have altered the energy balance of the climate system - Depletion of ozone layer - Overexposures to UV radiation leads to Skin cancer, cataracts

give an example of a confounding variable

Driving without seatbelts increases the risk of a fatal automobile accident. However, nonusers of seat belts are likely to speed, and speeding is another cause of automobile fatalities. Therefore, some of the apparent benefits of seat belts relate to differing driving speeds of users and nonusers of seat belts. In this example, speeding is a confounding variable.

True or false: If you receive inpatient care at a hospital that participates in your health plan's provider network, all the doctors who care for you while you're in the hospital will also be in network.

False Often doctors who work in a hospital don't work for the hospital.

What is the difference between atmospheric and ground level ozone?

Ground level (bad ozone) - the ozone layer closest to the Earth's surface - an air pollutant that is harmful to breathe and it damages crops, trees, and other vegetation - it is a main ingredient of smog Atmospheric (good ozone) - above the ground level ozone layer - high-altitude - protects life on Earth from the sun's harmful ultraviolet rays

Give an example of dependent and independent variables

The dependent variable is the outcome or result that the investigator is studying. The dependent variable can change (e.g. health status, knowledge, and behavior). The independent behavior is the presumed "cause" of or contributor to variation in the dependent variable. For example, the lack of exercise (the independent variable) contributes to gestational diabetes (dependent variable) Another example: a student studied for 10 hours for her biology exam, and she received an A on the exam. what is the independent and dependent variables? - independent: amount of hours studying - dependent: test grade

Decision Making in Screening: Practical and Ethical Considerations

Read p. 51 !!! Review table 3.3 (sensitivity and specificity of a screening test)

Types of Rates - rates can be broken-down into what 3 categories? Match the following to their correct type of rate a) rates computed for a population as a whole, irrespective of age b) cause specific c) rates computed for subgroups d) ex: mortality/death rate, birth rate e) ex: 75yrs old and over mortality rate, Breast cancer mortality rate, heart disease mortality rate f) can be adjusted for age, race, and gender but are most common for age g) age specific h) a summary measure in which statistical procedures remove the effect of differences in the composition of the various populations

*Crude-rates*: a, d - rates computed for a population as a whole, irrespective of age - ex: Crude mortality/death rate, Crude birth rate *Specific-rates*: b, c, e, g - rates computed for subgroups - Age specific - Cause specific - ex: 75yrs old and over mortality rate, Breast cancer mortality rate, heart disease mortality rate *Adjusted rates*: f, h - a summary measure in which statistical procedures remove the effect of differences in the composition of the various populations - can be adjusted for age, race, and gender but are most common for age

Incidence vs Prevalence: match the following to their correct term a) Allows the estimation of risk necessary to assess causal association (relative risk) b) used to track effectiveness of primary and secondary prevention c) Total number of people in the population who have a condition at a particular point in time d) Number of people who develop a condition during a specified time period (most common calendar year) e) May be calculated in a "one-shot" cross-sectional or retrospective study f) Influenced by rate of new cases, number of existing cases, new treatments, and deaths g) New cases (new diagnoses) h) Generally a prospective study is required to determine this i) Used to describe scope of problem and need for services. j) existing cases, old and new cases

*Incidence*: a, b, d, g, h •Number of people who develop a condition during a specified time period (most common calendar year) - New cases (new diagnoses) - Events (falls, heart attacks, deaths) •Allows the estimation of risk necessary to assess causal association (relative risk) •Generally a prospective study is required to determine incidence •Incidence and incidence rates used to track effectiveness of primary and secondary prevention. *Prevalence*: c, e, f, i, j •Total number of people in the population who have a condition at a particular point in time •May be calculated in a "one-shot" cross-sectional or retrospective study •Influenced by rate of new cases, number of existing cases, new treatments, and deaths •Used to describe scope of problem and need for services. •Period prevalence: Rarely used. Total number of people who have the condition during a specified period of time. Not limited to new cases, which would be incidence.

Heat and Human Health: Personal Risk Factors - ___ (older ___ and children under ___ are at greater risk) - ___-____ medical condition including excess ____ - ____ - ____ (ability to afford ____; ______; adequate shelter from the ____) - acclimation to being in the ____ - amount of ____, ____ and ____ consumed - access to health ____ for heat-related illnesses

- Age (older adults and children under 4 are at greater risk) - Pre-existing medical conditions including excess weight - Medications - Poverty (ability to afford A/C; transportation; adequate shelter from the heat) - Acclimation to being in the heat - Amount of water, alcohol and caffeine consumed - Access to health care for heat-related illnesses

Climate Change, Allergies and Asthma - both ____ temperatures and increasing levels of ____ have been implicated in contributing to the ____ in the percentages of people living with ____ and ____ - ____ temperatures have been linked to ____ ragweed pollen (____) seasons - increasing levels of ___ boost ___ production in ____ plants - both ragweed pollen and ozone air ____ are expected to worsen with higher ___ and ____ temps - worsening of ____ and ____ symptoms - ragweed pollen pollution works _____ with ____ pollution ____ the impact of both on ____ and ____

- Both higher temperatures and increasing levels of carbon dioxide have been implicated in contributing to the increase in the percentages of people living with asthma and allergies. - Higher temperatures have been linked to longer ragweed pollen (allergy) seasons. - Increasing levels of carbon dioxide boost pollen production in ragweed plants - Both ragweed pollen and ozone air pollution are expected to worsen with higher CO2 and warmer temperatures. - Worsening of allergy and asthma symptoms - ragweed pollen pollution works synergistically with ozone pollution magnifying the impact of both on asthma and allergies.

Climate-Health Impacts - extreme _____ events - heat ____ - ____ pollution - pollens and ____ - ____-borne diseases - ____-borne diseases - ____-borne diseases - _____ impacts - ____ and ____ supply insecurity - ____ health impacts - environmental _____

- Extreme Storm Events - Heat Waves - Air Pollution - Pollens and Allergy - Water-borne diseases - Food-borne Diseases - Vector-Borne Diseases - Ecosystem Impacts - Food and Water Supply Insecurity - Mental Health Impacts - Environmental Refugees From ppt notes: While climate change has not be blamed for any one storm, science tells us that increases in carbon pollution have contributed to an increasing intensity and frequency of storms. Warmer temperatures increase the atmospheric moisture content. Extreme flooding created by these storms causes injuries, drowning, water and food contamination (leading to food and water insecurity as well as food and water-borne illnesses), community displacement and outbreaks of infectious diseases. Extreme storms also damage infrastructure and result in health risks such as exacerbation of allergies and respiratory illnesses due to mold.. Air pollution contributes to more smog and respiratory illnesses. Smog is linked to increased hospital admission rates and deaths for people with respiratory diseases such as asthma.. Water-borne diarrheal diseases such as Giardia and Cryptosporidium are associated with heavy rainfall and flooding. Food security is threatening by both floods and droughts. Droughts harm crops, diminish food variety, nutritional content and availability. Warming ocean temperatures bring shifts in range of fish populations. Higher temperatures increase the risk of food-borne illnesses. Warmer and wetter climates are more hospitable to mosquitoes and ticks, affecting patterns of diseases such as dengue fever, West Nile virus and Lyme disease. Dengue Fever, a painful viral vector borne disease, was once limited to South and Central American countries'. There are confirmed cases of Dengue in many of the US southern states and 173 million Americans live in counties with mosquitoes that can carry dengue fever. Environmental refugees are people forces to flee their homes because of rising sea levels, flooding, droughts and desertification. Migration contributes to urban crowding, trauma, social unrest, lack of clean water and transmission of infectious diseases. (National Resources Defense Council, 2011). According to the CDC (2014), extreme weather events can affect mental health in several ways. Following disasters, mental health problems increase , both among people with no history of mental illness, and those at risk. For example, there were high levels of anxiety and post traumatic stress disorder among people affected by Hurricane Katrina. Some patients with mental illness are susceptible to heat. Suicide rates rise with high temperatures, which suggests a potential climate change impact on depression and other mental illnesses. Dementia is a risk factor for hospitalization and death during heat waves. Finally, people living with serious mental illnesses such as schizophrenia are an increased risk for heat related illnesses because their medications may interfere with temperature regulation or even directly cause hyperthermia.

