WGU C425 Review Finals Exam With Complete Solution

Universal Access - Answer Developed countries have national health insurance programs. It provides routine and basic health care. It is ran by the government and financed-through general taxes. All Americans are not "entitled" to routine and basic health care services. - Answer Access also requires an adequate health delivery infrastructure. There is a shortage of primary care physicians mostly in the southern and mountains region. Obesity, chronic disease and aging population will create a much greater demand for medical services and the size of physician workforce will decline. 50 % of PCP accept Medicaid and Participation in Medicare by PCP 36% why PCP are reluctant to accept Medicaid insured patients because of low reimbursement to providers and delays to receive payments after the services. Health Care Reform - Answer Is the extension of health insurance to the uninsured. For system to remain solvent, it must be accompanied by control costs measures. To control costs: · Manage utilization · Limit reimbursement to providers · Employ some sort of rationing for supply of health care services Only the government can control costs in a single payer system because they finance the healthcare system for all citizens. In a single payer system, - Answer Medicare, Medicaid, CHIP and VA are no longer needed. The government will have the right to over the availability of services, utilization and payments to providers. This will be opposed by many Americans and it is not seen as an alternative for the future. ACA proposed interventions to control costs but few provisions on addressing control of health care expenditures. - Answer If the US does not cut expenses in the bloated government, US may be left with no choice except to take drastic "austerity measure" a term used to describe spending cuts, including cuts in social program. To save Medicare from bankruptcy, changes to reduce costs are proposed in the ACA. Medicare benefits and allow a government panel to make decisions about end of life care. Medicaid, the push to enroll beneficiaries to managed care and paying MCO capitated monthly fees to cover all health care expenses for Medicaid beneficiaries. Taxes will increase for Americans to pay for the health care programs to be expanded. If ACA fails: Patient choice act, Health Care Freedom Plan, Empowering Patients First Act were proposed by republican legislatures and the main features for these plans are. - Answer 1. Established state-based health care exchanges to facilitate individuals to buy private health insurance and create a market where private health plans compete for enrollees based on price and quality. 2. Create a national market for health insurance to allow individuals to purchase health insurance plans across state lines which are currently prohibited. 3. Allow automatic enrollment in employer plans and create tax incentives for small business for auto enrollment. 4. Give tax credit or vouchers to individuals to purchase health insurance. High risk pools that enable hard to insure people to purchase subsidized covered. • . Replace Medicaid with a program to provide grants to state for: a) Acute Medical Care Assistance to the blind, foster care children, low income women with breast cancer or cervical cancer, TB infected individuals; b) long term care services and support disabled and elderly populations 6). Establish and implement a bidding mechanism to promise competition among Medicare Advantage plans (Part C). 7) Prevent Medicare fraud and abuse. 8) Supplement the costs of Private health insurance for low income families by distributing debit cards which may be used for costs and accessing health care. 9). Repeal CHIP because options for this program may not be necessary. 10) Reform the Tort System by developing mechanism for the resolution of disputes concerning injuries allegedly caused by health care providers. Reduce frivolous lawsuits. 11) Assure consumers have access to price information prior to treatment so that they can make their own decisions about the care. What issues exists in this system which is driven by medical model of health are unresolved? - Answer 1) inadequate emphasis on wellness, disease prevention and health promotion 2) a rise of chronic conditions and ensuing disabilities, the current health care system focuses on acute illnesses. 3) Inadequate access to primary care resulting in patients overutilizing the ER 4) increases the costs of health care w/o any improvement in health care 5) The delivery of care is fragmented instead of continuous and coordinated. 3 emerging models of health care delivery - Answer 1) Medical Home Model 2) Community Oriented Primary Care Model 3) Accountable Care Organizations. Teamlet Model - Answer 1) refers to two-person team consisting of a PCP, nurse practitioners or physician assistant and an allied health professional who will function as a health coach. The main function of health coach: · is to assist patient in gaining the knowledge and skills, confidence to self manage their chronic conditions. · Assist in coordinating appts · Help patients adopt a healthy lifestyle · Help patients understand and adhere to medication regimen Connected Health Care Model - Answer 1) uses communication technology 2) patient self management and distant home monitoring Main objective is to keep chronically ill patients connected to necessary clinical expertise in between office visits Future work force challenges - Answer · Shortage of health care professionals · To have a successful model of health care delivery system to be highly effective must have trained professionals. · Nurses should practice to their full extent through education and training. · Licensing requirements rules governing scope of practice should be allowed across states for nurses who have masters or doctoral degrees · Residency programs for nurses need to incorporate training in community health, public health and geriatrics Future workforce challenges - Answer PCP need to be trained to function as a comprehensivist to address the needs of growing number of people with chronic conditions. PCP must be prepared to manage complex pharmacology to address end of life issues and medical ethics and lead health care teams PCP need to be trained to function as a comprehensivist to address the needs of growing number of people with chronic conditions. PCP must be prepared to manage complex pharmacology to address end of life issues and medical ethics and lead health care teams. There is a shortage of health professionals trained in geriatrics which is a challenge because of shortage of faculty in colleges and universities who are trained in geriatrics. The elderly uses most home health care services and nursing homes, accounts for hospital inpatient days and ambulatory care visits. Elderlies suffer from chronic conditions complicated by comorbidities, the use of many prescriptions and increased in mental conditions and dementia. These trends demand will have shortage of MD, nurses, therapist, social workers and pharmacists who are trained in geriatrics. Integration of a racially and culturally diverse workforce will be a challenge as the U.S. Healthcare System itself becomes more complex in taxing both patients and workers. Cultural Competence: - Answer refers to knowledge, skills, attitudes and behavior required of a practitioner to provide optima health care services to persons from a wide range of cultural and ethnic backgrounds. Health care providers need to understand the different belief systems, cultural biases, ethnic origins, family structures and many other culture-based factors that influence people who have illnesses in compliance with medical advice and respond to s to knowledge, skills, attitudes and behavior required of a practitioner to provide optima health care services to persons from a wide range of cultural and ethnic backgrounds. Health care providers need to understand the different belief systems, cultural biases, ethnic origins, family structures and many other culture-based factors that influence people who have illnesses in compliance with medical advice and respond to treatment. GLOBAL THREATS AND INTERNATIONAL COOPERATION - Answer Early identification of infectious threats and rapid response to prevent further spread of disease - a goal that is often difficult to achieve without international cooperation. Efforts to strengthen global health security includes disease surveillance of outbreaks of international importance and urgency, exchange of technical information on new pathogens and control animal disease. IHR (International Health Regulations) - Answer Aim is to help prevent and respond to acute public health risk that can potentially cross borders. ·Apply to other public health emergencies such as chemical spills, leaks and dumping or nuclear melt downs. There are 8 types of medical technology that affect the future of delivery of patient care: - Answer Rational Drug Design: refers to the development of medications based on the study of the structures and functions of target molecules. The role of rational drug design, besides developing effective drugs, is to avoid having to wait for pure luck to design a new drug or to use a shotgun approach in drug design. 2) Imaging technologies: focuses on finding new energy sources and focusing an energy beam to avoid damage to tissues; detects abnormalities; faster accurate analysis using 3 D technology and higher resolutions displays 3) Minimally invasive surgery 4) Genetic mapping: to determine genes complex disease 5) Gene Therapy insertion of functioning gene into target cells to correct an inborn defect 6) Vaccines; for prophylactic basis 7) Research and developing of fluids and artificial bloods 8) Transplantation of organs such as xenotransplantation; animal tissues used to transplant humans Evidence Based Health Care - Answer 1) Geographic variations in the practicing of medicine without clinical justification have both quality and cost implications. 2) Has little evidence that high spending providers deliver better outcomes. Tools for the practice of EBM is - Answer Is formed of practice clinical guidelines. Evidence based practice guidelines are intended to represent "best practices" and "proven therapies." Many MD thinks the guidelines and protocols are too simple or too complicated, promote cookbook care, authors lack credibility or evidence are biased, decreases flexibility, reduces autonomy and are not applicable to the practice population. The goal of EBM is to increase the value of medical care. - Answer 1) Consumers fear that reducing costs will result in lower quality of care. Quality of care can be improved while cutting costs thereby increasing the value of medical care by reducing misuse and overuse. Recommendations for EBM that can be made for the future. - Answer 1) Practitioners, payers and policy makers need to become stakeholders. 2) Computer based models will help incorporate EMB into medical decision making. Models that are easily usable and understandable are essential. 3) Robust research designs, using clinical trials where application can be the backbone of EBM. 4) Guidelines and protocols must be revised and kept current to incorporate with scientific evidence. 5) Future practice guidelines must incorporate economic analysis. Mounting health care expenditures will pressure society to make rational choices about certain types of services because of costs of certain treatments. 6) Financial incentives, including provider payments and patient cost sharing must be restructured. 7) Reimbursement methods should focus on paying for best care instead of paying for services. Future of EBM - Answer Will exceed what MDs do and will incorporate all caregivers. For example, it infuses the practice of nursing, pharmacology or disciplines associated with the practice of medicine. EMB will become the standard that will govern the multidisciplinary process of health care delivery. Foundation of US Health Care Delivery - Answer Curative Medicine decreasing returns on health improvement while health care spending increases. There is increasing recognition of benefits to society that can result from promotion of health and prevention of disease, disability and premature death. Health care money has been focused on curative medicine, slow progress toward health promotion and disease prevention. The slow progress has been d/t the insurance system, cultural values, and medical practice that emphasize disease rather than health. Beliefs and values in US - Answer - Have remained mostly private, • Not a tax-financed national health care program. - Are strong forces against Fundamental changes in the financing and delivery of health care. • Social norms explain - Answer - How we view illness and expectations. What Is Health? - Answer -U.S. health care has followed a medical/biomedical model. - It assumes illness or disease thereby emphasizing clinical diagnosis and medical in the treatment of disease or its symptoms. - It emphasizes • Clinical diagnosis and medical interventions to: - Treat disease or its symptoms. - Have a clinical diagnosis and medical interventions. Largely governed by the medical model/biomedical model. Medical Model: - Answer Under the medical model, health is defined as the absence of illness or disease. The problem with this is health exists when a person is free of symptoms and does not require medical treatment. The reason does not provide the definition of health but defines what health is not. Health Care Delivery System - Answer Is Prevention of disease and health promotion are relegated a secondary status . It is a term used often in a population that lacks health. WHO - Answer defines health as "a complete state of physical, mental and social well-being and not merely an absence of disease defines health care system as all of activities aimed at promoting, restoring or maintaining heath Indicators of Health: - Answer · Self-reported health status · Life Expectancy · Morbidity · Mental Well-being · Social Functioning · Functional limitations · Disability · Spirit wellbeing. • Absence of illness and disease • Optimum health exists when - A person is free of symptoms and does not require medical treatment. - " A state of physical and mental well-being that facilitates the achievements of individual and societal goals" Society for Academic Medicine: - Answer is an independent, not-for-profit organization that has been established to identify, define and address the unmet educational needs of today's healthcare professionals. • WHO - Answer defines Health as: " A complete state of physical, mental and social well being, not merely the absence of disease." • Referred to as the biopsychosocial model of health. • defined a health care system as - All the activities whose primary purpose is to promote, restore, or maintain health. Holistic Health - Answer seeks to treat the individual as a whole person. It incorporates spiritual dimension as fourth element with physical, mental and social aspects necessary for optimal health. Literature shows that: - Religious and spiritual beliefs and practices have been shown to positively influence a person's physical, mental and social well-being they may affect incidences, experiences and outcomes of medical problems. - It affects the incidence, experience, and outcomes of common medical problems. - approach to health also is incorporated with alternative therapies into medical models. Illness vs. Disease: are not the same. Illness is - Answer · is what a person may feel like pain, discomfort, weakness, depression or anxiety. Illness vs. Disease: are not the same. Disease - Answer can be acute, subacute or chronic. Acute Condition - Answer · is relatively severe, episodic for short duration often treatable. · Subacute Condition - Answer lies between acute and chronic extremes on the disease continuum but has not acute features. Requiring further treatment after a short stay in the hospital. (i.e. vents, head trauma) · Chronic condition - Answer is less severe but of long and continuous duration. The patient may not fully recovery fully. i.e. asthma, dm, htn Quality of Life - Answer - A person's overall satisfaction with life during and after a person's encounter with the health care delivery system. - The term is used two ways: how satisfied a person is with experiences while receiving health care - Person's overall satisfaction with life and self-perception of health, after some intervention. Goal: To have a positive effect on an individual's ability to function, meet obligations, feel self-worth. Balanced approach must emphasize health determinants for individuals and broad policy interventions for populations. • Factors that influence an individual and a population's health: - Answer - A person's genetic make up - Individual Behaviors - Medical Practice - Social and Environmental Factors - Environment • Physical, social, cultural, and economic factors - Behavior/Lifestyle • Diet and foods play a major role in most significant health problems. - Heredity • Genetic factors predispose individuals to certain diseases. • Healthy lifestyles and health promoting behaviors can influence the development and severity inherited disease and can pose a risk for future generation. - Medical care: Access to adequate preventive and curative health care services. • Misallocation can be attributed to many factors, including insurance system, cultural beliefs and traditional medical training and practice. The association of income difference with health indicators such as life expectance, age-adjusted mortality rates and leading causes of death is well documented. Healthy People 2020 - Answer - 10-year plans - Key national health objectives - Founded on the integration of medical care and prevention, health promotion, and education • Objectives define new relationships between public health dept and the health care delivery organization such as DHSS. Goals: 1) high quality lives free of preventable disease, injury and premature death 2) achieving health equity, eliminating disparities and improving the health of all groups 3) Creating social and physical environment that promotes good health for all 4) Promoting quality of life, health development and behaviors. Social and Market Justice Approaches - Answer • Equal production, distribution, and, consumption of health care • No society - Has a perfectly equitable method to distribute limited resources. • Any method of resource distribution leaves some inequalities. Market justice: - Answer • proposes free economy can best achieve fair distribution of health care. • Medical services