Midterm Review Sheet

HM 3501 Midterm Review Sheet This is a list of the key concepts from weeks 1 to 7. This does not mean that you can ignore any of the other concepts that we have discussed in class. Please note that all the points mentioned in this review sheet are taken directly from the power point slides. I recommend that you read the notes in parallel with the book and to further your understanding of the following concepts:  Week 1: Introduction  General Characteristics of the US health care system (such as health spending in the US compared to other developed nations, number and percentage of uninsured, etc…)  Healthcare is any service that has the potential to improve or sustain health status. Medical care is a component of health care in regard to medical institutions and professions.  Spending on education improved mortality more than health spending.  Healthcare spending trended upwards (2.8 trillion to 3.2 trillion from 2013- 2015). This is more than any other developed country.  In 2010 there were 48 million Americans without health insurance and in 2016 27.3 million Americans were without health insurance. Therefore, the number of Americans that were without health insurance went down.  In the united states, 36% of healthcare spending is from private insurance.  This represents the fact that these countries have a form of national healthcare. American has an infant mortality rate that is 50 th in the world but has a life expectancy that is the greatest after age 80.  The environment of health model (Health as a product of heredity, environment (such as education and employment), behavior and health services)  The environment of health model says that health & wellbeing is a product of heredity, health care services (quality), behavior, and the environment (fetal, physical, education, socio-cultural, employment)  Basic Concepts of Week 1 notes:  U.S healthcare system has a principle of duty to treat which means that ANY person deserves care.  Charitable care is when the provider gives care without expecting payment because of an inability to pay by patient.  Bad debt is when efforts to secure payment from the patient has failed.  Healthcare industry stakeholders are consumers, employers, government, and education and training organizations, research organizations, professional associations, pharmaceutical industry.  Iron Triangle:  Focuses on quality, cost, and access of a program  This all must be in balance to provide good healthcare.  If there is an increase in the cost, then there may be a decrease in access to affordable healthcare.  If there is a decrease in cost, then quality may suffer. 1

 Week 2: Measurement  WHO’s definition of health (it is important for you to know this definition and note that health is not merely the absence of disease according to the WHO)  World Health Organization defines health as “A state of complete physical, mental and social well-being, not merely the absence of disease.  Data sources and uses  Census (what is census data and why important)  Census is the official count or survey of a population, typically recording various details of individuals.  Also, the number of patients in a hospital on a given day or the number of beds occupied on a given day.  Environmental stuff  Vital Statistics (what are vital statistics and why important)  Statistics relating to births, deaths, marriages, health and diseases.  Morbidity Vs. Mortality:  Mortality is the number of deaths  Morbidity refers to sickness, illness, and disease  Mortality rates: what are the following rates and what is the difference between them  Crude Death Rate  Examples could be crude birth rates and crude death rates  Crude death rate = (number of deaths among residents in an area in a calendar year / average population in that area) * k  Age-Adjusted Death Rate  The most profound variations in disease are attributable to age. The higher the proportion of elderly people in the population, the higher the crude death rate for that population. This can be direct or indirect.  An adjusted rate is where the frequency of events is weighted by the population demographic characteristic whose effect we wish to control for.  Cause Specific Death Rate  From acute infectious diseases to chronic illnesses as a major cause of death.  Remember that age-adjusted death rates eliminate variability due to differences in the age distribution of various populations. For instance, Florida might have a higher crude death rate than California but that could be attributed to the fact that Florida has a higher percentage of elderly people. You need the age-adjusted death rates of both CA and FL in order for the comparison to be more meaningful.  Incidence and Prevalence Rates (you should know the definition of each, how to calculate, what is each used for, for instance incidence rate is a measure of risk, and also you should know what’s the limitation of each, for example, prevalence rates tends to favor the inclusion of chronic cases over acute ones). Bring a calculator to class.  Incidence rate:  (number of events occurring in the population during a specific amount of time / the population in the same area at the same time in which events 2

