WGU C425 Final Exam Questions With 100% Verified Answers | Latest Update 2023/2024 |

WGU C425 Final Exam Questions With 100% Verified Answers | Latest Update 2023/2024. 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. - Prevention strategies to change the dynamics linking social factors to poor health. OSHA - ANSWER-protects the employees of companies from potential dangers of an unsafe environment. OSHA established the injury and illness prevention program that require employers to implement a system that would ensure employee compliance. Community-Based Interventions - ANSWER-• Neighborhood poverty, the presence of local health and social welfare resources, and societal cohesion and support contribute to the level of inequalities in a community. • Community partnerships - Reflect the priorities of a local population and are often managed by members of the community they minimize cultural barriers and improve community buy-in to the program. - Addressing the problems using community approaches (i.e. resources that directly help the needy member of the community can provide business and local partners great incentives - Community solutions benefit from participatory decision making Social Policy and Community Level Interventions - ANSWER-are designed to address social problems in health. Health Care Interventions: - ANSWER-designed to improve the quality and efficiency of services provided and reduce disparities across groups. • Examples include: - Integrated electronic medical record systems to coordinate care for populations with multiple chronic and acute conditions. - Continuing education for pediatricians to target developmental services to children. - Educating pregnant mothers to receive regular prenatal care. Policy and community level interventions - ANSWER-are unable to reduce either social determinants. Individual-level Interventions - ANSWER-• Attempts to intervene and minimize the effects of negative social determinants on health status. • Altering behaviors that influence health is often the focus of these individual-level interventions - (e.g., reduce smoking and encourage exercise) managed care - ANSWER-A system of health care delivery that: 1) integrating the basic functions of healthcare delivery. 2) employs mechanisms to control (manage) utilization of medical services. 3) determines the price for services that are purchased and how much the providers get paid. 4) Is the most dominant health care delivery system 5) Employers and government are the primary financiers The VA health care system - ANSWER-Focuses on • Hospital, mental health and long-term care. • Is to provide medial care, education and training, research, contingency support and emergency management for the Department of Defense medical care system. • -Organized into 23 geographically-distributed Veterans Integrated Service Networks (VISN). Each VISN: o Coordinates its own services. o Receives federal funds. Special Vulnerable Populations - ANSWER-poor, uninsured, minorities and immigrants living in disadvantaged communities and receive care from "safety net" providers. Safety Net Providers - ANSWER-are public health insurance programs (Medicare and Medicaid, community health centers, free clinics and hospital ER Dept. Offers comprehensive medical and enabling services (language translations, transportation outreach, nutrition and health education, social support services, case management and child care for the vulnerable populations. • Medicaid, the primary financial source for the safety net, does not allow much cost shifting. Integrated Delivery: - ANSWER-The hallmark of the US health care industry or health networks represents various forms of ownership and other strategic links from hospitals, physicians, and insurers. Objective: To have one health care organization deliver a range of services. Integrated Delivery -A network of organizations that provides or arranges to provide a coordinated continuum of services to a specific population held clinically and accountable for outcomes and health status. Quality Improvement and cost control Have shown that hospitals provide higher quality of care compared to non integrated hospitals. long term care - ANSWER-• Consists of medical and nonmedical care that is provided to individuals who are chronically ill or who have a disability. • Provides support services for ADLs, and is delivered across venues, including patients' homes, assisted living facilities and nursing homes. • LTC services is not covered by Medicare. • Medicaid covers different levels of LTC • By 2020, more than 12 million Americans are projected to require LTC. Public Health's mission is to improve and protect the community. The National Public Health Performance Standards programs identifies 10 essentials in the public system needs to deliver: - ANSWER-• Monitoring health status to identify and solve health problems. • Diagnosing and investigating health problems and hazards. • Informing and educating people about health problems and hazards. • Mobilizing the community to solve health problems. • Developing policies to support individual and community health efforts. • Enforcing laws and regulations to support health safety. • Providing people with access to necessary care. • Assuring a competent and professional health workforce. • Evaluating the effectiveness, accessibility, and quality of personal and populationbased health services. • Performing research to discover innovative solutions to health problems. The main characteristics of U.S. Health Care System: - ANSWER-• No Central Governing Agency; Little Integration and Coordination • Technology-Driven and Focuses on Acute Care • High on cost, Unequal in Access, and Average in Outcomes • Delivery of health care under imperfect market conditions • Fusion of Market Justice and Social Justice • Multiple players and balance of power • Integration and accountability • Access to health care services selectively based on insurance coverage • Legal risks influence practice behaviors. The US system is different from other developed countries. - ANSWER-It is not centrally-controlled. • Central systems are less complex, less costly. • Has different payment, insurance, and delivery mechanisms. • Health care is financed both publicly and privately. Technology-Driven and Focuses on Acute Care - ANSWER-• The US invests in research and innovations in new medical technology. • Growth in science and technology helps create demand for new services, despite of the factors contribute to increase of demand for expensive technology care. (i.e. patients often assume the lastest innovations represents the best care and many want to try the latest gadgets. Even if having the modern equipment there is pressure to recoup their investments made in technology. High costs of these technology it would be difficulty for: - ANSWER-- Employers extending benefits to part-time workers and - For Insurers lowering premiums. Access - ANSWER-refers to the ability of an individual to obtain health care services when needed. It's restricted in the US to those who: 1. Have health insurance through an employer. 2. Are covered under a government program. 3. Can afford to buy insurance out-of-pocket. 4. Are able to pay for services privately 5. Can obtain services through safety net providers (public health, community Imperfect Market Conditions - ANSWER-Under national health care programs, • Patients have a choice in selecting providers. Even though the delivery of services are mostly in private hands, health care is partially governed by free market forces. Free market characteristics explain why U.S. is not a true free market. - ANSWER-In a free market, • Multiple patients (buyers) and providers (sellers) act independently. • Patients should be able to choose their provider based on price and quality of services. • Medicare, Medicaid, or MCO are the payors, prices are set by these agencies to the market, therefore it is not free and it is governed by supply and demand. For health care to be free, - ANSWER-competition exists among health care providers. T he consolidation of buying power into private health plans, however is forcing providers to form alliances and IDSs on the supply side. Free market requires - ANSWER-Patients have information available of various services. operates best when consumers are educated about the product they are using and patients are well informed about the decisions that need to be made regarding their care. Patients must make choices on technology, diagnostic methods, medications and interventions can be difficult because it requires an MDs input. Act as advocates, primary care providers can help reduce these gaps Health consumers have begun to take the initiatives to learn information on the internet and pharmaceutical companies advertise medications and consumers think they are available and paid by insurances. there are hidden costs making it difficult for patients to determine expenses of services ahead of time. Item-based pricing - ANSWER-refers to the costs of ancillary services that often accompany major procedures such as surgery. Package Pricing and capitated fees: - ANSWER-help overcome the draw backs by providing a bundled fee for a package related services. Package pricing covers s - ANSWER-ervices that are bundled together for one episode of care. Capitation - ANSWER-covers all services an enrollee may need during an entire year. In a free market for patients - ANSWER-directly bear the costs of services received. Moral hazard exists after an enrollee have purchased insurance that a health plan will tell you it is covered but are covered even if they don't have health insurance. In a free market for health care: - ANSWER-Consumers make decisions about the purchase of health care services. Limits patients ability to make health care purchasing decision Decisions about the utilization of health care is determined by price based demand Need has generally defind as the amount of medical experts believe a person should have to become healthy. Delivery of health care can result in creation Moral hazards leads to greater utilization