distributed on the basis of people's willingness and ability to pay. In other words, the people are entitled to purchse a share of goods and services that they value. Market Justice - Answer • The production of health care is determined by now much the consumers are willing and able to buy at the market price. • It follows that in a free market system individual without enough income or uninsured will face financial barrier. • Those who are not able to pay have barriers to health care. - The prices and ability to pay the types of services people consumes. These limitations on obtaining health care are referred to as Demand side Rationing or price rationing. • Focuses on individual rather than a collective responsibility for health. The key characteristic of market justice and their implications are - Answer • Views health care is good for the economy • Free market conditions of health services delivery • Markets are more efficient in allocating health care resources fairly • Production and distribution of health car are determined by market-based demand • Medical care distribution is based on people's ability to pay. • Access to medical care is viewed as an economic reward of personal effort and achievement. • Social Justice"The Good Society" - Answer • Theory is at odds with capitalism and market justice. • The fair distribution of health care is society's responsibility. - Goal can be achieved by letting the government take over the production and distribution of health care. - Should be collectively financed and available to every citizen regardless their ability to pay - Public health also has social justice orientation over the production and distribution function. an inability to obtain medical services because of financial barrier resources is considered unjust. The principles of Social Justice: - Answer 1) Health care is a social resource 2) Requires active government involvement i 3) Assumes that the government is more efficient in allocating health resources fairly 4) Medical resources allocation is determined by central planning 5) Ability to pay is unimportant or receiving medical care 6) Equal access to medical services is viewed as a basic right. 7) Planned rationing, supply-side rationing, or nonprice rationing is where a. Government limits the supply of health care services, particularly those who need basic level of care. The concept of planned rationing or supply side rationing is - Answer when the government find ways to limit the availability of certain health care services by deciding how technology will be dispersed and who will be allowed access to certain types of high tech services even though basic services may be available to all. Implications of Market Justice: - Answer 1) Individual responsibility for health 2) Benefits are based on individual purchasing power 3) Limited obligation to collective good 4) Emphasis on individual well being 5) Private solutions to social problems 6) Rationing based on ability to pay. Implications of Social Justice: - Answer 1) Collective responsibility 2) Everyone is entitled to basic package of benefits 3) Strong Obligation to the collective good 4) Community well being supersedes that of the individual 5) Public solutions to social problems 6) Planned rationing of health care Justice in the US Healthcare systems - Answer US health care system is not a market justice-based system because American health care delivery does not follow a free market principle because it also has Medicare and Medicaid. Private, employer-based health insurance for middle income Americans is driven by Market justice. Publicly financed Medicaid and Medicare coverage for certain disadvantaged groups and workers compensation programs are based on social justice. Public system reflects on organized efforts to delivery public health services within its community with a goal of improving well being of a population. Focusing on Determinants - Answer • To improve the nation's health and resolve disparities among its vulnerable populations, • A framework embodying the social and medical determinants because it is the combination of these factors that ultimately shapes health and well-being. Social Determinants of Health - Answer • The framework includes: • Demographics, personal behaviors, and community-level inequalities and their defining influence on health. • Personal demographics directly contribute to vulnerability levels. (e.g., race/ethnicity or age) • Socioeconomic status is defined by education, employment or income, both individual and community level socioeconomic status have independent effects on health • Personal behaviors: smoking or exercise • Social and income differences are contributions to health disparities (i.e. discrimination the difference in one's action towards another individual or group based on their personal characteristics.) Medical Care Determinants - Answer • The medical care system focuses primarily on treating illness or poor health. Preventative Care is an exception because problems with access and quality of care exists • This framework includes: - A broad spectrum of medical care services and interventions to improve health, - Some services through preventive and primary care contribute to general health status others are more influential in end-of-life mortality • (specialty and long-term care) Patients will likely come across issues such as poor continuity of care and insufficient coordination of care for multiple needs. Social and Medical Points of Intervention - Answer • Reductions in health disparities are obtainable through interventions in both social and medical domains. • Interventions are grouped according to four strategies: 1) Social or medical care policy interventions. 2) Community-based interventions. 3) Health care interventions. 4) Individual interventions. Policy Interventions: - Answer Social or public policy affects the health of the population. - Product safety regulations, screening foods and water sources and enforcing safe work environment guards the welfare of the nation. - Vulnerable populations - Are uniquely dependent upon social and public policy to develop and implement programs that addresses basic nutritional, safety social and health care needs.