Term
| Parson's Social Model of Health |
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Definition
| A person who is unable to perform the social roles is sick and is expected to adop the sick role...give societal permission to be less productive |
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Term
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Definition
1. Availability
2. Accessability
3. Accomodation
4. Affordability
5. Acceptability |
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Term
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Definition
| Fit between service capacity and individual's requirements |
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Term
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Definition
| Fit between provider location and patient location |
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Term
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Definition
| Fit between how resources are organized to provide services and individual's ability to use them |
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Term
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Definition
| Individual's ability to pay (out-of-pocket and insurance) for the needed services |
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Term
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Definition
| Compatability between patients' attitudes about providers personal and practice characteristics and providers' attitudes about the personal characteristics of the patient |
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Term
| Types of Access based on Andersons Behavioral Model of Health Services use |
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Definition
1. Potential Access
2. Realized Access
3. Equitable Access
4. Inequitable Access
5. Effective Access
6. Efficient Access
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Term
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Definition
| health care system characteristics and enabling resources that influence use of health services |
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Term
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Definition
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Term
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Definition
| use of health services is determined by demographic characteristics and need |
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Term
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Definition
| use of health services is determined by social characteristics and enabling resources...not need |
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Term
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Definition
| use of health services improves health status or satisfaction |
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Term
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Definition
| minimizes the cost of health services use and maximizes health status or satisfaction |
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Term
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Definition
| the condition or fact of being unequal or difference |
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Term
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Definition
| in healthcare, based on observed differences |
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Term
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Definition
| In healthcare, based on ethical judgments about differences (inequalities) |
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Term
| T/F: In assessing outcomes evaluated outcomes are more valuable than perceived outcomes from an employers perspective |
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Definition
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Term
| T/F: According to the article: Eight Americas Investigating Mortality Disparities across Races, Counties, and Race-Counties in the US, observed disparities in life expectancy are almost fully explained by race, income, or basic health-care access and utilization alone |
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Definition
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Term
| T/F: According to the article: Eight Americas Investigating Mortality Disparities across Races, Counties, and Race-Counties in the US life expectancy for males in all groups has generally increased between 1982-2000 |
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Definition
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Term
| T/F: According to the article: Eight Americas Investigating Mortality Disparities across Races, Counties, and Race-Counties in the US, male Asians in 1,889 counties with Pacific Islanders <40% of Asians has the second longest life expectancy throughout the 1982 and 2000 time period |
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Definition
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Term
| T/F: According to the article: Eight Americas Investigating Mortality Disparities across Races, Counties, and Race-Counties in the US, Native American females in 359 counties in western states has higher life expectancies than black females in 427 rural counties in Deep South with per capita black income <$7,500 |
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Definition
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Term
| T/F: In the article What If We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000, by Satcher et al, for the year 2000 males in the 15-34 age groups had the highest standardized mortality ratios |
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Definition
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Term
| T/F: In the article What If We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000, by Satcher et al, between 1960 and 2000 the deaths per 100,000 population rate improved for all groups of blacks except those over age 84 |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, healthcare disparities are measured using outcome, but not process measures |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, composite measures reflect whether individuals are receiving 50% or more of the recommended services |
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Definition
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Term
| T/F: According to the 2009 National healthcare Disparities Report, patient experiences are included based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) data |
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Definition
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Term
| According to the 2009 National healthcare disparities report, blacks received worse care than whites for 50% (10/20) of core measures, and received better care than Whites for 15% (3/20) of core measures. |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, Asians received worse care than Whites for 30% (6/20) of core measures and better care for 40% (8/20) of core measures |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, poor people received worse care than high income people for 75% (15/20) of core measures and better care for 5% (1/20) of core measures. |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, Blacks, Asians, and AI/AN has worse access to care than whites for one-third (2/6) of core measures |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, Hispanics had worse access than non-Hispanic White for 83% (5/6) of core measures |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, for Blacks, only about 80% of measures of disparities in quality of care improved (gap decreased). |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, for poor people, disparities are improving for almost half of the quality measures |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, for Blacks, Asians, and Hispanics, only (one-third) of measures of quality of care are not improving (gap either stayed the same or increased) |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, for Blacks, more than 80% of the core measures used to track access remained unchanged (gap stayed the same) or got worse (gap increased). |
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Definition
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Term
| T/F: According to the 2009 National Healthcare Disparities Report, over time, the Black-White difference in health insurance coverage among people under age 65 decreased. By 2007, the gap was not statistically significant. |
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Definition
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Term
| According to the 2009 National Healthcare Disparities report, for Blacks compared with Whites the largest disparities that are improving include: new AIDS cases per 100,000 population over age 13 and colorectal cancer deaths per 100,00 population |
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Definition
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Term
| According to the 2009 National healthcare disparities report, for Asians compared with Whites the largest disparity that is also improving is the percent of adults over age 65 who ever received a pneumococcal vaccination |
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Definition
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Term
| According to the 2009 National healthcare disparities report, for American Indians compared with Whites, the greatest disparity that is improving overtime is new AIDS cases per 100,000 population over 13 |
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Definition
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Term
| According to the 2009 National healthcare disparities report, Blacks, Asians, American Indians, and core measures in which all the disparity when compared to whites is getting worse include: adults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test; and, hospital patients with pneumonia who received recommended hospital care |
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Definition
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Term
| According to the article, Health Disparities for Men: 6 Lessons; Health Insurance for the Elderly has substantially Increased Their Access to Services |
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Definition
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Term
| According to the article, Health Disparities for men: 6 Lessons; SES is Associated With Health Care Utilization and Explains Some but Not All Racial Diaparities |
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Definition
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Term
| According to the article, Health Disparities for Men: 6 Lessons; Lesson 6: Disparities in Medicare Use Are Largely Unexplained |
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Definition
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Term
| According to the article, Health Disparities for Men: 6 Lessons; Medicare Utilization Patterns Indicate that Health Insurance Alone Does Not Ensure Equal Use of Services |
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Definition
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Term
| According to the article, Concentration and Quality of hospitals that care for elderly black patients," the 25% of hospitals with the highest volume of black patients cared for nearly half of all elderly black patients. |
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Definition
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Term
| According to the article, Concentration and Quality of hospitals that care for elderly black patients," the hospitals with the highest volumes of black patients tended to be concentrated in urban and private not-for-profit hospitals |
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Definition
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Term
| According to the article, Concentration and Quality of hospitals that care for elderly black patients," the authors conclude that the hospitals with the highest volumes of black patients tend to be located in regions that have pervasively poorer quality AMI care |
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Definition
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Term
| According to the article, Concentration and Quality of hospitals that care for elderly black patients," it would be fair to conclude that blacks generally receive poorer quality AMI care regardless of where the hospital is located. |
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Definition
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Term
| T/F: the difference between perceived and evaluated outcomes is that evaluated outcomes are based on the patient's assessment of the outcome |
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Definition
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Term
| In the article, What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000, by Satcher et al, the excess deaths experienced by African American males increased between 1960 and 2000 for all age groups |
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Definition
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Term
| According to the 2009 National healthcare disparities report, over time, the black-white difference in health insurance coverage among people under age 65 decreased. by 2007, the gap was not statistically significant |
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Definition
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Term
| Parson's Social Model of Health: what are the four features of the sick role? |
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Definition
1. individual is not held responsible for illness
2. being sick is recognized as legitimate basis for society to exempt individual from social role obligations (i.e. work, go to school, pay taxes)
3. Individual is exempted from these roles on the condition that he/she recognizes that being sick is undesirable and that there is an obligation to try to get well
4. sick individual must seek competent help and cooperate with medical agencies to get well |
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Term
| Penchanskey and Thomas's five dimensions of access include five dimensions: |
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Definition
1. Availability
2. Accessability
3. Accomodation
4. Affordability
5. Acceptability |
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Term
| What dimension of access is this: Individual's ability to pay (out-of-pocket and insurance) for needed services? |
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Definition
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Term
| What dimension of access: compatibility between patients' attitudes about providers' personal and practice characteristics and providers' attitudes about the personal characteristics of the patient |
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Definition
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Term
| What dimension of access?: Fit between provider location and patient location... |
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Definition
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Term
| What dimension?: fit between how resources are organized to provide services and individual's ability to use them... |
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Definition
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Term
| What dimension?: fit between service capacity and individual's requirements... |
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Definition
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Term
| What are the 6 types of access in Anderson's Behavioral Model of Health Services use? |
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Definition
1. Potential Access
2. Realized Access
3. Equitable Access
4. Inequitable Access
