Hsm 541 Study Guide Midterm
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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
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
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: