HCAD Delivering Healthcare in America | exam
elaborations
what is the epidemiology triangle ** Answ** a useful explanation of disease occurrence (for
communicable diseases in particular)
what is the host in the epidemiology triangle ** Answ** the organism—generally, a human
—that becomes sick
Factors include genetic makeup, level of immunity, fitness, and personal habits and behaviors.
what is the agent in the epidemiology triangle ** Answ** For the host to become sick, an
agent must be present, although presence of an agent does not ensure that disease will occur.
examples are chemical agents, radiation, tobacco smoke, dietary indiscretions, and nutritional
deficiencies.
what is the third entity in the epidemiology triangle ** Answ** the environment; external to
the host
includes the physical, social, cultural, and economic aspects of the environment.
what is the leading cause of preventable disease and death in the United States ** Answ**
smoking; because it significantly increases the risk of heart disease, stroke, lung cancer, and
chronic lung disease
what are behavioral risk factors? ** Answ** Substance abuse, inadequate physical exercise,
a high-fat diet, irresponsible use of motor vehicles, and unsafe sex, and smoking
what are environmental risk factors? ** Answ** sanitation, air pollution, anthro-cultural
beliefs, social equity, social norms, and economic status. *The environmental factors play a
moderating role that can either enhance or reduce susceptibility to disease
what are the three principles that a health promotion and disease prevention program is built on
** Answ** (1) An understanding of risk factors associated with host, agent, and/or
environment. Risk factors and their health consequences are evaluated through a process called
health risk appraisal. Only when the risk factors and their health consequences are known can
interventions be developed to help individuals adopt healthier lifestyles.
(2) Interventions for counteracting the key risk factors include two main approaches:
(a) behavior modification geared toward the goal of adopting healthier lifestyles
(b) therapeutic interventions.
,(3) Adequate public health and social services, as discussed later in this chapter, include all
health-related services designed to minimize risk factors and their negative effects in order to
prevent disease, control disease outbreaks, and contain the spread of infectious agents.
what is the term used for multiple health problems ** Answ** comorbidity
what does comorbidity require? ** Answ** it requires the balancing of the multiple
requirements, addressing changes in health conditions over time, and drug and disease
interactions.
what is a major funding source for medical school ** Answ** The Medicare program, which
provides explicit payments to teaching hospitals for each resident in training. The government,
however, does not mandate how these physicians should be trained
define maldistribution ** Answ** refers to either a surplus or a shortage of the type of
physicians needed to maintain the health status of a given population at an optimum level.
what are geographic maldistributions ** Answ** Rural areas, particularly, lack an adequate
supply of both PCPs and specialists even though residents in rural areas are sicker, older, and
poorer than those in nonrural areas. Whereas 20% of the US population lives in rural areas, only
9% of physicians practice there
what are specialty maldistributions ** Answ** considerable imbalance exists between
primary and specialty care in the United States. Approximately 42% of physicians work in
primary care; the remaining 58% are specialists
In other industrialized countries, only 25% to 50% of physicians are specialists
review reasons for the number of specialists growing ** Answ** *growth of new medical
technology is one major driving force behind the increasing number of specialists
other reasons include:
-Higher incomes of specialists relative to PCPs
-wide disparities between the incomes of generalists and specialists continue
-Specialists also have more predictable work hours and enjoy higher prestige among their
colleagues and the public at large
-High status and prestige are accorded to specialties engaged in employing the latest advances in
medical technology. Such considerations influence medical students' career decisions.
what are nurse practitioners and what are their roles ** Answ** individuals who have
completed a program of study leading to competence as RNs in an expanded role.
-NPs constitute the largest group of NPPs. As of 2011, the United States had approximately
105,780 NPs
-NPs work mainly in primary care settings
-Is considered an APN
-NPs may prescribe drugs in most states
what are physician assistance and what are their roles ** Answ** part of the healthcare
team[who] work in a dependent relationship with a supervising physician to provide
comprehensive care."
,-In 2011, there were approximately 83,640 jobs available for PAs in the United States
-The number of PA jobs exceed the number of PAs and about 15% of PAs work more than one
job.
-licensed to perform medical procedures only under the supervision of a physician who may be
on site or off site.
-The major services provided by PAs include: evaluation, monitoring, diagnostics, therapeutics,
counseling, and referral
what are healthcare administrators and what are their roles ** Answ** individuals who can
be employed at the top, middle, and entry levels of various types of organizations that delivery
health services
what are top-level healthcare administrators and what are their roles ** Answ** provide
leadership and strategic direction, work closely with the governing boards
are responsible for an organization's long-term success.
are responsible for operational, clinical, and financial outcomes of their entire organization.
what are middle-level healthcare administrators and what are their roles ** Answ** -may
have leadership roles for major service centers, such as outpatient, surgical, and nursing services,
or they may be departmental managers in charge of single
departments, such as diagnostics, dietary, rehabilitation, social services, environmental
services, or medical records.
-jobs involve major planning and coordinating functions, organizing human and physical
resources, directing and supervising, operational and financial controls, and decision making.
-often have direct responsibility for implementing changes, creating efficiencies, and
developing new procedures with respect to changes in the health care delivery system.
what is the difference between clinical nurse specialists and nurse practitioners ** Answ**
nurse specialists work in the hospital, NPs work in the primary care setting
what are entry-level healthcare administrators and what are their roles ** Answ** may
function as assistants to middle-level managers
They may supervise a small number of operatives
how has the percentage of primary care doctors changed over the years? ** Answ** Primary
care doctors have decreased from 60% in 1949 to 40% in 2010
define deductible ** Answ** the amount the insured must first pay each year before any
benefits are payable by the plan.
define co-payment ** Answ** a flat amount the insured must pay each time health services
are received
, what are experience risk ratings ** Answ** based on a group's own medical claims
experience. Under this method, premiums differ from group to group because different groups
have different risks. -For example, people working in various industries are exposed to various
levels and types of hazards, people in certain occupations are more susceptible to certain
illnesses or injuries, and older groups represent higher risks than younger groups.
what are community risk ratings ** Answ** spreads the risk among members of a larger
population. Premiums are based on the utilization experience of the entire population covered by
the same type of health insurance. Under pure community rating, the same rate applies to
everyone regardless of age, gender,occupation, or any other indicator of health
*When premiums are based on community rating, the good risks, that is, healthy people, actually
subsidize the insurance cost for the poor risks
what are adjusted community risk ratings ** Answ** also known as modified community
rating, overcomes the main drawbacks of experience rating and pure community rating. Under
this method, price differences take into account demographic factors such as age, gender,
geography, and family composition, while ignoring other risk factors.
what comprehensive study employing a controlled experimental design demonstrated the effect
of cost-sharing and what were the findings? ** Answ** the RAND experiment;showed that
modest cost sharing reduces use of services with negligible effects on health for the average
person; The study's conclusions encouraged the restructuring of private insurance and helped
increase the stature of managed care.
define risk selection ** Answ** occurs when healthy people disproportionately enroll into a
health plan.
define adverse selection ** Answ** occurs when high-risk individuals, that is, people who
are likely to use more health care services than others because of their poor health status, enroll
in health insurance plans in greater numbers, compared to people who are health
what are the effects of risk and adverse selection ** Answ** they distort the true function of
insurance, but
adjusting premiums to reflect health status and making potential high-cost enrollees pay more, a
practice called risk rating, is criticized on equity grounds.
review the development of outpatient care ** Answ** has been independent from services
provided in health care institutions. In earlier days, physicians saw patients in their clinics, and
most physicians also made home visits to treat patients within the limitations of medical science
prevalent in those days. Institutions for inpatient care, such as hospitals and nursing homes,
developed later. With advances in medical science, the locus of health care delivery concentrated
around the institutional core of community hospitals.
describe primary care services ** Answ** plays a central role in a health care delivery
system; distinguished from secondary and tertiary care according to its duration, frequency, and
level of intensity
elaborations
what is the epidemiology triangle ** Answ** a useful explanation of disease occurrence (for
communicable diseases in particular)
what is the host in the epidemiology triangle ** Answ** the organism—generally, a human
—that becomes sick
Factors include genetic makeup, level of immunity, fitness, and personal habits and behaviors.
what is the agent in the epidemiology triangle ** Answ** For the host to become sick, an
agent must be present, although presence of an agent does not ensure that disease will occur.
examples are chemical agents, radiation, tobacco smoke, dietary indiscretions, and nutritional
deficiencies.
what is the third entity in the epidemiology triangle ** Answ** the environment; external to
the host
includes the physical, social, cultural, and economic aspects of the environment.
what is the leading cause of preventable disease and death in the United States ** Answ**
smoking; because it significantly increases the risk of heart disease, stroke, lung cancer, and
chronic lung disease
what are behavioral risk factors? ** Answ** Substance abuse, inadequate physical exercise,
a high-fat diet, irresponsible use of motor vehicles, and unsafe sex, and smoking
what are environmental risk factors? ** Answ** sanitation, air pollution, anthro-cultural
beliefs, social equity, social norms, and economic status. *The environmental factors play a
moderating role that can either enhance or reduce susceptibility to disease
what are the three principles that a health promotion and disease prevention program is built on
** Answ** (1) An understanding of risk factors associated with host, agent, and/or
environment. Risk factors and their health consequences are evaluated through a process called
health risk appraisal. Only when the risk factors and their health consequences are known can
interventions be developed to help individuals adopt healthier lifestyles.
(2) Interventions for counteracting the key risk factors include two main approaches:
(a) behavior modification geared toward the goal of adopting healthier lifestyles
(b) therapeutic interventions.
,(3) Adequate public health and social services, as discussed later in this chapter, include all
health-related services designed to minimize risk factors and their negative effects in order to
prevent disease, control disease outbreaks, and contain the spread of infectious agents.
what is the term used for multiple health problems ** Answ** comorbidity
what does comorbidity require? ** Answ** it requires the balancing of the multiple
requirements, addressing changes in health conditions over time, and drug and disease
interactions.
what is a major funding source for medical school ** Answ** The Medicare program, which
provides explicit payments to teaching hospitals for each resident in training. The government,
however, does not mandate how these physicians should be trained
define maldistribution ** Answ** refers to either a surplus or a shortage of the type of
physicians needed to maintain the health status of a given population at an optimum level.
what are geographic maldistributions ** Answ** Rural areas, particularly, lack an adequate
supply of both PCPs and specialists even though residents in rural areas are sicker, older, and
poorer than those in nonrural areas. Whereas 20% of the US population lives in rural areas, only
9% of physicians practice there
what are specialty maldistributions ** Answ** considerable imbalance exists between
primary and specialty care in the United States. Approximately 42% of physicians work in
primary care; the remaining 58% are specialists
In other industrialized countries, only 25% to 50% of physicians are specialists
review reasons for the number of specialists growing ** Answ** *growth of new medical
technology is one major driving force behind the increasing number of specialists
other reasons include:
-Higher incomes of specialists relative to PCPs
-wide disparities between the incomes of generalists and specialists continue
-Specialists also have more predictable work hours and enjoy higher prestige among their
colleagues and the public at large
-High status and prestige are accorded to specialties engaged in employing the latest advances in
medical technology. Such considerations influence medical students' career decisions.
what are nurse practitioners and what are their roles ** Answ** individuals who have
completed a program of study leading to competence as RNs in an expanded role.
-NPs constitute the largest group of NPPs. As of 2011, the United States had approximately
105,780 NPs
-NPs work mainly in primary care settings
-Is considered an APN
-NPs may prescribe drugs in most states
what are physician assistance and what are their roles ** Answ** part of the healthcare
team[who] work in a dependent relationship with a supervising physician to provide
comprehensive care."
,-In 2011, there were approximately 83,640 jobs available for PAs in the United States
-The number of PA jobs exceed the number of PAs and about 15% of PAs work more than one
job.
-licensed to perform medical procedures only under the supervision of a physician who may be
on site or off site.
-The major services provided by PAs include: evaluation, monitoring, diagnostics, therapeutics,
counseling, and referral
what are healthcare administrators and what are their roles ** Answ** individuals who can
be employed at the top, middle, and entry levels of various types of organizations that delivery
health services
what are top-level healthcare administrators and what are their roles ** Answ** provide
leadership and strategic direction, work closely with the governing boards
are responsible for an organization's long-term success.
are responsible for operational, clinical, and financial outcomes of their entire organization.
what are middle-level healthcare administrators and what are their roles ** Answ** -may
have leadership roles for major service centers, such as outpatient, surgical, and nursing services,
or they may be departmental managers in charge of single
departments, such as diagnostics, dietary, rehabilitation, social services, environmental
services, or medical records.
-jobs involve major planning and coordinating functions, organizing human and physical
resources, directing and supervising, operational and financial controls, and decision making.
-often have direct responsibility for implementing changes, creating efficiencies, and
developing new procedures with respect to changes in the health care delivery system.
what is the difference between clinical nurse specialists and nurse practitioners ** Answ**
nurse specialists work in the hospital, NPs work in the primary care setting
what are entry-level healthcare administrators and what are their roles ** Answ** may
function as assistants to middle-level managers
They may supervise a small number of operatives
how has the percentage of primary care doctors changed over the years? ** Answ** Primary
care doctors have decreased from 60% in 1949 to 40% in 2010
define deductible ** Answ** the amount the insured must first pay each year before any
benefits are payable by the plan.
define co-payment ** Answ** a flat amount the insured must pay each time health services
are received
, what are experience risk ratings ** Answ** based on a group's own medical claims
experience. Under this method, premiums differ from group to group because different groups
have different risks. -For example, people working in various industries are exposed to various
levels and types of hazards, people in certain occupations are more susceptible to certain
illnesses or injuries, and older groups represent higher risks than younger groups.
what are community risk ratings ** Answ** spreads the risk among members of a larger
population. Premiums are based on the utilization experience of the entire population covered by
the same type of health insurance. Under pure community rating, the same rate applies to
everyone regardless of age, gender,occupation, or any other indicator of health
*When premiums are based on community rating, the good risks, that is, healthy people, actually
subsidize the insurance cost for the poor risks
what are adjusted community risk ratings ** Answ** also known as modified community
rating, overcomes the main drawbacks of experience rating and pure community rating. Under
this method, price differences take into account demographic factors such as age, gender,
geography, and family composition, while ignoring other risk factors.
what comprehensive study employing a controlled experimental design demonstrated the effect
of cost-sharing and what were the findings? ** Answ** the RAND experiment;showed that
modest cost sharing reduces use of services with negligible effects on health for the average
person; The study's conclusions encouraged the restructuring of private insurance and helped
increase the stature of managed care.
define risk selection ** Answ** occurs when healthy people disproportionately enroll into a
health plan.
define adverse selection ** Answ** occurs when high-risk individuals, that is, people who
are likely to use more health care services than others because of their poor health status, enroll
in health insurance plans in greater numbers, compared to people who are health
what are the effects of risk and adverse selection ** Answ** they distort the true function of
insurance, but
adjusting premiums to reflect health status and making potential high-cost enrollees pay more, a
practice called risk rating, is criticized on equity grounds.
review the development of outpatient care ** Answ** has been independent from services
provided in health care institutions. In earlier days, physicians saw patients in their clinics, and
most physicians also made home visits to treat patients within the limitations of medical science
prevalent in those days. Institutions for inpatient care, such as hospitals and nursing homes,
developed later. With advances in medical science, the locus of health care delivery concentrated
around the institutional core of community hospitals.
describe primary care services ** Answ** plays a central role in a health care delivery
system; distinguished from secondary and tertiary care according to its duration, frequency, and
level of intensity