5. Effective Access
6. Efficient Access |
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Term
| What are the 3 categories of outcomes included in Anderson's Behavioral Model of Health Services Use? |
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Definition
1. Perceived Health Status
2. Evaluated Health Status
3. Consumer Satisfaction |
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Term
| Explain the difference between perceived and evaluated health status |
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Definition
Perceived: is based on patient's assessment
Evaluated: is based on health care professional's assessment |
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Term
| When trying to determine if there are disparities in care what 4 methodological issues need to be considered? |
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Definition
1. Popultion subgroup definitions
2. Standard of evidence
3. Data sources
4. Analytic Approach |
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Term
| Give 2 examples of potential sources of bias at the patient level... |
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Definition
1. patient preferences
2. differences in clinical presentation of symptoms |
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Term
| Give 2 examples of potential sources of bias at the healthcare systems level |
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Definition
1. lack of interpretation and translation services
2. Availability and mix of health providers |
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Term
| Give 2 examples of potential bias at the provider level... |
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Definition
1. clinical uncertainty
2. beliefs/stereotypes about behavior of health patients |
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Term
List the 6 characteristics or components of quality used in the 2009 National Healthcare Disparities report:
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Definition
1. Effective
2. Safe
3. Timely
4. Patient centered
5. Equitable
6. Efficient |
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Term
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Definition
| Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit |
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Term
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Definition
| Avoiding injuries to patients from the care that is intended to help them |
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Term
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Definition
| Reducing waits and sometimes harmful delays for both those who receive and thos who give care |
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Term
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Definition
| providing care that is respectful of and responsive to individual pateitn preferences, needs, and values and ensuring that patient values guide all clinical decisions |
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Term
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Definition
| Providing care taht does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic factors |
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Term
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Definition
| Avoiding waste, including waste of equipment, supplies, ideas, and energy |
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Term
| What are the 4 ways that effectiveness is assessed in the 2009 national healthcare disparities report? |
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Definition
1. Prevention
2. Treatment
3. Management
4. Outcomes |
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Term
| What are 4 assumptions of "market justice" as discussed in class? |
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Definition
1. Healthcare is like any other good or service
2. individuals are responsible for their own achievements
3. people make rational choices in decisions to purchase healthcare
4. people, in consultation with their physician, know what is best for themselves
5. marketplace works best with minimum interference from the government |
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Term
| What are 4 assumptions of "social justice" as discussed in class? |
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Definition
1. Concept of social justice invented by critics of capitalism
2. equitable distribution healthcare is a societal responsibility...best achieved by a central agency (government) control the production and distribution functions
3. healthcare is viewed as a "social good" rather than an "economic good"
4. healthcare should be collectively financed and available to all citizens regardless of the individual's ability to pay |
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Term
| Market or Social Justice?: Strong obligation to the collective good... |
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Definition
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Term
| Market or Social Justice?: individual is responisble for health... |
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Definition
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Term
| Market or Social Justice?: community well-being supersedes that of the individual... |
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Definition
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Term
| Market or Social justice?: public solutions to social problems... |
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Definition
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Term
| Market or Social Justice?: Emphasis on individual well-being... |
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Definition
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Term
| Market or Social Justice?: private soluations to social problems... |
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Definition
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Term
| Market or Social Justice?: rationing based on ability to pay |
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Definition
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Term
| Market or Social Justice?: collective responsibility for health |
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Definition
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Term
| Market or Social Justice?: benefits based on individual purchasing power... |
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Definition
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Term
| Market or Social Justice?: limited obligation to the collective good... |
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Definition
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Term
| Market or Social Justice?: everyone is entitled to a basic care package of benefits... |
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Definition
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Term
| Market or Social Justice?: planned rationing of healthcare... |
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Definition
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Term
| By 2007 about 10% fo the US population reported having 14 or more mentally unhealthy days according to Behavioral Risk Factor Surveillance System |
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Definition
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Term
| According to survey data from the CDC, the percentage of adults experiencing serious psychological distress in the last 30 days increased by 5% points |
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Definition
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Term
| According to the Office of Minority Health and Health Disparities Mental Disorders are common in the US - 1 in 5 Americans has a diagnosable mental disorder each year |
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Definition
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Term
| According to the Office of Minority Health and Health Disparities Suicide as a Public Health Problem - Suicide is the 8th leading cause of death in the US...80 to 90% of people who die by suicide are suffering from a diagnosable mental illness |
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Definition
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Term
| According to the Office of Minority Health and Health Disparities, African Americans are less likely to experience a mental disorder than their white counterparts, are less likely to seek treatment, and when they do seek treatment, they are more likely to use the emergency room for mental health care |
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Definition
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Term
| An estimated 26.2% of Americans ages 18 or older - about 1/4 adults - suffer from a diagnosable mental disorder in a given year |
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Definition
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Term
| Mental Disorders are the leading cause of disability in the U.S. and Canada for ages 15-44 |
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Definition
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Term
| Mood disorders include major depressive and bipolar disorders as well as schizophrenia |
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Definition
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Term
| Approximately 20.9 million American adults or about 9.5% of the US population age 18 and older in a given year, have a mood disorder |
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Definition
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Term
| The median age of onset for mood disorders is 30 years. |
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Definition
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Term
| Major depressive disorder is the third most common cause of disability in the US for ages 15-44 |
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Definition
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Term
| While major depressive disorder can develop at any age, the median age at onset is 32 |
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Definition
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Term
| Major depressive disorder is more prevalent in women than in men |
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Definition
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Term
| Bipolar disorder affects approximately 5.7 million American adults, or about 2.6% of the US population age 18 and older in a given year |
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Definition
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Term
| The median age of onset for bipolar disorders is 25 years. |
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Definition
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Term
| In 2004, 32,439 (approx 11 in 100,000) people died by suicide in the US |
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Definition
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Term
| About 90% of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder |
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Definition
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Term
| The highest suicide rates in the US are found in white women over age 85 |
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Definition
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Term
| Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year, have schizophrenia |
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Definition
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Term
| Schizophrenia affects men and women with equal frequency |
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Definition
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Term
| Approximately 7.7 million American adults age 18 and older, or about 3.5% of people in this age group in a given year, have PTSD |
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Definition
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Term
| PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years |
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Definition
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Term
| About 10% of Vietnam veterans experienced PTSD at some point after the war |
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Definition
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Term
| The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder |
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Definition
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Term
| Females are much more likely than males to develop an eating disorder |
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Definition
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Term
| The mortality rate among people with anorexia has been estimated to be about 12 times higher than the annual death rate due to all causes or death among females ages 15-24 in the general population |
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Definition
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Term
| Only an estimated 5-15% of people with anorexia or bulimia and an estimated 35% of those with binge-eating disorder are male |
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Definition
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Term
| According to 2005 self-report data on the main cause of self-reported disabilities, a greater percentage of women than men over 18 years of age reported having mental or emotional problems as the main cause of self-reported disabilities |
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Definition
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Term
| According to 2005 self-report data on the main cause of self-reported disabilities, substance abuse was identified approximately 50% as often as mental or emotional problems by men |
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Definition
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Term
| According to 2005 self-report data on the main cause of self-reported disabilities, a greater percentage of men than women over age 18 reported substance abuse as the main cause of self-reported disabilities |
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Definition
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Term
| Between 1986 and 2014 mental health services as a percent of total health expenditures is expected to decrease |
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Definition
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Term
| By 2014, mental health services are expected to be approximately 7% of total health expenditures |
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Definition
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Term
| Between 2003 and 2014, the growth rate of mental health expenditures is expected to be greater than the growth rate for all health care expenditures |
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Definition
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Term
| For the 1990-2003 time period, the prevalence of mental health and substance use disorders in the United States' adult population (ages 18-54) has remained relatively constance while the rate of treatment has increased |
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Definition
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Term
| For the 1990-2003 time period, most people with mental illness or substance use disorders do not receive any treatment |
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Definition
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Term
| Since 1986, the percentage of mental health service funding from the public sector has increased and by 2014 is expected to account for 58% of the total funding |
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Definition
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Term
| Between 1986 and 2003 the percent of mental health spending as a share of all spending by private payers and Medicaid decreased, while the percentage increased for Medicare and Other State and Local governments |
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Definition
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Term
| By 2014, Medicaid and Private Insurance will account for over 50% of mental health expenditures |
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Definition
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Term
| In 1986, hospitals received the greatest percentage of mental health payments, but are expected to receive only the second highest percentage of mental health payments by 2014. |
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Definition
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Term
| By 2014, prescription drugs will account for the highest percentage of mental health expenditures |
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Definition
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Term
| Between 1986 and 2014, physician services are expected to consume an increasing percentage of mental health expenditures |
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Definition
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Term
| For both the 1986-2003 and the 2003-2014 time frames prescription drugs account for the greatest percentage increase in mental health expenditures |
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Definition
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Term
| Medicaid is forecasted to be the largest payer category at 27% in 2014 |
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Definition
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Term
| Between 2003 and 2014, the rate of growth in substance abuse expenditures will be greater than the rate of growth for health expenditures in general |
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Definition
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Term
| In 2003 public funding sources accounted for about 50% of total substance abuse treatment related expenditures |
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Definition
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Term
| By 2014, public funding sources are expected to account for over 80% of total substance abuse treatment related expenditures |
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Definition
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|
Term
| Between 1986 and 2003 the percent of total health spending specifically for substance abuse treatment decreased for private insurance, Medicaid and Medicare |
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Definition
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|
Term
| Private health insurance paid the greatest share of substance abuse treatment related expenditures in 1986 |
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Definition
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|
Term
| By 2014 Medicaid is expected to be the largest payer of substance abuse treatment services. |
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Definition
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|
Term
| Since 2003 non-Medicaid state and other local government funds have become the largest payer of substance abuse treatment services |
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Definition
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|
Term
| Since 1986, the role of hospitals as providers of substance abuse service providers has been greatly reduced |
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Definition
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Term
| According to the Better Not Best Health Affairs article; between 1996 and 2006 all age groups had an increase in the percentage of population with a diagnosed mental illness |
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Definition
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Term
| According to the Better Not Best Health Affairs article; since 1986 the percentage of primary care visits that included a mental health diagnosis has increased |
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Definition
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Term
| According to the Better Not Best Health Affairs article; adults under age 65 have the highest rate of mental health related hospital discharges |
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Definition
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Term
| In a sutdy of mental health services in Candad, Chile, Germany, the Netherlands, and the United States; the prevalence estimates for any DSM IV disorder ranged between 17.0 percent (Chile) and 29.1 percent (US) |
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Definition
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Term
| In a sutdy of mental health services in Canada, Chile, Germany, the Netherlands, and the US; with the exception of Chile and the US the percent of those with serious mental disorders was above 50% |
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Definition
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Term
| Between 1970 and 2003 the rate of increase in nominal expenditures for mental health services was about the same as that for national health expenditures |
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Definition
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|
Term
| By 2003 mental health expenditures accounted for less than 1% of GDP |
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Definition
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|
Term
| By 2006 per capita spending on mental health services increased to about $1,000 per year |
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Definition
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|
Term
| Between 1996 and 2006 the rate of growth in mental health spending has increased more than the rate of growth for health care for those with private insurance |
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Definition
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Term
| Mental health spending growth by Medicaid was about the same in 1996 as in 2006...unlike overall changes in health spending |
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Definition
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Term
| Between 1996 and 2006, the percentage of primary care visits for children that incldued a mental health diagnosis increased to just over 6% |
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Definition
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Term
| Teh VHS provides free mental health treatment for all veterans, regardless of income |
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Definition
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Term
| Recent data from a RAND study estimated that 18.5% of returned troops (about 300,000 of OEF/OIF veterans) met criteria on a structured survey assessing probable PTSD or depression |
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Definition
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Term
| Veterans eligibility to receive health care services from the Veterans' Administration is based exclusively on whether they were discharged from the military with a disability |
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Definition
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|
Term
| Some veterans receiving care from the Veterans' Administration are required to pay co-pays |
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Definition
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Term
| The Mental Health Parity Act of 1996 may prevents large group health plans from placing annual or lifetime dollar limits on mental health benefits that are lower - less favorable - than annual or lifetime dollar limits for medical and surgical benefits offered under the plan |
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Definition
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Term
| The Mental Health Parity Act of 1996 applies to small group (fewer than 51 workers) health plans or health insurance coverage |
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Definition
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Term
| The Mental Health Parity Act of 1996 does not prohibit large group health plans from covering mental health services within network only, even though the plan will pay for out of network services for medical/surgical benefits (although with higher) out-of-pocket cost to the subscriber |
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Definition
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Term
| The Mental Health Parity Act of 1996 prohibits large group health plans from increasing co-payments or limiting the number of visits for mental health benefits |
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Definition
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|
Term
| The mental Health Parity Act of 1996 does not prohibit large group health plans from imposing limits on the number of covered visits, even if the plan does not impose similar visit limits for medical and surgical benefits |
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Definition
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|
Term
| The Mental Health Parity Act of 1996 prohibits large group health plans from having different cost-sharing arrangements, such as higher coinsurance payments for mental health benefits, as compared to medical and surgical benefits |
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Definition
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Term
| The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act expands parity by requiring equality for deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days, and covered out-patient visits |
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Definition
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Term
| The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act requires health insurance plans that offer mental health coverage to provide the same financial and treatment coverage offered for other physical illnesses |
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Definition
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Term
| The 2008 Paul Wellstone and Pete Domenici Mental health Parity and Addiction Equity Act mandates that group plans must provide mental health coverage |
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Definition
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Term
| The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act allowed most provisions go into effect on a delayed basis, in 2010 |
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Definition
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|
Term
| Identify five types of organizational settings in which mental health services are commonly provided outside of hospitals and physician offices |
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Definition
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Term
| T/F: Hospitals account for about 31% of US healthcare expenditures |
|
Definition
|
|
Term
| T/F: Wages account for about 60% of hospital expenses |
|
Definition
|
|
Term
| T/F: Prescriptions drugs accoutn for about 15% of hospital expenses |
|
Definition
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Term
| T/F: Since 1987 the number of hospitals has increased as our population has increased |
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Definition
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Term
| T/F: Since 1987 the number of beds has decreased |
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Definition
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Term
| T/F: Since 1987 the number of beds/1000 population has decreased |
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Definition
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Term
| T/F: In the US, there is little variation in the number of beds/1000 population in different states |
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Definition
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Term
| T/F: Since 2000 there has been an increasing trend of hospital consolidation within multi-hospital systems |
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Definition
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Term
| T/F: Since 1981, there has been a steady decrease in the percent of outpatient surgeries performed in freestanding facilities, but an increase in the percent of outpatient surgeries performed in hospitals |
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Definition
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Term
| T/F: Since 2003 there has been an increase of over 60% in the number of outpatient surgery centers |
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Definition
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Term
| T/F: Between 1997 and 2007 there has been a general trend towards increasing physician affiliations with hospitals |
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Definition
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Term
| T/F: Fewer than 40% of hosptials provide hospice services |
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Definition
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Term
| T/F: In 2007 about the same percentage of hospitals provided hospice and home health services |
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Definition
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Term
| T/F: Since about 1995 inpatient admissiosn have increased every year except 2000 and 2001 |
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Definition
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Term
| T/F: Between 1987 and 2007 admissions per 1000 population have generally increased substantially each year |
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Definition
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Term
| Inpatient days per 1,000 persons between 1987-2007 have increased each year |
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Definition
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Term
| T/F: Average length of stay in community hospitals between 1987-2007 has steadily increased each year |
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Definition
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Term
| T/F: Since 1992 the number of community hospitals with emergency departments has increased |
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Definition
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Term
| T/F: Since 1992 the number of emergency department visits have increased each year |
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Definition
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Term
| T/F:In general, hospital emergency department visits per 1,000 persons have increased between 1991-2007 |
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Definition
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Term
| T/F: Teaching hospitals and urban hospitals report having the lower rates of their emergency departments operating at or above capacity |
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Definition
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Term
| T/F: over 1/3 of all US hospitals have reported being on ambulance diversion during the most recent year for which these data are available |
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Definition
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Term