Nursing interventions to promote environmental health in the community: - _____ ______: Reduce/eliminate environmental hazards and protective measures for self care - ______ _____: Market community level strategies on how to promote the environment's health. - ______ to identify at-risk community members who cannot protect themselves/help develop plans to protect them - ______ for environmental health protecting human health through lobbying, community ______, & _____ ______ - _______ for signs of hazardous environmental conditions (during community assessment) - _______ for signs of illness related to environmental hazards in the community - ______ with communities to help them manage the long-term effects of exposure to environmental hazards - _____ ______, _____ and ____-___ for individuals with chronic disease to help them avoid environmental triggers and manage associated symptoms. - ____ diseases and health ____ caused by environmental conditions - ______ __________ and ________ based on existing evidence, the precautionary principle and best practice standards - _______ _________: Provide routine immunizations against diseases caused by biologic agents; provide treatment for individuals with health problems caused by environmental hazards.

- Health Teaching: Reduce/eliminate environmental hazards and protective measures for self care - Social marketing: Market community level strategies on how to promote the environment's health. - Outreach to identify at-risk community members who cannot protect themselves/help develop plans to protect them - Advocate for environmental health protecting human health through lobbying, community organizing, & coalition building - Surveillance for signs of hazardous environmental conditions (during community assessment) - Screening for signs of illness related to environmental hazards in the community - Collaborate with communities to help them manage the long-term effects of exposure to environmental hazards - Case manage, referral and follow-up for individuals with chronic disease to help them avoid environmental triggers and manage associated symptoms. - Investigate diseases and health events caused by environmental conditions - Policy Development and enforcement based on existing evidence, the precautionary principle and best practice standards - Delegated functions: Provide routine immunizations against diseases caused by biologic agents; provide treatment for individuals with health problems caused by environmental hazards.

Ecologic Principles - ____ of ____ - everything is ____ to ____ ___, but some things are ____ more ____ than ____ - everything has to go ____ - everything is _____ _____

- Law of gravity - Everything is connected to everything else, but some things are connected more tightly than others - Everything has to go somewhere - Everything is constantly changing READ p. 62 for examples/details !!!

Physical Environmental Hazards - ____ and other heavy ____ --> one of the most significant ____ risks to ____ - _____: can lead to impaired _____ ____ - ____: #2 leading cause of ___ ____ - ____: problems related to this hazard-- ____, ____ BP, ____ disturbances, lost ____

- Lead and other heavy metals --> One of the most significant environment risks to health --> 535,000 US children ages 1-5 have blood lead levels high enough to damage health --> 24 million homes in the US have dangerous levels of lead - Mercury: Impaired neurological development! - Radon-#2 leading cause of lung cancer! - Noise-NIHL: problems related to noise: stress, HBP, sleep disturbances, lost productivity

Chemical Hazards - ____ - ____ pollution --> indoor: ____, radon, ___ ____, ____ --> outdoor: ____-____ ____, _____ matter - _____ pollution --> _____ pollution

- Pesticides - Air pollution --> Indoor: smoke, radon, carbon monoxide, mold --> Outdoor: ground-level ozone (O3) & particulate matter (PM2.5) - Water Pollution: Pharmaceutical pollution

List the environmental hazards to health

- Physical - Biological - Chemical - Climate-related

Pollution - pollution is the introduction of ____ ___ into the ____ making it not ___ or ____ to use - pollutants: ____ and _____ - pollution is the result of ____ _____ - demographic changes alter ___ inflicted on the ____ - as ____ grows, ____ increases - when a population moves, the ___ and intensity of environmental problems ____

- Pollution is the introduction of harmful substances into the environment making it (land, water, air, etc) not safe or suitable to use. - Pollutants: nondegradable & biodegradable - Pollution is the result of population growth - Demographic changes alter stress inflicted on the environment - As population grows, stress increases - When a population moves, the nature and intensity of environmental problems shift - When a pollutant is introduced: where does it go? how does it get there? how long will it stay? will it enter the food web? & what is the impact on humans and our ecosystem?

Groups considered Vulnerable and Marginalized - ____/ethnic/religious ____ - people living in _____ - ____ and/or seasonal farm workers - _____ (legal or illegal) - people with ____ - people who use illicit ___ - people who abuse ____ - the ____ - people who are morbidly ____ - ____ workers - people with ____ - frail ____ adults - _____ - _____ populations - _____ populations - _____ - people experiencing ______ - people who are/were ____ - people living with ___/____ - informal ____ (family and friends caring for older adults and children/adults with _____)

- Racial/ ethnic/religious minorities* - People living in poverty - Migrant and/or seasonal farm workers (MSFW) - Immigrants (legal or illegal)** - People with SMI - People who use [illicit]drugs (PWUD) - People who abuse ETOH - The uninsured - People who are morbidly obese - Sex Workers - People with disabilities - Frail older adults - Refugees - LGBTQ populations - Rural populations - Veterans - People experiencing homelessness - People who are/were incarcerated - People living with HIV/AIDS - Informal Caregivers (family & friends caring for older adults and children/adults with disabilities)

Major Pollutant Mechanisms: List the 5 pollutant mechanisms and match the following to their correct term a) build up of a toxic substance in an organism over time b) pollutants increase in concentration as they are taken in and passed up through the food web c) harmful pollutants becomes harmless or helpful/harmless substance become harmful d) the dispersing of pollutants, usually by wind and water, from an emissions source to a receptor e) the effect of a combination of pollutants that is greater than the effect of one of the components alone

- Transport: the dispersing of pollutants, usually by wind and water, from an emissions source to a receptor (D) - Transformation: harmful pollutants becomes harmless or helpful/harmless substance become harmful (C) - Bioaccumulation: build up of a toxic substance in an organism over time. (A) - Biomagnification: pollutants increase in concentration as they are taken in and passed up through the food web (B) - Synergism: the effect of a combination of pollutants that is greater than the effect of one of the components alone (ex: Both ozone and tobacco smoke have been shown to potentiate the harmful effects of other pollutants). (E)

The Precautionary Principle - when an _____ raises ___ of ___ to the environment or human ____, ____ measures should be taken even if some cause and effect _____ are not fully established _____ - even in the absence of ____ and _____ evidence, the appropriate course of action is to err on the side of ____ - based on ____ principles of ___-____, ___ ____, and ____ ____ principle of "better ___ than sorry" - used to guide ____ health ____ - Is environmental health a human right?