were expected to occur) * 10^k which is a unit of population to which the rate applies.  = number of new cases of a disease / population at risk  The Time period can range. This is so diseases of low frequency are able accumulated over several years. The factor of 10 is used to make the relationship between events and the population more meaningful.  Prevalence Rates:  (total number of persons with the characteristic (t) / total population (t)) *10^k  = number of existing cases of a disease / total population  Prevalence raters reflect the total burden of a condition within a population. It is a tool for the planning of facilities and manpower needs. A limitation of prevalence is that it tends to produce a biased picture of disease: It favors the inclusion of chronic cases over acute cases.  Incidence is a direct measure of risk. High prevalence does not necessarily signify a high risk. High prevalence may merely just reflect an increase in survival, which could be due to change in virulence or in host factors in addition to improvements in the medical care.  Low prevalence rates may reflect a rapidly fatal process or rapid cure of diseases as well as low incidence might.  Infant Mortality Rate as a health status indicator (why is that the case? Data is easily observable, infant mortality rate is very sensitive to variations in health services, access and use, especially primary care, etc…)  Infant mortality = (# of infant deaths / # of live births) * 1000  Number of infant deaths per 1000 live births  The US ranks 6 th out of the 30 countries from the bottome.  A criticism is that the US delivery system has poor prenatal care received by different ethnic groups.  Years of Potential Life Lost (you need to know the definition and what it is used for, you do not have to focus on how it is calculated)  Years of potential life loss (YPLL) is the measure of premature mortality. The number of deaths in each age group is multiplied by the difference between the midpoint of the age group and 65 years.  This difference represents the potential years of life lost for each age group and, when summed up over all age groups that are examined, becomes the YPLL.  This is repeated for each cause of death examined.  Week 3: Hospitals  Historical development of hospitals  The beginning, before 1870.  The hospital as a custodial institution.  Almshouses and Pesthouses (1700’s)  This is for custodial and public health reasons  Medical care in this era was a SECONDARY FUNCTION!!!! 3

 served the poor, hospitals provided food and shelter to the poor and consequently treated the ill. Used to quarantine people with contagious diseases.  Development of the community or voluntary hospital  Penn Hospital in Philadelphia (1751)  Cared for patients with acute illnesses and injuries  It was then that city, county, and state mental hospitals were established  First period of rapid growth, 1870-1910.  Up till the late 1800s there was little that hospitals could offer to patients. The hospitals then begun to transform from a custodial institution in which to isolate and shelter the poor to a curative institution.  From 1873 to 1909 there was a RAPID increase in number of hospitals.  There were huge advances in medical science and technology.  Surgical Procedures and techniques. There was development of diagnostic technology and nursing became a profession.  The period of consolidation, 1910-1945.  Less growth than the periods before and after this one  -1910 was the Flexner Report  1929-1941 economic depression  Medical science advances  1923 was the discovery of insulin  1929 was the treatment of pernicious anemia  1930 was when sulfa drugs came into use and penicillin was discovered  1943 there was a widespread introduction of antibiotics  Second period of rapid growth (1945-1980).  RAPID increase in hospital services, costs, and technology  Factors that contributed to this period of rapid growth:  Pre-1929: Baylor, Ross-Loos, Washington State, accommodation insurance  Blue Cross (1929)  Blue Shield (1939)  Blue Cross   and   Blue Shield   developed separately, with   Blue Cross   plans providing coverage for hospital services and   Blue Shield   covering physicians' services.   Blue Cross   is a name used by an association of health insurance plans throughout the United States.  NLRB- recognition of benefits in labor-management negotiations and rise of commercial health insurance (1943)  State-65 plans in 1950s- Kerr-Mills act  Post WWII actions to build health infrastructure and provide access to population  Hill Burton Act (1946)- (hospital surface and constriction)  National institutes of health (1948) 4

 Medicare and Medicaid (1965)  Health Professions Acts (1965-6)  Period of cost containment (1980 to present).  Cost-based reimbursement and medical care price inflation  Environmental changes in 1980s  Introduction of PPS in Medicare in 1983.  Increase use of prospective payment systems by insurers  Growth of managed care  Administrative mechanisms to review the appropriateness of use of hospital and specialized services.  You should understand the major characteristics of each period.  Hospital utilization trends and reasons behind these trends  Nearly two-thirds of hospitals have financial problems. As a result of increased competition of outpatient services which are often more cost effective, efficient, and consumer friendly and reduced reimbursement from Medicare and Medicaid, many hospitals are developing strategies to increase their financial stability.  Outpatient services have become the major competitors of hospitals. Advanced technology has enabled more ambulatory surgeries and testing. These services were often performed in a hospital. They are receiving revenue that used to be hospital revenue.  Hospitals have operated outpatient clinics since the 19 th century, these clinics were used to care for indigent people. Revenue continues to fall and these clinics became revenue generating by offering more hospital services.  In 2010 outpatient services account for 40% of total hospital revenue. They are continuing to focus on revenue generation by operating more outpatient services.  For instance, length of stay has decreased significantly since the 1980s, why is that the case?  You do not need to memorize actual numbers or percentages, but you should be clear about trends and what is behind the trends.  Week 4: Ambulatory Care  Definition and levels  Ambulatory care can be used interchangeably with outpatient services. Ambulatory means literally that a person can walk to receive a service which may not always be necessarily true. The term “outpatient” is a more general term for services than inpatient.  Lower income groups have more visits than higher income groups. This is because they have greater need as well as many programs directed specifically to these groups (Medicaid).  3 levels of care  Primary  Medical care that is oriented towards the daily routine needs of patients  Initial diagnosis as well as continuing treatment of common illness  Role of a primary care physician 5