| Between 1995 and 2004 there has been a decrease in both free-standing and hospital-based psychiatric facilities |
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Definition
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Term
| The 2 top reasons for ED diversions are lack of critical care beds and staff shortages |
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Definition
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Term
| The provision of behavioral health service in emergency departments has remained relatively unchanged |
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Definition
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Term
| About 1/3 of ED visits are for non-urgent or semi-urgent care reasons |
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Definition
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Term
| The proportion of physicians providing office/clinic based charity care has been declining since 1996 |
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Definition
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Term
| EDs serve proportionally more Medicaid and uninsured patients than physician offices |
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Definition
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Term
| Between 1987 and 2007 outpatient visits in hospitals have steadily increased |
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Definition
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Term
| According to the AHA state of America's Hospital 2010 pulse survey: about 28% of hospitals reported that it is somewhat more difficult or it is significantly harder to obtain ED call coverage for General Surgery and Orthopedics |
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Definition
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Term
| According to the AHA State of America's Hospital 2010 pulse survey: by 2010 about 50% of hospitals are paying for at least some type of ED call coverage |
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Definition
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Term
| According to the AHA State of America's Hospital 2010 pulse survey: about 21% of hospitals reported paying more than $1,000,000 per year for ED call coverage |
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Definition
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Term
| According to the AHA State of America's Hospital 2010 pulse survey: about 40% of hospitals require physicians with admitting privileges to provide ED call coverage |
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Definition
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Term
| According to the 2010 Press Ganey ED Pulse Survey: by state the average number of minutes patients waited in EDs ranged from about 179 to 300 |
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Definition
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Term
| According to the 2010 Press Ganey ED Pulse Survey patients waiting more than 2 hours demonstrate marked and consistent declines in their reported satisfaction scores. |
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Definition
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Term
| According to the authors of the article "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics," urgent care centers and retail clinics have emerged as alternatives to the emergency department for non-emergency care |
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Definition
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Term
| According to the authors of the article "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics, " Americas seek a relatively small amount of non-emergency care in emergency departments, where they often encounter long wait to be seen |
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Definition
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Term
| According to the authors of the article "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics", the majority of patients seen in Eds are female, and about 50% of ED patients are uninsured |
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Definition
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Term
| According the the authors of the article "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics", over 50% of patients seen for joint and muscle problems in the ED for non-emergency care occur when alternative sites such as urgent care clinics and retail clinics are also open |
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Definition
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Term
| According to the authors of the article "Where Americans Get Acute Care: Increasingly, It's Not At Their Doctor's Office", estimated that only 42% of the 354 million annual visits for acute care - treatment for newly arising health problems - are made to patients' personal physicians |
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Definition
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Term
| According to "Where Americans Get Acute Care: Increasingly, It's Not at their doctor's office", estimate that although fewer than 25% of doctors are emergency physicians, they handle 1/2 of all acute care encounters and more than half of such visits by the uninsured |
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Definition
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Term
| Hospital outpatient visits per 1,000 persons have remained relatively unchanged between 1987-2007 |
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Definition
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Term
| Between 1987-2007 the percentage of surgeries done in hospitals which are outpatient surgeries has surpassed the percentage of inpatient surgeries |
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Definition
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Term
| The percentage of hospitals with negative operating margins averaged about 25% between 1995-2007 |
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Definition
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Term
| Between 1991 and 2007 the average Patient margin in US hospitals was negative |
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Definition
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Term
| The Distribution of Outpatient vs. Inpatient Revenues between 1987-2007 demonstrates a steady increase percentages of revenues coming from outpatient sources |
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Definition
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Term
| The median average age of hospital plant has been gradually decreasing between 1990-2007 due to the hospital building boom |
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Definition
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Term
| DRGs and MS-DRGs are administratively cheaper, and less cumbersome for payers, because different payment levels need to be set for fewer types of inpatient care |
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Definition
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Term
| DRGs and MS-DRGs shift financial risk to hospitals by shifting form fee for service to case-based payment because services used in excess of the case-based fee are the financial responsibility of the hospital |
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Definition
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Term
| Clinically, there may be very different types of patients being assigned the same DRG or MS-DRG |
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Definition
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Term
| Both hospital and physician payments are included in the case-based DRG or MS-DRG based payments |
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Definition
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Term
| DRGs and MS-DRGs do not have a specific payment level attached to them |
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Definition
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Term
| DRGs and MS-DRGs represent a way of trying to cluster similar level of care inputs |
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Definition
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Term
| DRG 127, Heart failure and shock, is the most frequently billed DRG for Medicare |
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Definition
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Term
| When combining all sources of payment the most frequently billed DRG is for DRG, health failure and shock |
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Definition
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Term
| MS-DRGs currently uses ICD-9 diagnoses and CPT Procedure Codes to classify patients into one of 25 MDCs |
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Definition
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Term
| MS-DRGs include 735 categories |
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Definition
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Term
| MS-DRG represents a shift to "value purchasing" by Medicare |
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Definition
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Term
| All third party payers must use either the DRG or MS-DRG classification to pay for inpatient care |
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Definition
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Term
| Total full-time employees working in hospitals has remained relatively unchanged between 19987-2007 |
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Definition
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Term
| Between 1987 and 2007 both the number of FTE nurses and nurses per adjusted admission have steadily increased |
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Definition
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Term
| Since about 2001, RN Full-time equivalents as a percentage of total hospital full-time equivalents have increased each year |
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Definition
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Term
| In 2010 the majority of RNs will be under age 40 |
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Definition
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Term
| The number of full-time employees has increased in 12 of this 14 year period |
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Definition
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Term
| Average weekly earnings of hospital workers has been greater than weekly earnings increases for all service-providing industries between 1990 and 2007 |
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Definition
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Term
| List the 6 factors transforming hospitals identified by Shi & Sing |
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Definition
1) advances in medical science
2) development of specialized technology
3) advances in medical education
4) development professional nursing
5)growth of health insurance
6)role of government |
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Term
| List the 6 categories of hospitals discussed in class |
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Definition
1) Public hospitals
2) Voluntary Hospitals
3) Teaching vs Non-teaching Hospitals
4) Medicare location/type
5) Proprietary hospitals (for-profit)
6) General vs. specialty |
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Term
| From highest to lowest, what are the 5 more common factors contributing to ambulance diversions? |
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Definition
1) lack of critical care beds
2) ED overcrowded
3) Staff shortages
4) Lack of general acute care beds
5) lack of specialty physician coverage
6) lack of psychiatric beds |
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Term
| According to the AHA State of America's Hospital 2010 pulse survey, identify the top four strategies being used by hospitals to increase ED on-call coverage |
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Definition
(1) Increased # of employed dr's
(2) began paying for dr's ED on-call coverage
(3) Increased pay for dr. ED on-call coverage
(4) Hired dr's on a temporary basis to fill gaps in ED on-call coverage |
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Term
| Why would the 2 most common Medicare DRGs be different from the 2 most common DRGs when all payers are considered |
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Definition
| Medicare covers elderly, disabled, and other more sickly people than are in the general population. When all payers are considered, most general population patients are not as sick or have much different needs than Medicare patients. |
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Term
| What are the 2 primary reasons for the transition from DRGs to MS-DRGs? |
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Definition
(1) Transition to MS-DRG’s create greater differentiation and more refined payments
(2) Up-coding for complications and co-morbidities doesn’t distinguish community vs. hospital acquired conditions
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Term
| Why is it in Medicare's interest to increase the # of DRG categories as part of the MS-DRG transition? |
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Definition
Allows for greater differentiation in payment to providers
Allows for different payments based on severity of injury or sickness
Administratively cheaper, less cumbersome for payer … set fee for and track a small number of different payment categories
Shifts financial risk to hospitals by shifting from fee for service to case-based payment
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Term
| Which type of hospitals benefit financially more by having more DRG categories within a MDC? Why? |
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Definition
| Urban and larger hospitals benefit more by having more DRG categories within a MDC because it allows them to charge for more things |
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Term
| How does the information needed to document care change with an increased number of DRG categories in each MDC? |
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Definition
| Requires finer and finer documentation by the provider |
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Term
| What are the 3 severity levels used in the MS-DRG categorization? |
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Definition
1) no complications or comorbidities
2)complications or comorbidities and
3) major complications or comorbidities |
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Term
| What are the 8 Present on Admission conditions that if not documented at admission that Medicare will STOP paying for starting October 1, 2009? |
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Definition
1) Object left in during surgery 2) surgical site infection 3) air embolism 4) blood incompatibility 5) catheter associated UTI 6) Pressure ulcer 7) vascular catheter-associated infection
8) hospital falls and trauma |
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Term
| Define adjusted admissions and explain why they were developed |
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Definition
| an aggregate measure of workload reflecting the number of inpatient admissions, plus an estimate of the volume of outpatient services, expressed in units equivalent to an inpatient admission in terms of level of effort |
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Term
| Define economic multipliers |
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Definition
| extent to which personnel and other expenses create positive economic effects in local community |
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