- When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically" - Even in the absence of certainty and scientific evidence, the appropriate course of action is to err on the side of caution - Based on ethical principles of non-maleficence, social justice & common sense principle of "better safe than sorry" - Used to guide environmental health policy - Is environmental health a human right: yes, environmental health is a human right and is listed as such in the International Bill of Human Rights

The Epidemiologic Triangle - aka: ____-____-____ model - ____ view of health and disease developed when epidemiology was concerned chiefly with ____ disease, however this model is also applicable to other health conditions - in the model, the agent is an ____ capable of causing ____ - the host is the ____ at ___ for developing the ____ - the environment is a combination of ____, ____, and ____ factors that surround and influence both the ___ and the ____ - this model is used to analyze the ____ and _____ of each of the factors - according to this model, the agent, host, and environment can ____

- aka: agent-host-environment model - traditional view of health and disease developed when epidemiology was concerned chiefly with communicable disease, however this model is also applicable to other health conditions - in the model, the agent is an organism capable of causing disease - the host is the population at risk for developing the disease - the environment is a combination of physical, biologic, and social factors that surround and influence both the agent and the host - this model is used to analyze the role and interrelatedness of each of the factors - according to this model, the agent, host, and environment can coexist

The Person-Place-Time Model - this type of model examines the characteristics of the ____ affected, the ____ or ____, and the ___ ___ involved - What type of epidemiological study uses this model, analytic or descriptive?

- this model examines the characteristics of the people affected, the place or location, and the time period involved •What type of epidemiological study uses this model, analytic or descriptive: Descriptive

Health Insurance Literacy ppt

1. Discuss health insurance literacy as a social determinant of health 2. Define the key components of an insurance plan 3. Compare and contrast the primary private and government health insurance programs 4. Explain 3 alternatives to health insurance for selected populations 5. Describe the impact of the ACA on private and government sponsored health insurance 6. Develop nursing interventions for individuals/families and communities with limited health insurance literacy

Environmental Health ppt

1. Explain the ecologic mechanisms that affect human health. 2. Discuss the environmental issues affecting health. 3. Describe the physical, biologic, chemical and climate-related hazards to human health. 4. Identify the related health effects and those populations at greatest risk for the above hazards. 5. Apply the principles of ecology to nursing interventions to promote the health of communities.

Epidemiology and Population Health Nursing ppt

1. Explain the science of epidemiology. 2. Differentiate between descriptive and analytic epidemiology. 3. Assess and report risk in populations using descriptive measures of health. 4. Examine the considerations in deciding to screen for health conditions in a population. 5. Analyze cause and association. 6. Summarize the different sources of community health data. 7. Inspect three epidemiological models: the epidemiology triangle, person-place-time model and the web of causation

ACA Select provisions affecting individuals with private insurance 1. Requires individuals to have ____, with some _____ (_____ _____) 2. Plans must cover ____ ____ on ____ policies until age ____ 3. ____-_____ conditions: one's health, medical ____, and ____ can't affect _____ 4. Ends ____ and yearly ____ limits on ____ of essential health ____ 5. Mandates essential health ____ that all ____ must cover (including ____ ____ and _____ abuse) 6. No ___ or ___ for certain ____ services 7. _____ can no longer cancel health _____ because an individual got _____

1.Requires individuals to have insurance, with some exceptions (individual mandate). (The original law included a tax penalty for those who did not have health insurance, but congress passed a tax law in December 2017 eliminating the penalty, starting in 2019. So mandate remains, but there are no consequences for not following the law. Something I was not aware of, was that A handful of states still have tax penalties for those without health insurance.) 2.Plans must cover young adults on parents policies until age 26 3.Pre-existing conditions: One's health; medical history and gender can't affect premiums 4.Ends lifetime and yearly dollar limits on coverage of essential health benefits (That means your coverage won't run out, even if you have a costly medical condition; Essential services are: mental health and substance abuse treatment, maternity and newborn care, hospitalizations, outpatient care, laboratory services, emergency care, prescription drugs, rehab, pediatric care and preventive services) 5.Mandates essential health benefits that all plans must cover (including mental health and substance abuse) 6.No copays or coinsurance for certain preventive services. 7. Insurers can no longer cancel health insurance because an individual got sick

Which programs can be used by undocumented immigrants? a) ACA subsidies b) CHIP c) Community health centers d) State Medicaid programs

C

Analytic epidemiology can answer which of the following questions? (select all that apply) a. Which municipalities in Puerto Rico (PR) have been most severely affected by Zika virus infections? b. What percent of the lab confirmed cases of Zika virus in PR were in women? c. How does sexual transmission effect the gender disparity in Zika virus transmission? d. Why is Zika virus emerging now in PR?

C, D

Climate Health Impacts: Vulnerability factors Individual susceptibilities - underlying ____ conditions and limited ____ Demographics - age: ___ and __+ - ____ disadvantaged Housing - ___ of ____, ____ materials, ___ _____ Geography - ____ areas: ___ levels rise, ____ surges - ____ areas

Individual susceptibilities - Underlying medical conditions and limited mobility Demographics - Age (children and 65+) - Economically disadvantaged Housing - Floor of building, building materials, air conditioning Geography - Coastal areas: Sea Levels rise; storm surges - Urban areas In the US, the greatest climate-related risk to health comes from extreme heat events. The number of deaths and illnesses occurring from heat stress, heatstroke, as well as cardiovascular disease, respiratory, and kidney disease increases as temperature increase. On average in the US, extreme heat causes more weather-related fatalities than any other event, including hurricanes and floods

Rationale for Focus on Vulnerable Populations-- Many VPs are increasing in numbers (and percent of population): - some racial and ethnic ____ populations - people experiencing ____ - refugees and ____ - frail ____ adults - people who abuse ____ and ____ - people living with _____ - the _____ - people living in ____

Many VPs are increasing in numbers (and percent of population): •Some racial and ethnic minority populations •People experiencing homelessness •Refugees and immigrants •Frail older adults •People who abuse drugs and alcohol •People living with serious mental illness •The uninsured •People living in poverty

Commonly Used Rates

Measures of Natality: - Crude birth rate Measures of Morbidity and Mortality: - Crude death rate

Are natality and mortality rates incidence rates or prevalence rates?

Measures of natality and mortality are, in essence, measures of *incidence* of the conditions of "being born" and "dying" (p. 41)

Commonly Used Rates examples

Need to know!! Box 3.1 (p. 42)

Period Prevalence - rarely ___ - total ____ of people who have the ____ during a ____ ____ of time. not limited to ___ ___, which would be ____

Rarely used. Total number of people who have the condition during a specified period of time. Not limited to new cases, which would be incidence.

Biologic Hazards Pollutants - animal ____ - ___ mites - ____ parts - ___/mold - _____ - _____ Sources - septic ___ and untreated ____ - ____ flow - medical ____ - improperly cleaned ___, heating units, _____ - unvented ____ and rooms - water ____ - infectious ___ and ____ hosts

Pollutants - Animal dander - Dust mites - Cockroach parts - Fungi/mold - Bacteria - Viruses Sources - Septic tanks & untreated sewage - Rainwater flow - Medical waste - Improperly cleaned A/C, heating units & humidifiers - Unvented appliances and rooms - Water damage - Infectious human and animal hosts

Proportionate mortality rate (PMR) - ____ of ____ from a _____ cause - _____ name; not a true ____, it's a ____ - usually expressed as a ____ - numerator: the number of ____ from a ____ ____ (such as ____) - denominator: the ____ number of ____ - differs from cause ____ death rate where the denominator is the population at ____

Proportion of deaths from a specific cause -Misleading name. Not a true rate! It's a proportion. -Usually expressed as a percent -Numerator is the number of deaths from a specific cause, such as cancer. Denominator is total number of deaths -Differs from cause specific death rate where the denominator is population at risk - mathematically the PMR is expressed as: [(number of deaths due to a specific cause) / (total number of deaths from all causes)] x 100

Risk Factors associated with poor health insurance literacy Race and ____ - highest literacy is among who? - lowest literacy is among ____ and ethnic ____, esp. ____ ____ ____ groups - ____ adults lowest _____ - unstable ____ - access to ____ and the ____ Education - low ___ ____ - low ____/____ literacy - limited ____ Lack of previous ____ ____ coverage

Race and ethnicity -Highest literacy is among non-Hispanic whites -Lowest literacy is among racial and ethnic minorities, esp. low income minority groups (Hispanic adults lowest) Poverty -Unstable housing -Access to phones and the Internet Education -Low health literacy -Low financial/math literacy -Limited eLiteracy Lack of previous health insurance coverage

Examples of cost-sharing?

Some examples of cost sharing are *copayments, deductibles, and coinsurance*. Family cost sharing is the share of cost for deductibles and out-of-pocket costs you and your spouse and/or child(ren) must pay out of your own pocket. Other costs, including your premiums, penalties you may have to pay or the cost of care a plan doesn't cover usually are not considered cost sharing.

T or F: the independent variable causes a change in the dependent variable and it isn't possible that the dependent variable could cause a change in independent variable

TRUE the dependent variable depends on other factors such as independent variables (i.e. hours studying, exercising)

Health Insurance Literacy (HIL) - the capacity to find and evaluate _____ about health ____ ____, select the best ___ given ____ and ____ circumstances, and use the plan once _____

The capacity to find and evaluate information about a health insurance plans, select the best plan given financial and health circumstances, and use the plan once enrolled

True or false? If your health insurance or health plan refuses to pay for a service that you think is covered and your doctor says you need, you can appeal the denial and possibly get the insurance company to pay the claim.

True

Factors that can affect a health insurance plans monthly premium - where an individual _____ - ____ - _____ use - plan ____ - whether the plan covers _____

While a pre-existing condition cannot impact premiums, factors which can affect a plans monthly premium is where an individual lives, age, tobacco use, plan category and whether the plan covers dependents.

Which of the following best describes a health plan "provider network?" a) The hospitals and doctors that contract with your health plan to provide services for an agreed-upon rate or fee schedule. b) The computer system doctors and hospitals use to submit bills to insurance companies. c) A website where consumers can find information about the best doctors.

a) The hospitals and doctors that contract with your health plan to provide services for an agreed-upon rate or fee schedule.

Is a health insurance premium something you must pay every month, regardless of whether you use health care services, or do you only have to pay your health insurance premium during months when you use health care services? a) Must pay every month, regardless of whether you use services. b) Only have to pay in months when you use health care services.

a) Must pay every month, regardless of whether you use services.

Which of the following best describes the "annual out-of-pocket limit" under a health insurance policy? a) The most you will have to pay in deductibles, copays, and coinsurance for covered care received in network for the year. b) The most your insurance policy will pay for covered services in a year. c) The most you will have to pay for premiums in a year.

a) The most you will have to pay in deductibles, copays, and coinsurance for covered care received in network for the year. Health plans sold through the Marketplace and most employer health plans must cap the amount you are required to pay each year in deductibles, copays, and coinsurance for covered services received in network.

Which of the following is the best definition of the term "health insurance premium?" a) The best type of health insurance you can buy. b) The amount health insurance companies charge each month for coverage. c) A bonus you get at the end of the year if you stay covered.

b) The amount health insurance companies charge each month for coverage.

The ACA mandates that health insurance companies can no longer increase an individual's premiums or deny coverage based on which factors? (select all that apply) a) age b) pre-existing conditions c) gender d) tobacco use

b, c

Which of the following is the best definition of the term "annual health insurance deductible?" a) The amount that is deducted from your paycheck each year to pay for your policy. b) The amount of health expenses you can subtract from income on your yearly tax return. c) The amount of covered health care expenses you must pay yourself each year before your insurance will begin to pay.

c) The amount of covered health care expenses you must pay yourself each year before your insurance will begin to pay.

Which of the following best describes a "health insurance formulary?" a) The form you send to your insurance company when you need to have a medical bill paid. b) The name for permission you must get from your insurance company before surgery will be covered. c) The list of prescription drugs your health plan will cover.

c) The list of prescription drugs your health plan will cover.

Analytic Epidemiology - the ___ and the ___ of health and ____ - determinants of ___ and ____ - tests ___ or seeks answers to specific ____ - can be ____ or ____ in design

• The "how" and the "why" of health and disease • Determinants of disease and causality • Tests hypotheses or seeks answers to specific questions • Can be retrospective or prospective in design

Define Key Components of an Insurance Plan a) An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. b) The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. c) A provider who doesn't have a contract with your plan to provide services. If your plan covers out-of-network services, you'll usually pay more to see this type of provider d) Your share of costs for services that a plan covers that you must pay out of your own pocket (sometimes called "out-of-pocket costs"). e) Equipment and supplies ordered by a health care provider for everyday or extended use. f) our share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service g) Routine health care, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems. h) Yearly amount the federal government sets as the most each individual or family can be required to pay in cost sharing during the plan year for covered, in-network services. i) A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law and the terms of the plan, who provides, coordinates or helps you access a range of health care services j) A provider who has a contract with your health insurer or plan who has agreed to provide services to members of a plan. You will pay less if you see a provider in the network. k) A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. l) A list of drugs your plan covers. A formulary may include how much your share of the cost is for each drug. m) The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. n) A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary.

•*Premium*: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. (M) •*Cost Sharing*: Your share of costs for services that a plan covers that you must pay out of your own pocket (sometimes called "out-of-pocket costs"). Some examples of cost sharing are copayments, deductibles, and coinsurance. Family cost sharing is the share of cost for deductibles and out-of-pocket costs you and your spouse and/or child(ren) must pay out of your own pocket. Other costs, including your premiums, penalties you may have to pay or the cost of care a plan doesn't cover usually are not considered cost sharing. (D) --> *Deductible*: An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. A plan may also have only separate deductibles. (For example, if your deductible is $1000, your plan won't pay anything until you've met your $1000 deductible for covered health care services subject to the deductible.) (A) --> *Co-pays* (Copayment): A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. (K) --> *Co-Insurance*: Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. (For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.) (F) •*Primary Care Provider* (PCP): A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law and the terms of the plan, who provides, coordinates or helps you access a range of health care services (I) •*Preauthorization*: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn't a promise your health insurance or plan will cover the cost (N) •*Formulary*: A list of drugs your plan covers. A formulary may include how much your share of the cost is for each drug. Your plan may place drugs at different cost sharing levels or tiers. For example, a formulary may include generic drug and brand name drug tiers and different cost sharing amounts will apply to each tier. (L) •*Network*: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. (B) •*Preferred provider or network provider*: A provider who has a contract with your health insurer or plan who has agreed to provide services to members of a plan. You will pay less if you see a provider in the network. Also called "preferred provider" or "participating provider." (J) •*Out-of-Network Provider (Non-preferred provider)*: A provider who doesn't have a contract with your plan to provide services. If your plan covers out-of-network services, you'll usually pay more to see an out-of-network provider than a preferred provider. Your policy will explain what those costs may be. May also be called "non-preferred" or "non-participating" instead of "out-of-network provider". (C) •*Maximum Out-of Pocket Limit*: Yearly amount the federal government sets as the most each individual or family can be required to pay in cost sharing during the plan year for covered, in-network services. Applies to most types of health plans and insurance. This amount may be higher than the out-ofpocket limits stated for your plan. (H) •*Durable Medical Equipment (DME)*: Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include: oxygen equipment, wheelchairs and crutches. (E) •*Preventive Services*: Routine health care, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems. (G)

Health Insurance - a contract that requires a health ____ to pay ___ or ____ of an individuals health care ____ in exchange for a ____ - according to the US Census (2017), ___% of the US population had insurance all or part of 2017

•A contract that requires a health insurer to pay some or all of an individuals health care costs in exchange for a premium. A health insurance contract may also be called a policy or plan (CMM, n.d.) (Health insurance is basically a contract between a health insurer and an individual whereby an individual and/or an organization (such as an employer or the government) pays a premium and the insurer covers some or all of the individuals health care costs.) •According to the US Census (2017), 91.2% of the US population had insurance all or part of 2017.

Government Source: Medicare A ____ health insurance program for who? Parts: __, __, __, and ____ ____ policies - describe each part

•A federal health insurance program for: -People who are 65 and older -Certain younger people with disabilities -People with End-Stage Renal Disease requiring dialysis or transplant •Parts: A, B, & D + Supplemental policies -Medicare A (*hospital insurance*) -Medicare B (*medical insurance*) -Medicare D (optional; offered by private insurance; covers *prescription drugs*) -*Supplemental (Medigap) policies* which pay for deductibles, services and copays not covered by Medicare

Indian Health Service - a health care ____ for members of one of the ____ _____ recognized American ____ and ____ Native tribes in the US - IHS is a health care _____, not a health _____ system, or ____ program, or an established _____ package - consists of ___ hospitals, 59 health centers, 32 health ____, and 33 urban health ____ - most personal and public health care is provided directly by IHS staff at their ____. Some care can be provided by ___ facilities contracted by IHS, and very occasionally by ___-____ contracted _____ services - provides care for approximately ___ million American ___ and ____ _____

•A health care system for members of one of the 573 federally recognized American Indian and Alaska Native tribes in the United States. - IHS is a health care system, not a health insurance system, an entitlement program, or an established benefits package •Consists of 26 hospitals, 59 health centers, 32 health stations, and 33 urban health projects. •Most personal and public health care is provided directly by IHS staff at their facilities. Some care can be provided by tribal facilities contracted by IHS, and very occasionally by non-native contracted health services •Provides care for approximately 2.2 million American Indians and Alaskan Natives.

Epidemiology - a science for studying ____ _____ - the study of the ____ and ____ of health-related states in _____ - is a ____ discipline; based on ____ and ____ methods - goal of epidemiology is to control ____ ____ - some have ____/____ focus - more recently includes ____, health ____ strategies, injury, _____ conditions, etc

•A science for studying population health •The study of the distribution and determinants of health-related states in populations •Is a quantitative discipline; based on statistics and research methods. •Goal of epidemiology is to control health problems •Some have morbidity/mortality focus •More recently includes lifestyles, health-promotion strategies, injury, environmental conditions, etc

Key Provisions Impacting Medicare-- ACA: multiple provisions re Medicare program - free ____ for some ____ _____ - ____ premiums for ____ ____ beneficiaries - ____ ____ to hospitals and others HCPs/services - average monthly enrollment: ___ million people in 2017

•ACA: multiple provisions re Medicare program: E.g. free coverage for some preventive benefits; increased premiums for high income beneficiaries; reduced payments to hospitals and other HCPs/services •Average monthly enrollment: 58.5 million people in FY 2017

Demographics That May Affect Health Outcome - ___ - race - ____ - ethnicity - ____ - ____ - ____ level - ____ spoken at home - ____/employment status - ____ status/household type

•Age •Race •Sex •Ethnicity •Ancestry •Income •Educational level •Language spoken at home •Occupation/Employment status •Marital status/household type

You are asked to provide the number of patients with an active case of the COVID in a long-term care setting on October 9, 2020. This is an example of: a. Incidence b. Incidence rate c. Prevalence d. Prevalence rate

•Answer: c •The prevalence of a disease or condition refers to the total number of people in the population who have the condition at a particular time. Thus, prevalence may be calculated in a "one-shot" cross-sectional ("slice of time") or retrospective (backward looking) study.

Nurses Role in Health Insurance Literacy - _____: may include health and health ____ ____, whether they have _____, services covered, eligibility for ____ and health insurance coverage - health _____: providing information in ____ ____ - ____ and ____-____ --> for help with ____ --> for ___ or no ___ health ____ - _____ - ____ _____

•Assessment: may include health and health insurance literacy, whether they have insurance, services covered, eligibility for insurance and health insurance coverage •Health Teaching -Providing Information in plain language •Referral and Follow-up -For help with insurance -For low or no cost health care •Advocacy •Case management

Criteria for Evaluating Causation - association is _____ - association is _____ - association is temporally _____ - association is _____ - association is not the ____ of a ____ _____ - association is _____ and ____ with current _____

•Association is strong •Association is consistent •Association is temporally correct •Association is specific •Association is not the result of a confounding variable •Association is plausible and consistent with current knowledge Read p. 47 for details!!!!!

Consequences of Poor Health Insurance Literacy - being ____ or ____ ____ - making ____ insurance _____ --> not selecting the ____ plan for considering ____ --> frustration in using ___ leading to ____ _____ - inefficient use of _____ - _____ access to care due to high ____-____-____ costs - high medical ____ and medical _____ --> poor ____ ____ and _____ - poor _____ outcomes

•Being uninsured or under insured •Making poor insurance decisions -Not selecting the right plan for considering needs -Frustration in using plan leading to dropping insurance •Inefficient use of insurance •Limiting access to care due to high out of pocket costs •High medical bills and medical debt -Poor credit scores and bankruptcies •Poor health outcomes

Affordable Care Act (ACA) - comprehensive health _____ ____ law est in ____ - other names for this Act? - 4 main goals: --> _____ access to health _____ --> ____ consumer _____ --> emphasize ____ and _____ --> _____ _____ health care _____ - multiple provisions: some ____, some not; impacting both ____ and ____ insurance

•Comprehensive health care reform law (2010) •Aka: Obamacare or Patient Protection and Affordable Care Act ; P.L.111-148 •4 main goals: --> increase access to health insurance, --> increase consumer protections, --> emphasize prevention and wellness and --> reduce rising health care costs •Multiple provisions: Some popular, some not; impacting both private and government insurance

Descriptive Measures of Health - _____ - ____ and ____ statistics --> ____ and ____ --> ratios, _____, PMR, ___-____ rates ---> ____ rates

•Demographics •Morbidity and Mortality Statistics -Incidence and prevalence -Ratios, proportions, PMR and case-fatality rates -True rates

List the 3 Types of Variables Match the following to their correct variable: a) the outcome or result that the investigator is studying b) an extraneous factor that is statistically related to the independent variable thus possibly affecting the outcome or dependent variable c) health status, knowledge, behavior d) the presumed cause or contributor to the variation in the dependent variable

•Dependent variable: the outcome or result that the investigator is studying (A, C) -Health status -Knowledge -Behavior •Independent variable: the presumed cause or contributor to the variation in the dependent variable (D) •Confounding variable: an extraneous factor that is statistically related to the independent variable thus possibly affecting the outcome or dependent variable. (B)

HP2030 addresses vulnerable populations and health disparities in 2 of their 5 overarching goals: - eliminate health _____, achieve health _____, attain health ____ to improve the health and well-being for ____ - create ____, physical, and _____ environments that promote attaining the full potential for health and well-being for ____

•Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of *all*. •Create social, physical, and economic environments that promote attaining the full potential for health and well-being for *all*.

Community Resources for the Care of the Uninsured - ____ ____ (1985 ____ Law) - ____ Qualified ____ _____ --> Community ____ ___; Rural Health ____; Migrant ____ Centers; Health Care for the ____ --> ____ _____ --> Tucson: ___ Rio, St. ____, Marana ___ ____ - Free ____ (Clinica ____) - Pima County ___ ____ --> ____ ____ Clinic --> ____ for Children Program - Pima Community ___ ____ All of the above serve populations regardless of the ability to ____ (____ ____) and ____ status

•Emergency rooms (1985 Federal Law): requires hospitals to screen and stabilize all emergency patients regardless of their insurance or citizenship status; Emergency Medicaid reimburses hospitals for emergency treatment for the poor who are ineligible for Medicaid and have no ability to pay for the services •Federally Qualified Health Centers (FQHC) -Community Health Centers; Rural Health Clinics; Migrant Health Centers, Health Care for the Homeless -Sliding scale: El Rio Health offers a Sliding Fee Scale to all income eligible uninsured or under‐insured patients. This program allows qualifying patients to receive care at a lower cost. Eligibility for the sliding fee scale will be established by determining the household size and annual household income. -Tucson: El Rio, St. Elizabeth's; Marana Health Centers •Free clinics (Clinica Amistad) •Pima County Health Department -Family Planning Clinic -Vaccines for Children program •Pima Community Access Program (PCAP) All of the above serve populations regardless of the ability to pay (sliding scale) and immigration status.

Healthcare Cost Sharing Ministries - ____-based organization that facilitate ____ of health ___ ____ among _____ - members pay their ___ ___ every ____ - usually ___-pay for health ___; plans then ____ members after the ____ (some may pay providers ____) - open to members who must follow the ____ of their ____ ____ - used to replace ____ insurance or _____ ____ plans - exempted from most ____ regulations --> HCSM members exempted from the ____ _____ --> may deny enrollment based on ____ ____; may exclude care for ____ ____ - no ____ for ____; no ____ ____ - covers over a ____ members

•Faith-based org. that facilitate sharing of health care costs among members. •Members pay their fair share every month. •Usually self-pay for health care; plans then reimburse members after the fact (some may pay providers directly) •Open to members who must follow the practices of their faith community •Used to replace health insurance or Medicare supplemental plans •Exempted from most ACA regulations -HCSM members exempted from the individual mandate -May deny enrollment based on health status; may exclude care for preexisting conditions •No guarantees for reimbursement; no consumer protection •Over a million members

Government Source: Tricare - formerly known as what? - health ____ program for ____ ____ and ____ _____ ____ members and their ____ (similar to ____ ____ insurance) - has ____-care and ____-____ options - care is provided at ____ ____ facilities or by ____ HCPs, depending on the plan - covers almost ___ million people

•Formerly known as CHAMPUS •Health insurance program for active duty and retired uniformed service members and their families (similar to private employer insurance) •Has managed-care and preferred-provider options •Care is provided at military treatment facilities or by private health care providers, depending on the plan •Covers almost 9.4 million people

List Government and Private Alternatives to Health Insurance

•Government -Veteran's Health Care System -Indian Health Service •Private -Health Care Cost Sharing Ministries

Who pays for health insurance: Private Sources Group (usually ____-based) health insurance - ____/____ ____ costs - ____ million people _____ purchased health insurance plans - directly from ____ ____ - _____ - insurance ____ or brokers - purchased through a ____ (____); Health Insurance ____ or _____

•Group (usually employer-based) health insurance -Employer/employee share costs -155 million people •Individually purchased health insurance plans -Directly from insurance company -eHealth (a private online marketplace for health insurance) -Insurance agents or brokers -Purchased through a government (ACA) Health Insurance Marketplace or Exchange (health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance)

Government: Children's Health Insurance Program (CHIP) - health insurance for ___ ____ ____ whose family has income ____ the ____-___ for ____ eligibility - administered by ____, based on ____ guidelines - funded by who? - benefits may vary ____ to ____ --> some states include ____ (including AZ) - in AZ, the CHIP program is called _____ - avg monthly enrollment: ___ million people in 2017

•Health insurance for low income children whose family has income above the cut-off for Medicaid eligibility •Administered by state, based on federal guidelines; funded by state & feds •Benefits may vary state by state -Some states include dental (including Arizona) (Medicaid.gov) •In Arizona, the CHIP program is called KidsCare •Average monthly enrollment: 6.7 million people in FY 2017

Why do people remain uninsured: - ____ cost of insurance - ____ for work-____ insurance --> the working ____ - ____ for ____ programs --> live in states that did not ____ ____ --> _____ (___; undocumented) _____ - poor ___ insurance _____ --> about ____ --> ____ --> ____ in selecting a plan

•High cost of insurance •Ineligible for work-sponsored insurance -The working poor •Ineligible for government programs -Live in states that did not expand Medicaid -Unauthorized (illegal; undocumented) immigrants •Poor health insurance literacy -About eligibility -Process -Confidence in selecting a plan

Contributions of Epidemiology - identification of ____ factors - pinpoint ____ ____ factors - promotes ____ changes - ____ policy _____ - promotes a healthy ____ - ____ and disease ____ - health ____

•Identification of risk factors •Pinpoint modifiable risk factors •Promotes lifestyle changes •Public policy modifications •Promotes a healthy environment •Injury and disease prevention •Health promotion

Match the following to their correct terms a) Based on a 2013 national survey, there was an estimate of people identified as living with ALS as 5.0 people per 100,000 population at the time of the survey b) 3,370 (new) cases of acute Hepatitis B virus (HBV) infection were reported to the CDC in 2015 c) Based on a 2013 national survey, there were 15,908 people identified as living with amyotropic lateral sclerosis (ALS) d) There were 1.1 (new) cases of HBV infection per 100,000 population in 2015.

•Incidence: 3,370 (new) cases of acute Hepatitis B virus (HBV) infection were reported to the CDC in 2015. (B) •Incidence rate: There were 1.1 (new) cases of HBV infection per 100,000 population in 2015. (D) -Can also be expressed as % (number of people with condition per 100 population) Not common though. •Prevalence: Based on a 2013 national survey, there were 15,908 people identified as living with amyotropic lateral sclerosis (ALS) (C) •Prevalence rate: Based on a 2013 national survey, there was an estimate of people identified as living with ALS as 5.0 people per 100,000 population at the time of the survey (A) -For more common diseases, a prevalence rate might be expressed as a percent: 9.4% of population has diabetes (9.4 people out of 100 have diabetes)

Government Source: Medicaid - ____ ____ and ____ health insurance program for who? - ____ match ____ spending - eligibility and covered services vary ____ to _____ - covers care for ___% of ____ ____ residents - covers ____ premiums and ____ for ___ ___ older ____ - in Arizona, our ___ program is called Arizona Health Care ____ _____ System - ACA: gave states the ____ to ____ ___ through ____ ____. As of 2018, ___ states have adopted the _____

•Joint federal and state health insurance program for people with low income (feds match state spending) •Eligibility and covered services vary state to state •Covers care for 60% of nursing home residents •Covers Medicare premiums and copays for low income older adults •In Arizona, our Medicaid program is called Arizona Health Care Cost Containment System (AHCCCS or ACC) •ACA: gave states the $ to expand Medicaid through increased eligibility. As of 2018, 34 states have adopted the expansion.

Government: ACA Subsidies - key ____ of the ACA - provides government _____ to ____ ____ _____ and ___-__-____ costs (called ____ _____) - for people with ____ or ____ ____ who purchase their ____ health _____ - health insurance must be _____ through a ______-sponsored health insurance ______ (______) - does not impact people on ____ or those with _____-sponsored health insurance - ___ million people received subsidies in 2016

•Key provision of the ACA •Provides government subsidies to reduce monthly premiums and out of pocket costs (called tax credits) •For people with low or moderate incomes who purchase their own health insurance •Health insurance must be purchased through a government-sponsored health insurance marketplace (exchange). •Does not impact people on Medicare or those with employee-sponsored health insurance •Ten million people received subsidies in 2016 ACA subsidy definition: Obamacare offers subsidies, also known as tax credits, that work on a sliding scale. They limit the amount you pay in monthly premiums to a percentage of your annual income. Most people are eligible for subsidies when they earn 400% or less of the federal poverty level.

Match the following to their correct Type of Private Insurance Plans a) covers providers out of network, but at an increased cost b) cover only care provided by doctors and hospitals inside the HMO's network. Members often need to sign up with a PCP, and that provider becomes the gate keeper. Often require members to get a referral from their PCP for other services and specialists. Often the least expensive but most restrictive. c) have grown in popularity significantly over the last 5 years as insurance costs have skyrocketed. Premiums are significantly lower than the others, but there are much higher out of pocket costs. Many HDHP plans have deductibles well over $3000 d) usually have higher premiums and deductibles, but offer greater flexibility. Less costly to use Preferred providers, but can use out of Network providers. Also don't need referrals e) special accounts that may be offered with HDHP. People have $ deducted from their paychecks into an account which they can be used to pay for out of pocket medical and dental bills. Some companies offering these HDHP with an HSA also contribute to these HSA accounts. g) limits providers to those in network

•Limited industry standard •List ranges from most expensive with most flexibility/coverage/choice to choice least expensive/coverage/choice 1.Preferred provider organizations (PPO): usually have higher premiums and deductibles, but offer greater flexibility. Less costly to use Preferred providers, but can use out of Network providers. Also don't need referrals (D) 2.Health maintenance organizations (HMO): cover only care provided by doctors and hospitals inside the HMO's network. Members often need to sign up with a PCP, and that provider becomes the gate keeper. Often require members to get a referral from their PCP for other services and specialists. Often the least expensive but most restrictive. (B) 3.Point of services (POS): covers providers out of network, but at an increased cost (A) 4.Exclusive provider organizations (EPO): limits providers to those in network (G) 5.High Deductible Health Plans (HDHP): have grown in popularity significantly over the last 5 years as insurance costs have skyrocketed. Premiums are significantly lower than the others, but there are much higher out of pocket costs. Many HDHP plans have deductibles well over $3000 (C) --> A.) Health Savings Account (HSA): special accounts that may be offered with HDHP. People have $ deducted from their paychecks into an account which they can be used to pay for out of pocket medical and dental bills. Some companies offering these HDHP with an HSA also contribute to these HSA accounts. (E)

List the types of Private Insurance Plans The list ranges from ____ ____ with most ____/_____/____ to ____ ____/____/_____

•Limited industry standard •List ranges from most expensive with most flexibility/coverage/choice to least expensive/coverage/choice 1.Preferred provider organizations (PPO) 2.Health maintenance organizations (HMO) 3.Point of services (POS) 4.Exclusive provider organizations (EPO) 5.High Deductible Health Plans (HDHP) --> A. Health Savings Account (HSA)

Veterans Health Administration - many but not all ____ are eligible for ___ health ____ - the VA defines a veteran as what? - health ____ can vary significantly and are based on a ____ system which considers: --> ____ service, --> _____ ____, --> ____ level, --> and other criteria - care for some is ____; for others there are ____ - care provided at VA medical centers and ____ clinics. Some care is provided by ____ HCPs under limited conditions - serves about ___ million Veterans a year

•Many but not all veterans are eligible for VA health benefits - The VA defines a veteran as one who served in active military service and has been discharged or relieved under conditions other than dishonorable. •Health benefits can vary significantly and are based on a priority system which considers military service, disability rating, income level, and other criteria. •Care for some is free; for others there are copays •Care provided at VA medical centers and outpatient clinics. Some care is provided by community health care providers under limited conditions. •Serves about 9 million Veterans a year

Rates - measure the amount of ____, injury, or ___ within a unit of the ____ and within a unit of ____ - enable researchers to compare different ____ in terms of health ____ - ____ reliable when based on small numbers - usually based on data from a ____ ____ - the denominator in the equation (for rate) is the ____ at ____

•Measure the amount of disease, injury, or death within a unit of the population and within a unit of time •Enable researchers to compare different populations in terms of health risk •Less reliable when based on small numbers •Usually based on data from a calendar year •Commonly Used Rates (Box 3.1) -Measures of Natality (scientific term for birth rate) -Measures of Morbidity and Mortality •You do need to know that the denominator in the equation is the population at risk!

Who pays for health insurance: Government Sources - _____ - _____ - _____ - ____ ____ - government as an ____: ____

•Medicare •Medicaid •Children's Health Insurance Program (CHIP) •ACA Subsidies •Government as an employer -TriCare

Descriptive Epidemiology - person, ___, and ____ of the health ____ - distribution of ____ - patterns of health ___ according to ___, ____, and ____ - compares _____ groups and ____ groups - suggests ____ for further study - descriptive studies usually ____ ____ ones - generate ____ and _____ statistics

•Person, place and time of the health problem -Distribution of frequencies -Patterns of health events according to "person," "place," and "time" •Compares affected groups and unaffected groups •Suggests hypotheses for further study •Descriptive studies usually precede analytic ones •Generate morbidity and mortality statistics

Who pays for health insurance?

•Private sources •Government sources

Screening Tests Purpose: - to ____ and ____ identify ____ people who have a ____ probability of having or developing an _____ - so they can be ____ for diagnosis and _____ Screenings do not _____ - positive screen are ___ for further ____ and ____ Considerations in deciding to screen - early ____ and ____ can ____ alter the course of the ____ - definitive ___ and ____ facilities are available, either through the screening agency or through ____ - the group being screened is at ____ for the ____ - the screening ____ are ____ and ____

•Purpose: -to rapidly and economically identify asymptomatic people who have a high probability of having or developing an illness -So they can be referred for diagnosis and treatment •Screenings do not diagnose; -positive screens are referred for further workup and diagnosis •Considerations in deciding to screen - early diagnosis and treatment can favorably alter the course of the illness - definitive diagnosis and treatment facilities are available, either through the screening agency or through referral - the group being screened is at risk for the illness - the screening procedures are reliable and valid

Match the following to their correct term a) one number divided by another in which the numerator is not part of the denominator b) Proportion of deaths from a specific cause c) one number divided by another in which the numerator is a subset of the denominator and is usually expressed as a percentage

•Ratio: one number divided by another in which the numerator is not part of the denominator (A) •Proportion: one number divided by another in which the numerator is a subset of the denominator (i.e. it is included in the denominator) and is usually expressed as a percentage (C) •Proportionate mortality rate (PMR): Proportion of deaths from a specific cause (B)

Screening Tests - define reliability - define validity --> what is the difference between sensitivity and specificity? --> a test with a high sensitivity will have what? --> a test with a high specificity will have what? As sensitivity _____, specificity _____

•Reliability: consistency or repeatability of test results (precision) •Validity: ability to measure what it's suppose to (accuracy) -Sensitivity: ability of the test to identify those who have it; a test with a high sensitivity will have few false negatives -Specificity: ability of the test to identify those who don't; a test with a high specificity will have few false positives As sensitivity increases, specificity decreases

Demography - statistical study of ____ ____ with reference to ____ and ____, ____, vital _____ - how population _____ influence community ___ and delivery of health care ____ - descriptions and ____ are made according to ___, race, ___, ____-____ status, geographic distribution, ____, death, marriage, and ____ - the US Census is a comprehensive ____ ____ study

•Statistical study of human populations with reference to size and density, distribution, and vital statistics •How population characteristics influence community needs and delivery of health care services •Descriptions and comparisons are made according to age, race, sex, socio-economic status, geographic distribution, birth, death, marriage and divorce •The US Census is a comprehensive descriptive demographic study

List the 3 Epidemiological Models

•The Epidemiologic Triangle •The Person-Place-Time Model •The Web of Causation

For the Final Know:

•The definition of epidemiology and it's relationship to public health •The difference between descriptive epidemiology, analytic epidemiology, and demography •The difference between incidence, prevalence, and their rates •Recognize and label commonly used "true" rates, ratios, proportions, case-fatality rates and PMR •The various types of variables •The criteria for evaluating causation •The purpose of screening along with ethical and practical issues •Reliability and validity with sensitivity and specificity •How and when to apply each of the 3 epidemiological models

Case-Fatality Rate - the ____ of people ____ with a specified ____ who ____ as a result of that ____ within a given ____ - usually used for measuring ____ in ____ - how is the case-fatality rate calculated (what's the formula)? - how is it different from cause-specific mortality rate?

•The percentage of people diagnosed with a specified illness who die as a result of that illness within a given period. •Usually used for measuring mortality in outbreaks. •It is calculated: (# of people who die from the illness) / (# of people who are dx with illness) •A case-fatality rate is different from a cause-specific mortality rate because the denominator is # of people who have been diagnosed with the illness rather than the at-risk population.

Web of Causation - views ____ problems as ____ _____ of numerous ____ - ____ or ____ risk of disease - attempts to identify all possible ____ on ____ and ____ processes - central to the web of causation model is the concept of _____ --> the ____ is ____ than the ___ of its ____ _____ --> give an example

•Views health problems as complex interrelationships of numerous factors •Increase or decrease risk of disease •Attempts to identify all possible influences on health and illness processes • central to the web of causation model is the concept of Synergism: the whole is more than the sum of its separate parts - for example, the effects of a Shigella infection of the infant, combined with the effects of poverty, youth, and low education level of the mother, are more deleterious to infant health that the sum of the effects of the individual risk factors

Rationale for Focus on Vulnerable Populations - vulnerable populations have _____ health needs - vulnerability and ____ cannot ___-____ - while VP frequently do not use a significant amount of preventative health services, they do use a ____ amount of ____ health care

•Vulnerable populations (VP) have greater health needs •Vulnerability and equity cannot co-exist And while these populations frequently do not use a significant amount preventative health services, they use a disproportionate amount of acute health care.

Groups considered Vulnerable - while racial and ethnic minorities are vulnerable populations in themselves, they are also _____ in other marginalized and vulnerable populations Subgroups of vulnerable populations may have _____ vulnerability compounding their risk for ____ health outcomes - ____ African Americans - ____ adults living in _____ - ____ veterans with ____ - Muslim _____

•While racial and ethnic minorities are vulnerable populations in themselves, they are also overrepresented in other marginalized and vulnerable populations Subgroups of vulnerable populations may have double vulnerability compounding their risk for poor health outcomes. •Transgender African Americans •Older adults living with poverty •Homeless veterans with serious mental illness •Muslim refugees

Vulnerable and Marginalized populations - definition: groups at ____ risk for _____ health outcomes because of some _____ factor (age, ____, ethnicity, _____, income, sexual ____ or orientation, language, ____ status, citizenship, geography, education/literacy, disability status, health care need or ____) - related to ____, discrimination, _____, and/or _____ access to _____ health care

●Groups at greater risk for poor health outcomes because of some demographic factor (age, race, ethnicity, gender, income, sexual identity or orientation, language, immigration status, citizenship, geography, education/literacy, disability status, health care need or religion) ●Related to marginalization, discrimination, isolation, and/or limited access to quality health care For example, while health care workers as a group, including nurses, are at greater risk for a number of occupational hazards, infectious diseases, pesticide exposure, back injuries, and violence in the work place, they are not considered a "vulnerable population" in this context