Hsm 541 Study Guide Midterm

HEALTH SERVICE SYSTEMS

STUDY GUIDE

WEEKS 1-4

Five essays, minimum 200 words and cited 1hr and 30 mins

Chapter 1 – TCOs A and E

The Roemer Model of a Health Services System

Roemer defines a health service as an activity whose primary objective is health.

Management, resources production, organization, delivery of service, and economic

support.

System Values: Access, Cost, and Expenditures, and Quality

it’s like economics. Access: geography, physical, cultural, economic increased by

Medicare and Medicaid. Cost: inflation, valume of service, health insurance coverage,

Quality: lowered by high access and high cost

Chapter 2 – TCOs A and E

Distinguishing Health from Illness and Disease

Health is a state of mental, physical and social well-being. The US focus on the physical

aspect of health. physcial+social= personal traits. fertility/birthrates, life expectancy,

birth weight, morbidity (effected by disease in population), mortality….Illness is a

individual response, disease is pathological state.

Factors That Affect Care-Seeking Behavior

Perceived health status where individual think they are not doing well, ease of access,

risk factors. Gender, age, race and ethnicity,

Models of Health Services Utilization

Socioeconomic status= limited resources

Health behavior model= policy, satisfaction, ultization, charateristics of pop and system

Health belief model – taking action

Hospital uses age older, more females, more blacks, lower income

Home health care chromic, meidcare,

Nursing home, ekderky mostly Although appropriate health services utilization can be important in maintaining personal health, it is possible to overuse services in a way that can negatively affect health status.

Chapter 3 – TCOs A & E

Access to Health Services: entry or use of service

Access to care has a direct bearing on the two other important dimensions of the health

services system: cost/expenditures and quality. Increasing access to health services can

actually decrease unit costs in some instances but inevitably increases expenditures

Factors Affecting Access to Health Services

Georgraphic: influence by there living rural vs urban, transportation

Physical: mobility and mental competence, ease of access

Temporal: time constraints / sociocultural barrier: language cultures

Finacnial: access to health insurance coverage public or private

1) Affecting health not influenced by access to the individual ( genetic, behavior) personal health service 2) physical access : potential and realized 3) Potential social adverse health outcomes: lack of access 4) excessive access

2) Predisposing (gender/age, demographics, education) need factors( notions) Enable (other)

Public and Private Health Insurance

Private great for under 65 years old. Medicare for retirement is public over 65

Private: employer base, individual out of pocket, veterans, prison,indian reserve

Formed by President lyndon Johnson for his great society plan. Medicaid is a welfare program for low-income children and their caretakers. Disibilities

Medicare: 65+/diabled/railroad (eligible): (Finacing) A: employer contribution co pay/ B premium.deductables/ C: advantage/ D: outpatient drug coverage: ( benefit)

Pages 55-70hospital inpatient, hospice, home health, physical and outpatient service 43.2 mill/5 mill disable

Medicaid: Low income mom, child, elderly, aids. (finacing: 50% fed fund limit co-pay: ( benefit) everything 55.6 mill income and asset limits

Having financial access to health services directly affects care-seeking behavior. A lack of health insurance is associated with reduced access to medical care, a lower prevalence of recommended preventive services, potentially avoidable hospitalizations, and subsequently higher mortality independent of other risk factors

The destabilization of the U.S. economy that became alarmingly evident in the fall of 2008 suggests that a larger proportion of the population may delay seeking care because they have lost their employer-sponsored health insurance because of unemployment or have had related events that have compromised their financial access to health services. Destabilization is not a phenomenon unique to the United States: the global economy and that of many individual countries have also been affected, and although their various health services differ, a reduction in financial resources affects every resident of a country. Ineffective treatments and practices

Unisured: pay out of pocket or none. uch patients constitute a significant economic burden to hospitals, particularly public hospitals, whose provision of charity care (also called uncompensated care or bad-debt care) may jeopardize their ability to remain financially viable. Not have insurance for no employer , no job, $ for premiums , cannot get medicare ( expanding) or Medicaid

So may plans for insurance: changes state to state or have one federal insurance

Chapter 6 – TCOs C, D, & E

Major Financing Mechanism for U.S. Health Services

insurance is a mechanism to protect against unpredictable loss

set premiums to be paid periodically: