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Term 1Medical model
Definition 1Presupposes the existence ofillness or disease, thereby
emphasizing clinical diagnosisand medical intervention inthe treatment of disease or
its symptoms.
Term 2Health (via medical model)
Definition 2The absence of disease or
illness. When a person is freeof symptoms and needs no
medical treatment.Term 3
Health care delivery (medicalmodel)
Definition 3The delivery of medicalcare or illness care.
Term 4Health (medical sociologists)
Definition 4The state of optimal capacity
of an individualto perform his or her expectedsocial roles and tasks, suchas work, school, and household
chores.
Term 5Health (Society for Academic
Emergency Medicine)
Definition 5A state of physical and mentalwell-being that facilitatesthe achievement of indivdual
and societal goals.
Term 6Health (World Health
Organization)
Definition 6A complete state of physical,mental, and social well-being,and not merely the absence of
disease or infirmity.
Term 7Health care system (WHO)
Definition 7All activities aimed atpromoting, restoring, or
maintaining health.Term 8
Indicators of Health (8)Definition 8
-Self-reported health status-Life expectancy
-Morbidity (disease)
-Mental well-being-Social functioning
-Functional limitations-Disability
-Spiritual well-being
Term 9Holistic Medicine
Definition 9Seeks to treat the individual
as a whole person. Fouraspects of necessary foroptimal health: physical,
mental, social, and spiritual.
Term 10Illness
Definition 10Recognized by means of a
person's own perceptions andevaluation of how s/he feels.
Term 11Disease
Definition 11Determination is based on a
medical professional'sevaluation rather than on the
patient's assessment.
Term 12Acute condition
Definition 12Severe, episodic (of short
duration), and oftentreatable. Subject to
recovery, often treated ina hospitalsetting.
Term 13Subacute condition
Definition 13Between acute and chronic ondisease continuum. Requiresfurther treatment after a
brief stay in the hospital.
Term 14Chronic condition
Definition 14Less severe, but of long and
continuous duration.Controlled via appropriatemedical treatment, but if
untreated can lead to severeand life-threatening
consequences.Term 15 Definition 15
Quality of life
1) An indicator of howsatisfied a person was withhis or her experiences whilereceiving healthcare services.
2) Refers to a person'soverall satisfaction with lifeand with self-perceptions ofhealth, particularly aftersome medical intervention.
Term 16Determinants of health (4)
Definition 161) Environment - physical,
socioeconomic, sociopolitical,and sociocultural dimensions
of life.2) Behavior & Lifestyle -
personal choices such as diet,exercise, and risky behaviors.3) Heredity - genetic risk
factors4) Medical care - bothindividual andpopulation
health are closely linked toaccess to adequate
preventative and curativehealthcare services.
Term 17Healthy People 2010 (emphasis)
Definition 17Emphasized the role of
community partners such asbusinessses, local
governments, and civic,professional, and religiousorganizations as effective
agents for improving health intheir local communities.
Term 18Health People 2020 (goals)
Definition 18-Attaining high-quality,longer lives free of
preventable disease, injury,and premature death.
-Achieving health equity,eliminating disparities, andimproving the health of all
groups.-Creating social and physicalenvironments that promote good
health for all.-Promoting quality of life,healthy development, and
healthy behaviors across alllife stages.
Term 19Market Justice Characteristics
Definition 19-Views healthcare as an
economic good.-Assumes free market
conditions for health servicesdelivery
-Assumes that marketsare moreefficient in
allocating health resourcesequitably.
-Production and distributionof healthcare are determined
by market-based demand.-Medical care distribution isbased on people's ability to
pay.-Assess to medical care is
viewed as an economic rewardof personal effort and
achievement.Term 20
Social Justice CharacteristicsDefinition 20
-Views healthcare as a socialresource.
-Requires active governmentinvolvement in health services
industry.-Assumes that the government
is more efficient in
allocating health resourcesequitably.
-Medical resource allocationis determined by central
planning-Ability to pay is
inconsequential for receivingmedical care.
-Equal access to medicalservices is viewed as a basic
right.
Term 21Market Justice Implications
Definition 21-Individual responsibility for
health.-Benefits are based on
individual purchasing power.-Limited obligation to the
collective good.-Emphasis on individual well-
being.-Private solutions to social
problems.-Rationing based on ability to
pay.
Term 22Social Justice Implications
Definition 22-Collective responsibility for
health.-Everyone is entitled to abasic package of benefits.-Strong obligation to the
collective good.-Community well-beingsupersedes that of the
individual.-Public solutions to social
problems.-Planning rationing of
healthcare.Term 23 Definition 23
Demand-side rationing (pricerationing)
Prices and ability to paycombine to ration the quality
and type of healthcareservices people consume.
Term 24Supply-side rationing (planned
rationing)
Definition 24When the government makes
deliberate attempts to limitthe supply of healthcare
services, particularly thosebeyond the basic level of
care.
Term 25Public health
Definition 25A reflection of society's
desire and effort to improvethe health and well-being ofthe total population, andrelies on the role of
government, the privatesector, and the public in
addition to focusing on thedeterminants of population
health.
Term 26Public health system
Definition 26An organized effort to deliverpublic health services withina jurisdiction with the goalof improving health and well-
being of the population.
Term 27Turning Point Initiative
Definition 27Via the Robert Wood Johnson
Foundation, working totransform and strengthen the
public health system (21states are currently
participating).Term 28
Social and Medical Points ofIntervention (4)
Definition 281) Social or medical carepolicy interventions.2) Community-based
interventions.
3) Health care interventions.4) Individual interventions.
Term 29Discrimination
Definition 29The difference of one's
actions toward and individualor group based on the innatepersonal characteristics of
that group.
Term 1Managed care
Definition 1A system
of healthcare delivery that:-seeks to achieve efficiency
by integrating the basicfunctions of healthcare
delivery-employs mechanisms to control
(manage) utilization ofmedical services
-determines the price at whichthe services are purchased andhow much the providers are
paid.Term 2
Enrollee (member)Definition 2
The individual covered underahealth plan
Term 3Health plan
Definition 3The contractual agreement
between the enrollee and theMCO that contains the
collective array of coveredhealth services to which the
enrollee is entitled.Term 4
GatekeepersDefinition 4
Primary care physicians thatcontrol patient referrals to
higher-level or specialtyservices.
Term 5Capitation
Definition 5When a provider is paid a
fixed value for each patientunder their care, regardless
of the amount of carerequired, over the course of a
fixed period (typically 1year).
Term 6TriCare
Definition 6Insurance program for familiesand dependents of active-dutyor retired career military
personnel.
Term 7The Veterans Affairs (VA)
Definition 7The health care system
available to retired veteranswho have previously served inthe military, with priority
given to those who aredisabled.
Term 8Veterans Integrated Service
Network (VISNs)
Definition 8Geographic distribution of VAhealth care system. 23 VISNscoordinate all activities of
all health care entitieswithin its jurisdiction.
Term 9Special populations
(Vulnerable populations)
Definition 9Those with health needs butinadequate resources to
address those needs. Typicallyreceive care through thenation's "safety net."
Term 10Medicare
Definition 10One of largest sources
of public health insurance inUS. Serves the elderly,
disabled, and those with ESRD.Term 11 Definition 11
Medicare Coverage
Covers hospital care, post-discharge nursing care,hospice care, outpatient
services, and prescriptiondrugs. Does not cover long-
term care.
Term 12Medicaid
Definition 12Third largest source of healthinsurancein country. Serveslow-income adults, children,the elderly, and individuals
with disabilities.
Term 13Children's Health Insurance
Program (CHIP)
Definition 13Formed in 1997 to provideinsurance to children in
uninsured families. Coversphysician visits,immunizations,
hospitalizations, andemergency room visits.
Term 14Integrated Delivery Systems
(IDSs)
Definition 14A network of organizations
that provides or arranges toprovide a coordinated
continuum of services to adefined population, and that
is willing to be heldclinically and fiscally
accountable for the outcomesand health status of that
population.
Term 15Long-term care (LTC)
Definition 15Consists of the medical andnon-medical care that is
provided to individuals whoare chronically ill or whohave a disability. Not onlyhealth care but support
services for daily living.Term 16 Definition 16
Ten essential public healthservices a system should
deliver as defined by NPHPSP
1) Monitoring health status toidentify and solve community
health problems.2) Diagnosing and
investigating health problemsand hazards.
3) Informing and educatingpeople about health problems
and hazards.4) Mobilizing the community to
solve health problems.5) Developing policies tosupport individual and
community health efforts.6) Enforcing laws and
regulations to support healthsafety.
7) Providing people withaccess to necessary care.8) Assuring competent and
professional health workforce.9) Evaluating the
effectiveness, accessibility,and quality of personal andpopulation-based health
services.10) Performing research to
discover innovative solutionsto health problems
Term 17Ten Main Characteristics ofthe US Healthcare System (Be
able to explain each)
Definition 17-No central governing agencyand little integration and
coordination.-Technology-driven delivery
system focusing on acute care.-High in cost, unequal inaccess, and average in
outcome.-Delivery of healthcare under
imperfect market conditions.-Government as subsidiary to
the private sector.-Fusion of market justice and
social justice.-Multiple players and balance
of power.-Quest for integration and
accountability.-Access to healthcare servicesselectively based on insurance
coverage.-Legal risks influencepractice behaviors.
Term 18Item-based pricing
Definition 18Refers to the costs of
ancillary services that oftenaccompany major procedures.Example being that patientsknow the cost of the surgery,but can't anticipate the costs
of supplies etc.
Term 19Package pricing
Definition 19Payment covers services thatare bundled together for one
episode of care.
Term 20Need
Definition 20The amount of medical care
that medical experts believe aperson should have to remain
or become healthy.
Term 21Provider-induced demand
Definition 21The creation of artificialdemand commonly due to
practitioners with a financialinterest in a treatment or
organization.Term 22
Market JusticeDefinition 22
Places the responsibility forfair distribution of
healthcare on market forces ina free economy. Medical
services are distributed basedon ability and willingness to
pay.
Term 23Social Justice
Definition 23Emphasizes the well-being of
the community over theindivdual, therefore the
inability to obtain medicalservices due to a lackoffinancial resources is
considered unjust.
Term 24The Emergency Medical
Treatment and Labor Act of1986 ("EM-Tala")
Definition 24Requires the screening andevaluation of eery patient,
provision of necessarystabilizing treatment, andhospital admission whennecessary, regardless of
ability to pay.
Term 25Cost-shifting
Definition 25The patients able to pay forservices, privately insuredindividuals, employers, andthe government ultimatelycover the costs of medical
care provided to theuninsured.
Term 26Defensive medicine
Definition 26When providers prescribe
additional diagnostic tests,schedule check-up
appointments, and maintainabundant documentation in
order to avoid any negativelegal issues.
Term 27System
Definition 27Consists of a set ofinterrelated and
interdependent componentsdesigned to achieve some
common goals.
Term 1ACA of 2010 (PPACA)
Definition 1Patient Protection and
Affordable CareAct of 2010Term 2ACO
Definition 2Accountable Care Organization
Term 3ADLs
Definition 3Activities of daily living
Term 4AHA
Definition 4American Hospital Association(Heart and Health count too,
but not in our context)
Term 5AHRQ
Definition 5Agency for
Healthcare Research andQuality
Term 6AIDS
Definition 6Acquired immunodeficiency
syndromeTerm 7ALOS
Definition 7Average length of stay
Term 8AMA
Definition 8American Medical Association
Term 9AOA
Definition 9American Osteopathic Associati
onTerm 10APC
Definition 10Ambulatory payment classificat
ionTerm 11CAH
Definition 11Critical access hospital
Term 12 Definition 12
CBO Congressional Budget OfficeTerm 13CCRC
Definition 13Continuing-care retirement
communityTerm 14CDC
Definition 14Centers for Disease Control
and PreventionTerm 15CEO
Definition 15Chief Executive Officer
Term 16CHIP
Definition 16Children's Health Insurance
ProgramTerm 17CMS
Definition 17Centers for Medicare and
Medicaid ServicesTerm 18CPI
Definition 18Consumer price index
Term 19CPOE
Definition 19Computerized physician-order
entryTerm 20CPT
Definition 20Current procedural terminology
Term 21DHHS
Definition 21Department of Health and Human
ServicesTerm 22DME
Definition 22Durable Medical Equipment
Term 23DRG
Definition 23Diagnosis-related group
Term 24EBM
Definition 24Evidence-based medicine
Term 25EHR or EMR
Definition 25Electronic Health Record orElectronic Medical Record
Term 26ESRD
Definition 26End-stage renal disease
Term 27FDA
Definition 27Food and Drug Administration
Term 28FPL
Definition 28Federal poverty level
Term 29 Definition 29
GDP Gross domestic productTerm 30HDHP
Definition 30High-deductible health plan
Term 31HEDIS
Definition 31Healthcare Effectiveness Data
and Information SetTerm 32HHRG
Definition 32Home health resource group
Term 33HI
Definition 33Hospital insurance (in
Medicare)Term 34HIPAA
Definition 34Health Insurance Portability
and Accountability ActTerm 35HIV
Definition 35Human immunodeficiency virus
Term 36HMO
Definition 36Health maintenance
organizationTerm 37HRA
Definition 37Health reimbursement
arrangementTerm 38HSA
Definition 38Health savings account
Term 39HTA
Definition 39Health technology assessment
Term 40IADLs
Definition 40Instrumental activities of
daily livingTerm 41ICF/MR
Definition 41Intermediate care facility for
the mentally retardedTerm 42IDS
Definition 42Integrated delivery system
Term 43IHR
Definition 43International Health
RegulationsTerm 44IPA
Definition 44Independent practice
associationTerm 45 Definition 45
IT Information technology
Term 46JCAHO ("Jay-Co")
Definition 46Joint Commission on
Accreditation of HealthcareOrganizations; AKA The Joint
CommissionTerm 47LPN
Definition 47Licensed Practical Nurse
Term 48LTC
Definition 48Long-term care
Term 49LTCH ("L-Tack")
Definition 49Long-term care hospital or
Long-term acute care hospitalTerm 50LVN
Definition 50Licensed vocational nurse
Term 51MA-PD
Definition 51Medicare
Advantage Prescription DrugPlan
Term 52MCO
Definition 52Managed Care Organization
Term 53MMA
Definition 53Medicare Prescription Drug,
Improvement, and ModernizationAct
Term 54MRI
Definition 54Magnetic resonance imaging
Term 55MSA
Definition 55Metropolitan statistical area
Term 56NCQA
Definition 56National Committee for Quality
AssuranceTerm 57NF
Definition 57Nursing facility(certification)
Term 58NIH
Definition 58National Institutes of Health
Term 59OASIS
Definition 59Outcomes and Assessment
Information SetTerm 60 Definition 60
OPPS Outpatient prospective paymentsystem
Term 61PDP
Definition 61Stand-alone prescription drug
planTerm 62PERS
Definition 62Personal emergency response
systemTerm 63PHO
Definition 63Physician-hospital
organizationTerm 64PMPM
Definition 64Per member per month
Term 65POS
Definition 65Point-of-service (plan)
Term 66PPO
Definition 66Preferred provider
organizationTerm 67PPS
Definition 67Prospective payment system
Term 68R&D
Definition 68Research and Development
Term 69RBRVS
Definition 69Resource-based relative value
scaleTerm 70RHS
Definition 70Remote health services
Term 71RN
Definition 71Registered Nurse
Term 72RUG
Definition 72Resource utilization group
Term 73SARS
Definition 73Severe acute respiratory
syndromeTerm 74SMI
Definition 74Supplementary medical
insurance (in Medicare)Term 75
SNF ("Sniff")Definition 75
Skilled nursing facilityTerm 76SSI
Definition 76Supplemental Security Income
Term 77UCR
Definition 77Usual, customary, andreasonable (charges)
Term 78VA
Definition 78Department of Veterans Affairs
Term 1Managed care
Definition 1A system
of healthcare delivery that:-seeks to achieve efficiency
by integrating the basicfunctions of healthcare
delivery-employs mechanisms to control
(manage) utilization ofmedical services
-determines the price at whichthe services are purchased andhow much the providers are
paid.Term 2
Enrollee (member)Definition 2
The individual covered underahealth plan
Term 3Health plan
Definition 3The contractual agreement
between the enrollee and theMCO that contains the
collective array of coveredhealth services to which the
enrollee is entitled.
Term 4Gatekeepers
Definition 4Primary care physicians thatcontrol patient referrals tohigher-level or specialty
services.Term 5 Definition 5
Capitation
When a provider is paid afixed value for each patientunder their care, regardless
of the amount of carerequired, over the course of a
fixed period (typically 1year).
Term 6TriCare
Definition 6Insurance program for familiesand dependents of active-dutyor retired career military
personnel.
Term 7The Veterans Affairs (VA)
Definition 7The health care system
available to retired veteranswho have previously served inthe military, with priority
given to those who aredisabled.
Term 8Veterans Integrated Service
Network (VISNs)
Definition 8Geographic distribution of VAhealth care system. 23 VISNscoordinate all activities of
all health care entitieswithin its jurisdiction.
Term 9Special populations
(Vulnerable populations)
Definition 9Those with health needs butinadequate resources to
address those needs. Typicallyreceive care through thenation's "safety net."
Term 10Medicare
Definition 10One of largest sources
of public health insurance inUS. Serves the elderly,
disabled, and those with ESRD.Term 11
Medicare CoverageDefinition 11
Covers hospital care, post-discharge nursing care,hospice care, outpatient
services, and prescriptiondrugs. Does not cover long-
term care.
Term 12Medicaid
Definition 12Third largest source of healthinsurancein country. Serveslow-income adults, children,the elderly, and individuals
with disabilities.
Term 13Children's Health Insurance
Program (CHIP)
Definition 13Formed in 1997 to provideinsurance to children in
uninsured families. Coversphysician visits,immunizations,
hospitalizations, andemergency room visits.
Term 14Integrated Delivery Systems
(IDSs)
Definition 14A network of organizations
that provides or arranges toprovide a coordinated
continuum of services to adefined population, and that
is willing to be heldclinically and fiscally
accountable for the outcomesand health status of that
population.
Term 15Long-term care (LTC)
Definition 15Consists of the medical andnon-medical care that is
provided to individuals whoare chronically ill or whohave a disability. Not onlyhealth care but support
services for daily living.Term 16
Ten essential public healthservices a system should
deliver as defined by NPHPSP
Definition 161) Monitoring health status toidentify and solve community
health problems.
2) Diagnosing andinvestigating health problems
and hazards.3) Informing and educating
people about health problemsand hazards.
4) Mobilizing the community tosolve health problems.
5) Developing policies tosupport individual and
community health efforts.6) Enforcing laws and
regulations to support healthsafety.
7) Providing people withaccess to necessary care.8) Assuring competent and
professional health workforce.9) Evaluating the
effectiveness, accessibility,and quality of personal andpopulation-based health
services.10) Performing research to
discover innovative solutionsto health problems
Term 17Ten Main Characteristics ofthe US Healthcare System (Be
able to explain each)
Definition 17-No central governing agencyand little integration and
coordination.-Technology-driven delivery
system focusing on acute care.-High in cost, unequal inaccess, and average in
outcome.-Delivery of healthcare underimperfect market conditions.-Government as subsidiary to
the private sector.
-Fusion of market justice andsocial justice.
-Multiple players and balanceof power.
-Quest for integration andaccountability.
-Access to healthcare servicesselectively based on insurance
coverage.-Legal risks influencepractice behaviors.
Term 18Item-based pricing
Definition 18Refers to the costs of
ancillary services that oftenaccompany major procedures.Example being that patientsknow the cost of the surgery,but can't anticipate the costs
of supplies etc.
Term 19Package pricing
Definition 19Payment covers services thatare bundled together for one
episode of care.
Term 20Need
Definition 20The amount of medical care
that medical experts believe aperson should have to remain
or become healthy.
Term 21Provider-induced demand
Definition 21The creation of artificialdemand commonly due to
practitioners with a financialinterest in a treatment or
organization.Term 22
Market JusticeDefinition 22
Places the responsibility forfair distribution of
healthcare on market forces ina free economy. Medical
services are distributed based
on ability and willingness topay.
Term 23Social Justice
Definition 23Emphasizes the well-being of
the community over theindivdual, therefore the
inability to obtain medicalservices due to a lackoffinancial resources is
considered unjust.
Term 24The Emergency Medical
Treatment and Labor Act of1986 ("EM-Tala")
Definition 24Requires the screening andevaluation of eery patient,
provision of necessarystabilizing treatment, andhospital admission whennecessary, regardless of
ability to pay.
Term 25Cost-shifting
Definition 25The patients able to pay forservices, privately insuredindividuals, employers, andthe government ultimatelycover the costs of medical
care provided to theuninsured.
Term 26Defensive medicine
Definition 26When providers prescribe
additional diagnostic tests,schedule check-up
appointments, and maintainabundant documentation in
order to avoid any negativelegal issues.
Term 27System
Definition 27Consists of a set ofinterrelated and
interdependent componentsdesigned to achieve some
common goals.
AlphabeticalOriginal
What are the two main objectives of a health delivery system?The primary objectives of any health delivery system are to enable all citizens to receive health careservices whenever needed, and to deliver health services that are cost-effective and meet pre-established standards of quality.What is the primary reason for employers to purchase insurance plans to provide health benefits to their employees?The United States does not have a universal health care system covering all citizens. Health insurance is primarily employer-based.What is managed care?Managed care is a system of health care deliverythat seeks to achieve efficiencies by integrating the basic functions of health care delivery, and employs mechanisms to control utilization of medicalservices and the price at which the services are purchased.Discuss the intermediary role of insurance in the delivery of health care.the insurance function introduces a third party into the transaction between the patient and the
provider. Health insurance insulates the consumer from the cost of health care. Providersare sometimes restricted from delivering services that are non covered.Who are the major players in the US health services system? What are the positive and negative effects of these players?The key players in the system are the physicians, administrators of health service institutions, insurance executives, large employers, and the government. One positive effect of these opposing forces is that they prevent any single entity from dominating the system. On the other hand, they also make it difficult to achieve system wide reforms.What main roles does the government play in the US health services system?The government is a major financier of health care delivery through the Medicareand Medicaid programs. The governmentdetermines eligibility criteria asto who can receive services under these programs; it also determines the reimbursement rates that providers will receive for rendering services to Medicaid and Medicare patients. In order to render services to Medicare and Medicaid, these organizations must comply with the standards of participation formulated by thegovernment.What is socialized health insurance (SHI)?In a socialized health insurance system, health care is financed through government-mandated contributions by employers and employees.What are the two major goals of chapter 2?
The first goal is to propose a holistic approachto health care delivery that focuses on curativemedicine, health promotion, and disease prevention. The second goal is to further explore the issue of equity in the distribution of health services using the contrasting theories of market justice and social justice inU.S. Health Care Delivery.Distinguish between illness and disease. How are these concepts related to the medical model of health care delivery?Illness reflects what a person feels. Disease may or may not be present. On the other hand, disease reflects the physician's diagnosis. It requires therapeutic intervention. A person who is ill seeks health care with the objective of finding relief of symptoms and discomfort. A medical professional attempts to diagnose the illness and prescribes treatment if disease is present.What are the 3 classifications of disease? Define them.Acute condition: relatively severe, episodic andoften treatable, Sub acute condition, and Chronic condition: less severeWhat are the 4 major determinants of health? Explain each determinant.Environment, Behavior and Lifestyle, Heredity, Medical CareWhat are the main objectives of public health?Public health is concerned with ensuring conditions that promote optimum health for society as a whole. Its main objectives are to
prevent disease, prolong life, and promote health through organized community effort.What are the two overarching goals of Healthy People Initiatives?The first goal is to help individual of all agesincrease life expectancy and improve their quality of life. The second goal is to eliminatehealth disparities among different segments of the population.Describe how health care is rationed in the market justice and social justice systems.In the market justice system, health care services are rationed through prices and the ability to pay. The uninsured and those who lacksufficient income to pay privately cannot obtainthe quantity and type of health care services when they want them. This is referred to as demand-side rationing, or price-rationing.What is the role of health risk appraisal in health promotion and disease prevention?Health risk appraisal is the process of evaluating risk factors and their health consequences in individuals. Only when the risk factors and their health consequences are known can avenues be developed for motivating individuals to alter their behaviors to more healthful patterns.Which type of health insurance is based on themarket justice?Private, employer-based health insurance, mainlyfor middle-income Americans, falls under the heading of market justice.
Health promotion and disease prevention may require both behavioral modification and therapeutic intervention. Discuss.Behavior can be modified through educational programs and incentives directed at specific high risk populations. For example cigarette smokingDiscuss the significance of an individual's quality of life from the health delivery perspectiveDuring institutionalization, life domainssuch ascomfort, ability to make decisions, respect and dignity, and attention to personal preferences are important indicators of quality of life. Self-perceptions of health, ability to function,and role limitations stemming from physical or emotional problems are important life domainsafter the patient has returned to the community.What are the 2 major objectives of chapter 4?The first objective is to provide an overview ofthe large array of health professionals employedin the vast assortment of health delivery settings. The second objective is to describe the differences and imbalances between primary and specialty care services characterized in theU.S. health care system.Explain why the health care sector of the U.S.economy continues to grow?The first reason is that there is a growth in population that now utilizes a greater amount ofhealth services. This growth is mainly due to immigration. Another reason is the aging of the population. This particularly describes the babyboom generation that starts to hit retirement age in the year 2011 and beyond.
What factors are associated with the development of health services professionals in the U.S.?The development of health services professionalsin the U.S. is closely related to population trends, advances inresearch and technology, disease and illness trends, and the changing environment of health care financing and delivery.What are the major distinctions between primary care and specialty care?Primary care may be distinguished from specialtycare by the time, focus, and scope of the services provided to the patients. Primary care is first-contact care or the portal to the health care system, whereas specialty care, if needed, generally follows primary care. Primary care focuses on the person as a whole, whereas specialty care centers on diseases or organ systems. Primary care is comprehensive in scope and includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis, and treatment of acute and chronic illnesses. Specialists are more narrowly focused.Why is there a geographic mal distribution of the physician labor force in the U.S.?Physicians are more likely to concentrate in metropolitan and suburban areas than in rural and inner-city areas because they're normally offered higher income, professional interaction,access to modern facilities and technology, continuing education and growth, high standards of living, and social amenities. The basic physician labor force problem in the United
States is that while the supply of physicians islargely determined by population need, medical services are delivered in a market that links services to ability to pay, whether through insurance or out of pocket.Why is there an imbalance between primary careand specialty care in the U.S.?The principal determinant of need for primary care physicians is the demographics of the general population. The major driving force behind specialists is the development of medicaltechnology. The rapid advance of medical technology expands the demand for specialty services. Specialists not only earn higher incomes, but they also have more predictable work hours and have higher prestige.What measures have been or can be employed to overcome problems related to physician mal distribution and imbalance?To alleviate the shortage of physicians, for example, new medical schools were instituted in the underserved areas (inner city and rural) Nurses in expanded roles (e.g., nurse practitioners) emerged as a viable option to remedy the health labor force problem. A combination of various policy options has also been initiated. These options include the regulation of health care professions, change inreimbursement policies, and targeting programs for underserved areas. Federal programs addressing specialty mal distribution include the National Health Service Corps, the Migrant and Community Health Programs, support of primary care training programs, and support of Area Health Education Centers. To achieve a better balance in the proportion of primary care
physicians and specialists, continual efforts are needed to improve the specialty distributionof physician labor forces. Medical schools need to develop students' competencies in skills, values, and attitudes relevant to the practice of primary care. Their curricula can be orientedtoward issues of special concern to generalists such as outpatient experience, public health concepts, disease prevention, and cultural, ethnic, and population specific knowledge. Medical programs can provide students with opportunities to work with the poor, minorities,and the uninsured and to practice in rural or underserved areas. The means of financing medical training and physician services can be improved. The system of graduate medical education payments through Medicare contributes to specialty-oriented training and creates disincentives for primary care training. A possible solution is to encourage and provide priority funding for primary care residency slots and primary care-related research. Hospitals whose graduates actually go into primary care in underserved areas should be rewarded. Reimbursement to providers and patients should emphasize preventive, primary care services and should stress the attributes of primary care. Since physicians tend to practice in affluent urban areas, it is necessary to differentially reward providers whopractice in "less desirable" areas or care for socially disadvantaged populations. A more rational referral system may be established thatachieves a reasonable division of work based on the frequency and severity of health problems inthe populations. Disincentives for non-referred specialist care should also be established.
Describe the major types of physicians, including their roles training practice requirements and practice settingsThe major roles of physicians are to diagnose diseases and treat patients. Physicians must be licensed and graduated from a credited medical school and complete their residency. Physicians often work in hospitals or have their own private practice but also work in a spectrum of outpatient settings including group practices, surgi centers, diagnostic imaging centers, urgent care centers, and managed care organizations such as health maintenance organizations (HMOs).Describe the major types nurses including their roles, training, practice requirements, and practice settings.Nurses are the major caregivers of sick and injured patients, serving their physical, mental, and emotional needs. All states require nurses to be licensed to practice as RNs. The licensure requirements include graduation from an approved nursing program that awards an associate degree (ADN), diploma, or baccalaureate degree (BSN), and successful completion of a national examination. ADN programs take about two years and are offered bycommunity and junior colleges. Diploma programs take two to three years and are offered by hospitals. BSN programs take four to five years and are offered by colleges and universities. Nurses work in a variety of settings, including hospitals, nursing homes, private practices, surgi centers, community and migrant health centers, emergency medical centers, HMOs, worksites, government and private agencies, clinics, schools, retirement communities, rehabilitation centers, and patients' homes.
Describe the major types of dentists, their roles, training, practice requirements, and practice settings.*Dentists are the major providers of dental care. The major roles of dentists are to diagnose and treat dental problems related to the teeth, gums, and tissues of the mouth. All dentists must be licensed to practice. The licensure requirements include graduation from an accredited dental school that awards a Doctorof Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree and successful completion of both written and practical examinations. Mostdentists practice in private offices as solo or group practitioners. Some dentists work in dental clinics in private companies, retail stores, franchised dental outlets, or HMOs. The federal government also employs dentists, mainlyin the hospitals and clinics of the Department of Veterans Affairs and the U.S. Public Health Service.Describe the major types of health services professionals (physicians, nurses, dentists, pharmacists, physician assistants, nurse practitioners, certified nurse midwives), including their roles, training, practice requirements, and practice settings.*The major roles of pharmacists are to dispense medicines prescribed by physicians, dentists, and podiatrists and to provide consultation on the proper selection and use of medicines. All states require a license to practice pharmacy. The licensure requirements include graduation from an accredited pharmacy program that awards a Bachelor of Pharmacy (BPharm) or Doctor of Pharmacy (PharmD)degree, successful completion
of a state board examination, and practical experience or completion of a supervised internship. Most pharmacists hold salaried positions and work in community pharmacies that may be independently owned or are part of a national chain of drugstores, grocery stores, ordepartment stores. Pharmacists also work in hospitals, managed care organizations, home health agencies, clinics, government health services organizations, and pharmaceutical manufacturing companies.Describe the major types of physician assistants including their roles, training, practice requirements, and practice settings.Physician assistants are licensed to perform medical procedures under the supervision of a physician. The supervising physician may be either on-site or offsite. The major services provided by PAs include evaluation, monitoring, diagnostics, therapeutics, counseling, and referral. They practice in offices, hospitals, HMOs, clinics, nursing homes, mental health facilities, rehabilitation centers, community and migrant health centers, and government institutions. As of 1995, there were 68 accredited PA training programs that awarded a certificate, an associate degree, a bachelor's degree, or a master's degree. Although the typical student has already completed a baccalaureate program in another discipline, most of the programs grant a baccalaureate degree upon graduation. PAs are certified by theNational Commission on Certification of Physician Assistants. PAs have prescribing authority in most states.
Describe the major types of nurse practitioners, certified nurse midwives), including their roles, training, practice requirements, and practice settings.Nurse practitioners are individuals who have completed a program of study leading to competence as registered nurses in an expanded role. The training of NPs may be a certificate program (at least nine months' training) or a master's degree program (two years' fulltime study). States vary with regard to licensure andaccreditation requirements. There are more than 150 educational training programs nationwide. Inaddition, NPs complete clinical training in direct patient care. Certification examinations are offered by the American Nurses CredentialingCenter, the American Academy of Nurse Practitioners,and specialty nursing organizations. The primaryfunction of NPs is patient education. NPs spend considerable time with patients to make them understand the need to take personal responsibility. Nurse practitioners emphasize wellness promotion, illness prevention, early intervention, and illness management. NPs have statutory prescribing authority in 47 states, and 49 states allow direct Medicaid reimbursement for NP services.Describe the major types of certified nurse midwives, including their roles, training, practice requirements, and practice settings.Certified nurse midwives are registered nurses with additional training in midwifery, such as materna land fetal procedures, nursing, and patient assessment, from a nurse-midwifery program. They manage gynecological and obstetriccare and can be used as substitutes for obstetricians/gynecologists. They are certified
by the American College of Certified Nurse Midwives to provide care for normal expectant mothers, and they refer abnormal or high-risk patients to obstetricians or manage them jointly. Very few training programs exist for CNMs (9 certificate programs and 20 master's degree programs).Describe the major types of physician assistants, nurse practitioners, certified nurse midwives including their roles, training, practice requirements, and practice settings.* Non-physician primary care providers include nurse practitioners, physician assistants, and certified nurse midwives. They play a critical role in the provision of health care, particularly primary care to underserved populations. NPs and PAs often give care equivalent to that provided by physicians. Moreover, NPs have been noted to have better communication and interviewing skills than physicians. Clients are more satisfied with NPs than with physicians because NPs generally spendmore time with the patients, express greater personal interest in patients, and provide care at less cost. CNMs are considered to be effective in providing access to obstetrical andprenatal services in rural and poor communities.Among the issues that need to be resolved beforenon-physician primary care providers can be usedfully are legal restrictions to practice, reimbursement policies, and relationships with physicians.Describe the major types of health services administrators including their roles,
training, practice requirements, and practice settings.* Health services administrators are employed atthe top, middle, and entry levels of various types of organizations that deliver health services. Top level administrators provide leadership and strategic direction, work closelywith the governing board, and are responsible for an organization's long term success. They are responsible for operational, clinical, and financial outcomes of the entire organization. Middle level administrators may have leadership roles for major service centers such as outpatient, surgical services, nursing services,etc., or they may be departmental managers in-charge of single departments such as diagnostics, dietary, rehabilitation, social services, environmental services, or medical records. Their jobs involve major planning and coordinating functions, organizing human and physical resources, directing and supervising, operational and financial controls, and decision-making. They often have direct responsibility for implementing changes, creating efficiencies, and developing new procedures with respect to changes in the healthcare delivery system. Entry level administratorsmay function as assistants to mid-level managers. They may supervise a small number of operatives. Their main function may be to oversee and assist with operations critical to the efficient operation of a departmental unit.Describe the major types of Allied health professionals including their roles, training,practice requirements, and practice settings.*Allied health professionals can be divided intotwo broad categories: technicians/assistants andtherapists/technologists. Assistants and
technicians include physical therapy assistants (PTAs), certified occupational therapy assistants (COTAs), medical laboratory technicians, radiologic technicians, and respiratory therapy technicians. Technologists and therapists include physical therapists (PTs),occupational therapists (OTs) , medical dietetics, speech-language pathologists, and social workers. Allied health professionals constitute approximately 60 percent of the U.S. health care work force. They are an integral part of the health care delivery system and complements the physician and nursing workforce.Although medical technology brings numerous benefits, what have been some of the main challenges posed by the growing use of medicaltechnology in the United States?As a whole, medical technology has contributed to the increase in health care costs. Technologyraises consumer expectations and leads to wasteful care especially because insured individuals do not bear the costs. It leads to overspecialization in medical practice.What main types of information technology applications are used in medical care delivery?A. Clinical information systems support patient care delivery, clinical decision making, and clinical reports. Electronic health records can provide quick and reliable information to guide clinical decision making. Telemedicine, based onintegrated applications of telecommunications and information technologies, enables distant delivery of health care. Medical informatics uses IT applications that are designed to improve clinical efficiency, accuracy, and
reliability. B Administrative information systems enable the organization to carry out financial and administrative support functions. C Decision support systems provide analytical tools for managerial decision making.D The Internet and e-health enable patients and practitioners to access information, facilitate interaction between consumers or between patients and providers, add certain conveniencesfor both physicians and patients, and enable thepossibility of virtual visitsHow do American cultural beliefs and values influence the use of medical technology?American beliefs in capitalism and lack of government intervention promote innovation because the developers of new technology reap financial rewards. On the other hand, Americans believe that it is absolutely essential that they get the most advanced tests, drugs, procedures, and equipment. Americans have high expectations of what the medical care system should do for them.What is meant by technology diffusion? What role does the Food and Drug Administration play in technology diffusion?The proliferation of technology once it is developed is called technology diffusion. The FDA ensures the safety and effectiveness of drugs and medical devices. It also controls access by deciding which drugs need prescriptions and which ones can be obtained over the counter.What type of medical devices are classified asClass III? What type of approval do they require from the Food and Drug Administration?
Class III devices support life or prevent healthimpairment. They require premarket approval fromthe FDA regarding their safety and effectiveness.What outcomes may suggest technology's positive impact on quality of life?Ability to do things in spite of disablement, Ability to manage chronic conditions, Relief from pain and suffering, and Fast recovery and return to normal lifeWhat impact has technology made on access to medical care?Technology has had a positive effect on access in rural and geographically remote areas. Mobileequipment can be transported to these sites. Telemedicine has enabled generalists to consult specialists located at a distance without havingto transport the patient to a distant medical center. Technology has also made it possible formany patients to receive in-home care instead ofbeing admitted to a healthcare facility.What is meant by technology assessment? What is the main practical use or objective of assessment?Technology assessment is the evaluation of medical technology to determine its safety, effectiveness, and cost benefits. The main practical use of assessment is to determine whether new technology is appropriate for widespread use based on criteria such as safety,efficacy, and cost effectiveness.What is meant by financing? What are its desirable and undesirable effects?
Financing is any mechanism that gives people theability to pay for health care services. Desirable effects: It enables people to obtain health care, and it compensates providers for the services they deliver.Briefly explain how insurance functions in relation to risk for individuals and groups.Risk is unpredictable for an individual, Risk can be predicted with reasonable accuracy for a large group, Insurance shifts risk from the individual to the group, and Resources are pooled and losses are shared on some equitable basis by all members of the insured groupDiscuss how cost sharing applies to health insurance.Employers and employees generally share in the cost of premiums. In addition, the insured pays out of pocket expenses referred to as deductibles and copayments. A deductible, paid annually, is the amount the insured must first pay before benefits are received. Copayment is the portion of total medical costs that the insured has to pay out of pocket each time health services are received.Why are managed care plans regarded as health insurance? How do managed care plans differ from traditional insurance?Managed care plans are regarded as health insurance because they assume risk in exchange for an insurance premium. Unlike traditional insurance, managed care plans assume the responsibility for providing health care services to their enrollees by contracting with a network of providers.
What is Medicare Part A? Discuss the financingMedicare Part A. What services does Part A cover?Part A is the hospital insurance (HI) portion ofMedicare. It is financed by a mandatory payroll tax. The employer contributes an equal amount. Part A covers hospital inpatient services, care in a skilled nursing facility (SNF), home healthvisits, and hospice care. A maximum of 90 days of inpatient hospital care is allowed per benefit period, Up to 100 days of care in a Medicare certified skilled nursing facility (SNF) are allowed, provided the beneficiary has been hospitalized for at least three consecutivedays, not including the day of discharge. Admission to the SNF must occur within 30 days of hospital discharge, Home health care is covered when a person is homebound and requires intermittent or part time skilled nursing care or rehabilitation care, and For terminally ill patients, Medicare pays for care provided by a Medicare certified hospice.What is Medicare Part B? Discuss the financingof Medicare Part B. What services are covered under Part B?Part B is the Supplementary Medical Insurance (SMI) portion of Medicare. It is a voluntary program financed partly by general tax revenues and partly by required premium contributions from the enrollees. The main services covered bySMI are outpatient services such as physician services, hospital outpatient services (outpatient surgery, diagnostic tests, radiology, etc.), emergency department visits, outpatient rehabilitation services, renal dialysis, prostheses and medical equipment, and supplies.
Discuss the financing, eligibility, and covered services for the Medicaid program.Medicaid finances health care services for the indigent. The program is jointly financed by thefederal and state governments. The federal government provides matching funds to the statesbased on the per capita income in each state. Medicaid is a means tested program in which eligibility is based on the beneficiary's incomeand assets. Federal law requires that certain low income people be covered.Federal law also mandates that every state provide some specific health services. The main federally mandated services include hospital inpatient and outpatient care, physician services, laboratory and X-ray services, SNF care, home health services for those eligible for SNF services, prenatal care, and family planning services and supplies. In addition, states may elect to covercertain optional services such as prescription drugs, optometrists' services, eyeglasses, and dental care.Discuss the payment method and risk sharing under capitation.Under capitation, an HMO pays a provider a set fee per member per month. The provider is required to deliver whatever services the members need. Capitation shares risk with providers because if the cost of services exceeds the fixed payment, the additional costs have to be absorbed by the provider. Risk sharing makes the providers prudent in the delivery of services. It removes the incentive for provider induced demand.
What is the main difference between retrospective and prospective methods of reimbursement? What are the main advantages ofa prospective payment system?Retrospective reimbursement is based on actual costs incurred by a provider during the previousyear. In prospective reimbursement, certain pre-established criteria, not costs, are used to determine in advance the amount of reimbursement. Whereas the retrospective system encourages providers to increase their costs because the costs would be reimbursed, the prospective system eliminates such perverse incentives by rewarding providers for controlling costs.Discuss the prospective payment system under DRGs.The prospective payment system (PPS) under DRGs is used by Medicare to determine reimbursement rates for inpatient hospital care. The amount ofpayment is set per discharge rather than per diem. Hence, it is a rate established for bundled services. On admission, a patient is assigned a DRG category according to the principal diagnosis. Based on the patient's DRG classification, the hospital receives a set amount.Integrated delivery system (IDS)A network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and health status of the population serviced.Managed care
A system that integrates the functions of financing, insurance, delivery, and payment and uses mechanisms to control costs and utilizationof services.Market justiceA distributional principle according to which health care is most equitably distributed through the market forces of supply and demand, rather than government interventions. See socialjustice.MedicaidA joint federal state program of health insurance for the poor.MedicareA federal program of health insurance for the elderly, certain disabled individuals, and people with end-stage disease.Social JusticeA distribution principle, according to which health care is most equitably distributed by a government-run national health care program.Socialized MedicineAny large-scale government sponsored expansion of health insurance or intrusion in the private practice of medicineChildren's Health insurance Program (CHIP)Provide- low income families with children with health insurance coverage that covers access to health care servicesTRICARE
A program that is financed by the military. Thisinsurance plan permits the beneficiaries to receive care for both private and military medical care facilitiesVeterans Integrated Service Networks (VISNs)Responsible for coordinating the activities of the hospitals, outpatient clinics, nursing homes, and other facilities located within its jurisdictionAcute ConditionRelatively severe, episodic (of short duration),and often treatable. It is subject to recovery and treatment is generally provided in a hospitalBehavioral FactorsIndividual lifestyles are also a key determinantof health. For example diet, exercise, a stress-free lifestyle, risky or unhealthy behaviors, and other individual choices have been found to play a major role in the most of significant health problems of today.Chronic ConditionLess severe but of long and continuous duration.The patient may not fully recover. The disease may be kept under control through appropriate medical treatment, but if left untreated, the condition may lead to severe and life-threatening health problems. Examples include asthma, diabetes, and hypertensionDemand- Side RationingPrices and ability to pay ration the quantity and type of health care services people consume
Determinants of healthThe leading determinants of health can be classified into four main categories: environment, behavior, and lifestyle, heredity, and medical care.Health Care SystemAll of the activities aimed at promoting, restoring, or maintaining healthHealthA complete state of physical, mental, and socialwell-being, and not merely the absence of disease or infirmity.Holistic medicineA philosophy of health care that emphasizes the well-being of every aspect of a person includingthe physical, mental, social, and spiritual aspects of healthPlan rationing or supply side rationingRefers to government means 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 servicesPublic Health SystemReflects an organized effort to deliver public health services within a jurisdiction with the goal of improving health and well-being of the populationPublic Health
A wide variety of activities undertaken by stateand local governments to ensure conditions that promote optimum health for society as a wholeSubacute ConditionBetween acute and chronic but has some acute features. Subacute conditions can be post acute requiring further treatment after a brief stay in the hospital. Examples include ventilator andhead trauma care.The medical modelPresupposes the existence of illness or disease,thereby emphasizing clinical diagnosis and medical intervention in the treatment of diseaseor its symptoms.Advances Practice Nurse (APN)A general name for nurses who have education andclinical experience beyond that required of a RN. APNs include four areas of specialization innursing: clinical nurse practitioners (NPs) and certified nurse midwives (CNMs)Allied HealthA broad category that includes services and professionals in many health-related technical areas. Allied health professionals include technicians, assistants, therapists, and technologists.Allopathic MedicineViews medical treatments as an active intervention to produce a counteracting reactionin an attempt to neutralize the effects of disease.
GereralistsIn the US physicians trained in family medicine/general practice, general internal medicine, and general pediatrics are considered primary care physicians or generalistsMaldistributionAn imbalance of the distribution of health professionals such as physicians, needed to maintain the health status of given population at an optimum level. Geographic maldistribution refers to the surplus in some regions but shortage in other regions of needed health professionals. Specialty maldistribution refers to the surplus in some specialties but shortage in others.Osteopathic MedicineEmphasized the musculoskeletal system of the bodyClinical TrialA carefully designed research study in which human subjects participate under controlled observationsCost EfficiencyA step beyond the determination of efficacy. Whereas efficacy is concerned only with the benefit to be derived from the use of technology, cost-effectiveness weighs benefits against cost. Health care is cost-effective whenbenefits exceed the costs.Decision support systems
Computer based information and analytical tools to support managerial decision making in health care organizationEfficacyrefers to the health benefit to be derived from the use of technologyE-HealthAll forms of electronic health care delivered over the internet, ranging from informational, educational, and commercial products to direct services offered by professionals, non-professionals, businesses, or consumers themselves.Which type of health insurance is based on thesocial justice?Publicly financed Medicaid and Medicare coveragefor certain disadvantaged groups, and the workers' compensation program for those injured at work, fall under the heading of social justice.
National Oceanographic and Atmospheric Association (NOAA)It is a well organized, highly integrated systemthat provides comprehensive services.TriCareFamilies and dependents or active duty or retired career military personnel are either treated at the hospital ordispensaries or are
covered by this program that is financed by the U.S. Department of Defense.Veterans Administration(VA)Health care system that's available to retired vets who have previously served in the military, with priority given to those who are disabled.Veterans Integrated Service Networks (VISNs)The entire VA is organized into 23 geographically distributed of this. Each is responsible for coordinating the activities of the hospitals, outpatient clinics, nursing homes, and other facilities located within its jurisdiction.Safety NetProviders like Medicare and Medicaid that offer comprehensive medical and enabling services targeted to the uniques needs of vulnerable populations.The Bureau of Primary Health CareBPHCDepartment of Health and Human ServicesDHHSCMSCenters for Medicare and Medicaid ServicesCHIPChildren's Health InsuranceProgram-providesinsurance to children in uninsured families
Integrated Delivery Systems (IDS)Represents various forms of ownership and other strategic linkages among hospitals, physicians, and insurers.(LTC) Long-term CareConsists of medical and non-medical care that isprovided to individuals who are chronically ill or who have a disabilityItem-based Pricingrefers to the costs of ancillary services that often accompany major procedures such as surgeryPackage PricingCovers services that are bundled together for one episode of care.CapitationCover all services an enrollee may need during an entire year.(NHS) National Health ServicePublicly funded and run operation that reflects the principle that every citizen is entitled to health care.
Public HealthA reflection of society's desire and effort to improve the health and well being of the total populationPublic Health System
A reflects an organized effort to deliver publichealth service within a jurisdiction with the goal of improving health and well-being of the population.Discriminationthe difference in one's action toward an individual or group based on the innate personalcharacteristics of that group, such as race or ethnicitySocial or Medical Care Policy Interventionsproduce safety regulations, screen food and water sources, and enforce safe work environmentsCommunity-Based Interventionsaddressed at the community or local level, managed by the community, minimize cultural barriers and improve community by the programHealthcare Interventionsis monitored by social policy and community level interventionIndividual-Level Interventionsattempt to intervene and minimize the effects ofnegative social determinants on health status. (reduce smoking and increase exercise)Gatekeeperalso known as primary care physicians. They typically deliver routine medical services and make decisions about referrals for higher-level or specialty services.Medical Model's 'Health'
the absence of illness or disease.Society for Academic Emergency Medicine's 'Health' (SAEM)a state of physical and mental well-being that facilitates the achievement of individual and societal goals.World Health Organization's 'Health' (WHO)a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.Quality of Lifethe essence of overall satisfaction with life during and after a person's encounter with the health care delivery system.Environmental Factorsas opposed to individual factors, examplesinclude physical, socioeconomic, sociopolitical, and socioculturaldimensions.Hereditarythe genetic make up of an individual that could influence one's health status.Planned Rationing (supply side)Government efforts to limit the availability of certain health care services by deciding, for instance, how technology will be dispersed and who will be allowed access to certain types of high tech services.Illness
a medical condition recognized by means of a person's own perceptions and evaluation of how they feel.Holistic Medicinea philosophy of health care that emphasizes the well-being of every aspect of a person, including the physical, mental, social, and spiritual aspects of health.Demand Rationinga situation in a lack of health insuranceprevents people from obtaining health care services
Almshouse (poor house)was an infirmary, old-age facility, mental asylum, homeless shelter, and orphanage all rolled into one institution.Asylum (inpatient psychiatric facilities)built by state governments for patients with untreatable, chronic mental illness.Pest houseoperated by local governments to isolate people who had contracted a contagious disease such as cholera, small pox, typhoid, yellow fever.Dispensariesestablished as outpatient clinics to provide free care to those who couldn't afford to pay. They provided basic care and dispensed drugs to ambulatory patients.
Corporatizationrefers to how healthcare delivery in the U.S. has become the domain of large organizations.Beneficiariesenrollees in a public insurance program , such as Medicare or Medicaid.Organized MedicineThe concerted activities of physicians through the American Medical Association.(Part A of) MedicareHospital insurance and short term, post-hospitalnursing home coverage for Medicare beneficiaries.(Part B of) MedicareInsurance to cover physicians' bills and other outpatient services for medicare beneficiaries.Socialized MedicineAny large scale government-sponsored expansion of health insurance or intrusion in the private practice of medicine.Voluntary Health InsurancePrivate health insurance.Means-tested ProgramA program in which eligibility for public insurance is determined by a person's assets andincome.Blue CrossHospital insurance plan.
Blue Shielddesigned to pay for physician fees.Globalizationrefers to various forms of cross-border economicactivities.
Residencya graduate medical education in a specialty thattakes the form of paid on-the-job training, usually in a hospital.Osteopathic Medicinepracticed by DOs, emphasizes themusculoskeletal system of the body.Allopathic Medicinepracticed by MDs, views medical treatment as an active intervention to produce a counteracting reaction in anattempt to neutralize the effects of disease.Generalistphysician trained in family medicine/general practice, generalinternal medicine, and general pediatrics.Specialistsphysicians in non-primary care specialist dealing with diseases or systems.Hospitalist
a health care provider who is involved in inpatient medicine and who fulfills a role parallel to that of a primary physician in an outpatient setting, in that the provider managesthe care of the hospitalized patients.Allied Healtha broad category that includes services and professionals in many health-related technical ares. These areas includes therapists, technicians, assistants and technologists.NPPsClinical professionals who practice in many areas, similar to to those in which physicians practice, but who do not have an MD or a DO degree.Pharmaceutical CareA mode of pharmacy practice in which the pharmacist takes an active role on behalf of patients, which includes givinginformation on drugs and advice on their potential misuse and assisting prescribers in appropriate drug choices.
Financingrefers to any mechanism that gives people the ability to pay for health care services.Moral Hazardconsumer behavior that leads to a higher utilization of health care services when the services are covered by insurance.Provider-induced Demand
the providers' ability to create demand.Riskrefers to the possibility of a substantial financial loss from some event.Insuredan individual who is protected by insurance against the possible risk of financial loss.Underwritingis a systematic technique for evaluating, selecting (or rejecting), classifying, and rating risks.Deductiblethe amount the insured must first pay before anybenefits by the plan are payable.Copaymentthe amount that the insured has to pay out of pocket each time health services are received after the deductible amount has been paid.Coinsurancecost sharing in the form of a percent amount. Insurance pays 80%, you pay 20%.Stoploss Provisionthe maximum out of pocket liability an insured would incur in a given year.Third Party Payersinsurance companies, MCOs, Blue Cross/Blue Shield, and the government.
Reimbursementpayment made by third party payers to the providers of the services.Balance Billproviders ask the patient to pay the difference between the actual charges and the payments received from insurers.Capitationa provider is paid a set monthly fee per enrollee, regardless of whether an enrollee seesthe provider, and regardless of how often an enrollee sees the provider. (PMPM)Prospective Reimbursementuses certain pre established criteria to determine in advance the amount of reimbursement.Case Mixthe overall acuity level in a facility, as determined by the severity of the patients' conditions.Benefit PeriodFor the purpose of determining theMedicare Part A benefits, a period of time that begins on the day a beneficiary is hospitalized, and that endswhen the beneficiary has not been in a hospital or a skilled nursing facility for a consecutive 60 days.Bundled ChargesA number of related services included in one price.
Consumer Price Index (CPI)a measure of inflation in the general economy.Categorical Programspublic insurance programs , such as Medicare or Medicaid, that are designed to provide benefits to a certain category of people who meet the eligibility criteria to become beneficiaries.Medigapprivately purchased supplementalinsurance policies to pay for costs not covered by Medicare.Premiumthe amount charged for insurance coverage.ReinsurancePrivate insurance obtained by self-insured employers to protect themselves against any potential risk of high losses.
The U.S. health care system is Based on the:market justice principleThe government program designed to provide health care to people who are 65 years of age or older is called:MedicareBaring major system changes, health service expenditures are projected to continue to decrease. (True or False)False (Health care costs are exploding and are out of control.)
The U.S. safety net is for the nation's most vulnerable populations. Whic of the following is not considered a vulnerable population?Persons 45-60A primary motivation in the development of managed care was to:contain costs and expenditures of health careThe U.S. government plays a limited role in the health delivery system. The government's role in this arena is to:to organize and be responsible for care deliveryfor Medicare and Medicaid programsThe U.S. health care delivery system is complex and massive. (True or False)TrueWhich one of these choices is not a characteristic of managed care?manages to take care of those only in financial needThe financing of a managed care organization is based oncapitationMedicare is a government program for theelderly: Why is the US health care market considered to be "imperfect"?
prices are determined by health plansrather thanthe interaction of the forces of supply and demandTrue or False: Managed care is the most dominant health care delivery system in the UStodayTrueWhat is the main role of the government in theUS health delivery system?To be the major financier of health caredeliverythrough Medicare and Medicaid programsIn a socialized health insurance system, health care is financed throughgovernment-mandated contributions by employers and employeesIn a free market, ______ and ______ act independently.buyers and providersTrue or False: The national health care model for Germany, Israel and Japan is the national health system.FalseThe social justice emphasizesthe well-being of the community over that of theindividualMedicaid is a government program for thePoor
Which party does not act as a the key players in the US health services system?PoorWhat is the primary reason for employers to purchase insurance plans to provide health benefits to their employees?Due to the fact that the U.S. does not have a universal health care system, employers purchase health insurance plans as a fringe benefit for their employees.True or False: The tax-supported national health care program in a national health insurance system is financed by private providers rather than the government.FalseOver the last decade, the hallmark of the US health care industry has beenorganizational integration to form integrated delivery systems or networksAmerica's safety net is forthe nation's vulnerable populationsTrue or False: Capitation is a payment mechanism in which all health care services are included under one set fee per covered individual.TrueThe military medical care system is _______ toactive military personnel of theFree
Vulnerable populations does not include which of the following poor, uninsured, minority status, insured employeesinsured employeesGrowth in science and technologycreates demand for new servicesThe US health care system is based on the social justice principal (True or False)FalseThe United States spend more than any other developed country on health care, and costs havecontinued to riseHealth care managers are needed tomanage and coordinate various types of health care servicesThere are no racial and economic disparities in the health care system (true or false)FalseThe World Health's Organization's definition of health isstate of physical and mental well-being that facilitates the achievement of individual goalsIllness is different from a disease in that illnessis the person's own perceptions and evaluation of how he or she feels
: One of the purposes of the Healthy People Initiative is tointegrate medical care with preventive servicesTrue or False the system of health care delivery in the US is predominantly privateTrueIn a social justice system, the equitable distribution of health isThe society's responsibilityDemand-side rationing means therationing the quantity and type of health servicesPolicy interventions use _______ to affect thehealth of the populationsocial/public policyTrue or False: Under the social justice system, inability to obtain medical services because of a lack of financial resources is considered unjust.TrueAn acute condition is notlongIT IS severe, short, treatableCommunity health assessment is a method used for conductingof broad assessments of populations at the localor state level
True or False: From an economic perspective, curative medicine seems to reproduce decreasing returns in health improvement whilehealth care expenditures increase.TrueAn epidemic occurs whena large number of people get a specific diseaseIn the United States, the principles of marketjustice and social justicecomplement each otherWhich answer is not one of the four major determinants of health? (Environment, Religion, Heredity, Behavior)ReligionTrue or False: Quality of life refers to the overall satisfaction with life during and following a person's encounter with the healthdelivery systemTrueWhat type of health insurance is based on the market justice?private, employer-based health insuranceCommunity-based strategies have the particularbenefit ofas a whole personHealthy behavior can be modified throughEdu programs and incentives
True or False: A chronic condition is more severe than an acute conditionFalseWhat is the role of health risk appraisal?To evaluate risk factors and their health consequences in individualsThe medical model emphasizesClinical and medical interventionsTrue or False: Heredity is a key determinant of health because genetic factors predispose individuals to certain diseases.TrueMorbidity is defined asdisease or disabilityWhich of the following has been the primary factor that has shielded the U.S. health care system from a major overhaul?Beliefs and valuesEducational reform for training physicians in the Postindustrial era was based on:European ModelPrivate health insurance emerged as a result ofeconomic necessityWhich of the following was not a factor that led the rapid expansion of employer-based health insurance? (The Supreme Court ruled that employee benefits were a legitimate part
of union-management negotiations, Employer-provided health coverage became nontaxable, The Congress mandated that employers offer health insurance, OR Employers offered health insurance to compensate for loss of raises in salaries during World War IIThe Congress mandated that employers offer health insuranceMedical MalpracticeOne of the most clinical present threats to practicing physiciansDuring the Preindustrial era, medical practicewas extremely competitive. What caused this intense competition?Anyone, untrained or trained, could be a physicianThe American Medical Association (AMA) played a dominant role in:Protecting the interests of physiciansWhat was one of the main reasons for the failure of national health insurance proposed by President Clinton in 1993?Americans were unwilling to pay higher taxes forsuch a programWHich of the following programs is means tested?Medi-Care Part BIn 1964, health insurance for the aged and thepoor became a top priority for President Johnson's administration. In 1965, Medicare was created as:
a two-part program for the elderly that provideshealth insurance-regardless of incomeWhich of the following illustrates corporatization in the American health care delivery system?Managed Care OrganizationsTrue or False: Because the factors that shape health care delivery are easily identifiable, it is often easy to trace a change to the factor responsible for bringing about the change.FalseWhich of these factors has primarily shielded the U.S. health care system from a major overhaul?Beliefs and ValuesTrue or False: Medical practice in the U.S. emphasizes specialization while basic care is given only secondary importance.TrueWhich factor has mainly prevented the expansion health insurance to all Americans?CostFundamental reforms in the financing and delivery of health care will requireA change in mind set of middle-class AmericansThe first medical schools were opened byphysicians
Medical schools in the US were first openedto supplement physicians' incomesWhy was medical practice characterized by intense competition in the preindustrial era?Anyone could practice medicineTrue or False: In Europe, hospitals had developed much earlier than they did in the United States.TrueTrue or False: The early health care institutions in the U.S. served mainly a charitable purpose.TrueWhat was the main purpose of a pesthouse?Serve as isolation facilitiesOrganized medicineConcerted activities of physicians through the American Medical AssociationTrue or False: The AMA was the first organization to support salaried employment ofphysicians by hospitals.FalsePhysicians began to play a dominant role in hospitals mainly becausethey could decide where to hospitalize their patientsHealth insurance in America was bornduring the Great Depression
True or False: Private health insurance began in the form of hospital plans that did not include outpatient services.TrueWhich of the following triggered employer-based health insurance as a benefit? (Union-management negotiations, The World War, Wage Freezes, Supreme Court Ruling)Wage FreezesWhat has primarily kept national health insurance from taking roots in America?The American PublicTrue or False: Medicaid was created as a public insurance program to cover the elderlyFalseMedicare was created asa two part program for the elderlyTrue or False: The Medicaid program varies from state to state.TrueMeans testEligibility is determined by income levelHMOs were initially created tolower health care costsWhat is the latest addition to the Medicare program?Prescription drug benefit
The health care subdivision of the U.S. economy continues to grow becauseimmigration continues to rise leading to a growth in population & baby boomers hit retirement age and are receiving MedicareWhich answer does not describe a negative consequence of specialty maldistribution? (a. high volume of intensive, expensive medical services, b. specialist services have less impact in improving overall health status, c. there are access problems by the underserved, d. more predictable hours and higher prestige for specialists)more predictable hours and higher prestige for speciaistsStudies have shown that Nurse Practitioner servicesimprove access to primary care & concentrate more time with patients than physiciansA health or hospital administrator does which of the following? (A. helps patients receive medical care but only if they have insurance, B. organize the operational, clinical, and financial outcomes of the entire health system, C. increase health care spending to help make a profit for their hospital, or D. attract specialists, which increases the maldistribution of physicians in rural areas)organize the operational, clinical, and financial outcomes of the entire health systemA doctor of osteopathic medicine is different from an MD in that they have training in:
preventive and holistic medicineTrue or False: Most MDs are specialists and most DOs are in primary care.TrueThe allied health professionalconstitutes approximately 60% of the U.S. healthcare work force and complements physicians and nurses in delivering health careTrue or False: Most DOs are specialists and most MDs are generalistsFalseThe health care sector of the US economy continues to grow due toAging of the population & growth of the populationThe physician's role is toEvaluate a patients health condition and diagnose abnormalitiesA doctor of osteopathy emphasizespreventive and holistic medicineSpecialists mustDo additional years of advanced residency training in their speciality and seekcertification in an sara of medical specialization onlyTrue or False: The differences between primaryand specialty care are by the time, focus, andscope of services provided to the patients
TrueWhy is there an imbalance and maldistribution of physicians?Geographic maldistribution, speciality maldistribution, and aggregate physician oversupplyWhich answer is not a negative consequence of specialty maldistribution? (high volume of intensive, expensive medical services, Specialist services have less impact in improving overall health status, Access Problems by the underserved, OR More predictable hours and higher prestige for specialists)More predictable hours and higher prestige for specialistsTrue or False: Physicians are more likely to concentrate in rural and inner-city areas thanmetropolitan,suburban areasFalseWhich answer does not belong to the four main categories of nurses? (Clinical, NP, Technicians, Certified Nurse Midwives)TechniciansTrue or False: Advanced Practice Nurses have attained education and training beyond the RN levelTrueWhat are the values of NPP services?
Improve access to primary care & Better communication and interviewing skills than physiciansAllied Health Professionals constitute60% of US health care workforcePhysical therapists and occupational therapists are consideredtechnicians and assistantsA health service administrator job is toorganize, coordinate, and mange health care services deliveryTrue or False: Nonphysician Practitioners practice in many of the areas in which physicians practice and also have an MD or DO degreeFalseMaldistribution refers toa surplus of health providers in a given area & a shortage of health providers in a given areaSpecialty care tends to be limited todisease process, illness episodes, and organ systemTo alleviate the maldistribution problem, which of the following has been done?Financial support for family medicine programs &expansion of nurses' roles
True or False: Pharmacists do not need a statelicense to dispense medicines prescribed by physiciansFalseWhich type of doctor encounters the greatest proportion of ambulatory care visits?General/family practicePsychologists need _______ to practiceeither a psyD or phDTrue or False: Health Services administrators can only work if they have a Master of Business AdministrationFalseWhich acts increased federal support of nursing education after WWII?More than a RNThe Health Insurance Portability and Accountability Act (HIPAA) was enacted to address which of the following?Confidentiality of patients' health informationWhat is meant by the term technological imperative?using technology despite its costIn the U.S., competition among providers results induplication of services and equipmentCurrent legislation regarding new drugs in theU.S. requires that
the FDA review the safety and effectiveness of anew drug before it is marketedCapitalism and lack of government interventionplay a major role in the desire to have the state-of-the-art technology. What three qualities are necessary to determine effectiveness of technology regarding patient care?does it work; is it valuable; is it safeTrue or False: In addition to drugs and devices, the FDA also has the authority to review medical and surgical procedures for their safety and effectiveness.FalseTrue or False: It is accurate to say that high-technology medicine equates to high-quality care.FalseQuality of life is measured bythe patient's overall satisfaction with lifeWhat is the primary benchmark for satety with regard to medical technology?Benefits must outweigh any negative consequencesWhich of the following has not taken central stage in U.S. health care delivery?incorporation of cost-effectiveness into clinical practiceMedical technology leads toincreased costs of delivering medical care
True or False: Countries that have national health insurance programs end up limiting the use of medical technology.TrueTrue or False: In a general sense, medical technology can include scientific advances from any branch of science.TrueWhich of the following is not included in the broad definition of medical technology?TrainingPrivacy of patient information is regulated bytheHealth Insurance Portability and Accountability ActInformation technology cannot be used toaccess personal information for purposes not related to medical careTrue or False: The U.S. develops most new technology, but, on a per capita basis, other advanced nations employ more technology than the United States does.FalseTechnological imperativeUse of high technology without regard to its cost
True or False: Specialists use more technologythan primary care physicians but only because specialists treat more complex conditions.FalseWhich of the following is true about the FDA'srole in approving new drugs today?The FDA recalls drugs only after harm has occurred.The Orphan Drug Actprovides incentives to develop new drugs for rare conditionsTrue or False: Accleration of the drug approval process by the FDA has resulted in a higher number of drug recalls due to safety concerns.TrueSale of new medical devices classified as Class III requirespremarket approval by the FDATrue or False: Medical and surgical proceduresare not subject to FDA review and approval.TrueTrue or False: High-technology medicine results in high-quality care.FalseQuality of life is assessed in terms ofthe patient's overall satisfaction with life
True or False: New technology often increases labor costsTrueTrue or False: Telemedicine is now widely available in rural AmericaFalseTechnology assessmentEvaluation
human resources managementIncludes formalhuman resources functions performed within the organization or external to it and informal management of employees performed by all administrators.strategic human resources managementThe comprehensive set of managerial activities and tasks related to developing and maintaining a qualified workforce that contributes to organizational effectiveness, as defined by the organization's strategic goals.environmental assessmentA crucial element of SHRM in which an organization reviews the changes in the legal and regulatory climate, economic conditions, andlabor market realities to understand current opportunities and threats.purposean organizations basic reason for existancemission
A statement created by an organization's board and senior managers specifying how the organization intends to manage itself to most effectively fulfill its purpose.SWOT analysisAnalysis of the organization's strengths, weaknesses, opportunities, and threats.Corporate strategyA set of strategic alternatives from which an organization chooses as it manages its operations simultaneously across several industries and markets.Business strategyA set of strategic alternatives from which an organization choose to most effectively compete in a particular industry of market.Functional strategiesStrategies that consider how the organization will manage each of its major functions such as marketing, finance, and human resources.Staffing strategyA set of activities used by an organization to determine its future HR needs, recruit qualifiedapplicants with an interest in the organization,and select the best of those applicants as new employees.Developmental strategyMethods that facilitate the enhancement of an organization's human resource's quality. Must beconsistent with corporate and business strategies.
Compensation strategyThe set of rewards that organizations provide tostaff in exchange for their performance of various organizational tasks and jobs.Workforce compositionThe demographics of the workforce, including factors such as gender, age, ethnicity, marital status, and disabilitystatus.HR metricsMeasure if HR outcomes and performance.
occupationOne's principle activity and means of support.ProfessionA calling that requires specialized knowledge and training. Professionals have more authority and responsibility than people in an occupation,and they adhere to a code of ethics.Functional trainingTraining that produces personnel who can performtasks but who may not know the theory behind the practice.Primary verificationInformation direct from the licensing authority;verifies a new hire's license.Secondary verificationA copy of a document that indicates licensure has been granted shows the license's expiration date.
Impaired practionerA healthcare professional who is unable to carryout his or her professional duties with reasonable skill and safety because of a physical of mental illness, including deterioration through aging, loss of motor skill, or excessive us of drugs or alcohol. Eachnational or state licensing authority maintains legal requirements for reporting impaired practitioners.National Labor Relations BoardAn independent agency of the US government that conducts elections for labor union representation and investigates and attempts to remedy unfair labor practices.Equal Employment Opportunity CommissionA federal agency responsible for ending employment discrimination. The EEOC files lawsuits on behalf of alleged victims of discrimination in the workplace.Civil Rights Act of 1964The law outlawing segregation in schools and businesses and illegalizing discrimination in employment on the basis of race or sex.Age Discrimination in Employment ActThe law passed in 1967 that prohibits employmentdiscrimination against employees and applicants older than age 40.Employment-at-willA principle that assumes that both employee and employer have the right to end the employment relationship at any time, for any reason.
Fair Labor Standards ActThe 1938 law that establishes a federal minimum wage for the 40 hour workweek and overtime provisions. It also sets limits on child labor.Compensatory damagesPayment to compensate a claimant in a court decision for loss, injury, or harm suffered by another 's breach of duty.Americans with Disabilities ActThe civil rights law passed in 1990 that prohibits discrimination based on disabilities.Reasonable accommodationThe concept that it is the employer's responsibility to accommodate within reasonable limitsAffirmative actionTaking race, gender, or ethnicity into consideration in an attempt to promote equal opportunity ; often used in hiring actions.Disparate impactThe result of a practice that may appear to be neutral but has a discriminatory effect.Protected classA group of individuals protected under a particular law.Disparate treatmentWhen employees are treated differently because of race, color, religion, or gender, national
origin, age, disability, or other protected class category.Bona fide occupational qualificationA specific employment qualification that requires some kind of discrimination because thejob requires someone of a particular race, sex, or other characteristic.Negligent hiringA situation in which an employer could have discovered a new employee's problematic conduct through due diligence but failed to do so, making the employer liable for damages caused bythe employee.Quid pro quo sexual harassmentWhen a benefit for an employee in the workplace is granted on condition of submission to sexual advances.Hostile environment sexual harassmentSexual harassment that interferes with a victim's work performance or creates an intimidating, hostile, or offensive working environment that affects the victim's psychological well-being.Retaliatory dischargeWhen an employer takes action to attempt to prevent an employee from filing a claim of discrimination against the employer, or where the employer punishes the employee for participating in a legalactivity.Whistle-blower
An employee who discloses or exposes to the government an illegal activity in the workplace.Noncompetition and nonsolicitation clausesClauses in a contract that prevent a departed employee from posing a competitive risk or a confidentiality breach.Severance agreementAn agreement that ensures a terminated employee certain benefits from the former employer.Alternative dispute resolutionA specified conflict resolution process used instead of litigation. Often a clause in an employee contract.MediationA nonbinding type of dispute resolution in whicha neutral third party attempts to assist in negotiations between two primary parties.ArbitrationA binding type of dispute resolution in which both parties agree beforehand to abide by the decision of the arbitrator.GarnishmentCollecting money from someone by deducting moneyfrom his wages.assessinga judgmental process that includes evaluation ofthe significance of the forecasted issue on the organization.brainstorming
a group gathers to understand an issue, assess or generate alternative. Each idea is recorded even if risky with the purpose being to generatenew ideas.delphi methodmethod for analyzing environmental data. Individuals are asked their opinion, the data iscollected and compiled and sent out to all the participants to develop new judgementsexpert opinionused to identify, monitor and forecast trends.external environmental analysisconsists of understanding the issues in the external environment to determine the implications of those issues for the organizatin.focus groupsbring together 10-15 individuals to develop, evaluate and reach conclusions regarding environmental issues.forecastinga process of extending the trends, developments,dilemmas, and events that the organization is monitoring.general environmentgovernment institutions, business organization, educational and religious institutions, research organizations, consumershealth care environment
planning and regulatory organization. primary and secondary providers providerrepresentatives.individual patientsissue identification and extrapolationa matter of identifying issues and then anticipating the importance of the issue and likelihood that it will remain an issue. widely practice analysis method.monitoringTracking of issues identified in the scanning process. Accomplishes 4 functions: 1. identifiesadditional sources of information for specific issues that were determined to be important 2. adds to the environmental database 3. attempts toconfirm or disprove issues 4. attempts to determine the rate of changenominal group techniqueall in the group make a list of ideas on the issue, these are put on a flipchart for the entire group to see and expand upon. After discussion, the group votes on and ranks the ideas.primary providerorganizations that provide health servicesscanningthe process of viewing external organizations insearch of current and emerging trends or issues.scenarioscoherent story about the future, based on data accumulated in the scanning and monitory process. multiple scenarios allow the future to
be represented by different cause-effect relationships.secondary providerorganizations that provide services for health care organizationssensemakingunderstanding the context in which an organization operates.stakeholder analysisthe individuals or groups who have an interest or stake in the success of the organization.strategic issuesTrends, developments dilemmas, and events that affect an organization and its position within the environment. Often are ambiguous and requirean interpretationWhat is Human Resources Management (HRM)the design of formal systems in an organization that ensure the effective and efficient use of human capital to accomplish organizational goalsWhat are Human Resources Information Systems (HRIS)applications that help manage HR data (such as employee records) and createcompliance reports.What are HR strategic activities also called?transformation activities -- they are things that move the organization toward new outcomes in the future.What is an enterprise management tool?
An application or group of applications that allows for shared data throughout the organization. It allows data mining to identify developing trends and begin planningWhat are the 5 characteristics that separate aprofession from an occupationNational organizationcode of ethicsresearchbody of knowledgecredentialingWhat is a supply chain?a network that delivers products and services from raw materials to end usersWhat is offshoringthe relocation of processes or functions from a "home" country to another country.What is the WARN ActThe Worker Adjustment and Retraining Notification Act. you must notify the federal government with layoffs of 100 ormore. In Wisconsin, you must notify of 50 or more.What is ethical behavioradhering to a set of governing principles, whether the philosophy is one of fairness, individual rights, avoiding conflicts of interest, or another philosophical grounding.What is divestiture?shedding assets that do not contribute to the bottom line of an organization
What is due diligence?an intensive investigation of all factors surrounding a business decision to ensure all risks of acquiring a company are understoodWhat is a form of collective bargaining?Pattern, or parallel, bargainging takes place when unions negotiate provisions covering wages and other benefits similar to those that alreadyexist in the industry.What is the significance of the Weingarten Right?Weingarten Rights allow a union employee to request the presence of a coworker during an investigatory interviewWhat stage of Maslow's hierarchy will the employee needs be satisfied by job enrichment plan?This would be at the esteem stage where the employee's job enrichment increases the employee's responsibilities with a sense of fullfillment.Which of the following activities illustrates the administrative role assumed by an HR professional?a. Filling out EEO reportsb. Implementing the grievance process for an employee threatened with terminationc. Evaluating the bottom-line contribution of HR programsd. conducting an interviewing seminar for linemanagersa. Filling out EEO reports (p 1-7)
Which of the following activities illustrates the operations role played by an HR professional?a. Ensuring currency of employee recordsb. Conducting recruitment for new job openingsc. Forming contact with key individuals outside the organization d. Developing criteria for selecting supply chain partnersb. Conducting recruitment for newjob openings (p1-7)Which of the following examples illustrates the strategic role played by HR todaya. Securing off-site backup and storage of employee transactions and recordsb. Developing a system to track the number of people leaving the organizationc. Creating a training program for conducing safe and legal terminationsd. Working with senior and line managers to forecast workforce needs for the next five yearsd. Working with senior and line managers to forecast workforce needs for the next five years(1-7)The impact of demographic changes on HR is best illustrated by which of the following?a. Need to learn more about local legislation and rule-making processb. Survey adequacy of existing organization communication vehicles for all employeesc. Establishment of employee self-service centersd. Evaluating ethical liabilities posed by supply chain partners
b. Survey adequacy of existing organization communication vehicles for all employees (p 1-12)Which of the following statements about SOX istrue?a. It applies to all companies, no matter their size or whether they are publicly or privately heldb. It relates primarily to compensation for high-level executivesc. It has little direct effect on HRd. It addresses both insider trading and whistleblowing activitiesd. It addresses both insider trading and whistleblowing activities (p 1-9)The supply chain is an example ofa. flexible internal organization boundariesb. a tendency to draw core competencies back into the organizationc. an extended organizationd. an organization structural change required by lean manufacturing principlesc. an extended organization (p 1-18)A software company is considering the acquisition of a training company that will provide documentation and training support forits key customers. The company begins a due diligence investigation. Which of the following items will have the LEAST impact on the due diligence process?a. Obligations to retirement plansb. History of OSHA complaintsc. Strategies to integrate compensation and benefit systemsd. Cultural fit of the two companies
b. History of OSHA complaints (p 1-20)HR can best prepare for a strategic role bya. enhancing its ability to demonstrate returnon investmentb. expanding the size of HR functionc. focusing on ways to cut production costs throughout the organizationd. centralizing HR activity for greater consistency and controla. enhancing its ability to demonstratereturn oninvestment (p 1-24)Which of the following best illustrates the way in which HR's strategic role has transformed its operations role?a. Upgrading an HRIS systemb. Establishing relationships with key decision makers throughout the organizationc. Taking a more active role in responding to employee complaintsd. Analyzing job descriptions for changes to required skills that will affect recruitment and selection decisionsd. Analyzing job descriptions for changes to required skills that will affect recruitment andselection decisions (p 1-9)Demographica section of the population sharing common characteristics, such as age, sex, class, etc
Civil Rights Act of 1964Outlawed racial segregation and discrimination in employment, public facilities, and education.Title VII
the most prominent piece of legislation regarding HRM, it states the illegality of discriminating against individuals based on race, religion, sex, or national origin.Equal Employment Opportunity ActGranted enforcement powers to the EqualEmployment Opportunities CommissionEqual Employment Opportunities CommissionThe arm of the federal goverment empowered to handle discrimination in Employment cases.Age discrimination in Employment ActThis act prohibits arbitrary age discrimination,particulary among those over age 40.Equal Pay ActRequires equal pay for equal work regardless of genderExecutive Order 11246Prohibits discrimination on the bases of race, religion, color, and national origin by federal agencies as well as those working under federal contractsExecutive Order 11375Added sex based discrimination to E.O. 11246Equal Employment Opportunity Act of 1978Increased mandatory retirement age from 65 to 70. Later ammended (1986) to eliminate the upperage limitPregnancy discrimination act of 1978
Affords EEO protection to pregnant workers and requires pregnancy to be treated like any other disabillityAmericans with disabilities act of 1990prohibits discrimination against an essentially qualified individual, and requires enterprises to reasonably accommodate individualsCivil rights Act of 1991Nullified selected Supreme Courts decisions. Reinstates burden of proof by employer. Allows for punitive and compensatory damages through jury trial.Family and Medical Leave Act of 1993Permits employees in organizations of 50 or moreworkers to take up to 12 weeks in unpaid leave for family or medical reasons each year.Uniformed Services Employment and ReemploymentRights Act of 1994Allows veterans the rights to return to their job in the private sector when returning from military serviceGenetic information Nondiscrimination Act of 2008Prohibits discrimination based on an employee's genetic informationLilly Ledbetter Fair Pay Actallows workers to file pay discrimination claimswithin 180 days of a discriminatorypaycheckreasonable accommodations
changes to the work place that allows qualified workers with disabilites to preform their jobsAdverse impacta consequence of an employment practice that results in a greater rejection rate for a minority group in the occupationadverse (disparate) treatmentan employment situation where protected group members recieve treatment different from other employees in matters such as performance evaluations and promotions.4/5ths rulea rough indicator of discrimination, this rule requires that the number of minority members a company hires must equal at least 80 percent of the majority members in the population hired.McDonnell-Douglas Corp v. GreenSupreme court case that led to a four part test used to determine if discrimination has occurred.affirmative actiona practice in organizations that goes beyond discontinuance of discriminatory practices to include actively seeking, hiring and promoting minority group members and women.bona fide occupational qualificationsjob requirements that are reasonably necessary to meet the normal operations of that business or enterprisesseniority systems
decisions such as promotions, pay and layoffs are made on the basis of an employee's seniorityof length of serviceGriggs vs. Dukes Power CompanyLandmark supreme court decision stating that tests must fairly measure the knowledge or skills required for the job.Albemarle Paper Company v. MoodySupreme court case that clarified the methodological requirements for using and validating tests in selection.Wards Cove Packing Company v. Atonioa notable supreme court case that had the effectof potentially undermining two decades of gains made in equal employment opportunitiesreverse discriminationa claim made by white males that minority candidates are given preferential treatment in employment decisionsWashington v. DavisJob related tests are permissible for screening applicants.Connecticut v. Teal (1984)requires all steps in a selection process to meet the 4/5ths rule.Firefighters Local 1784 v. Stotts (1984)layoffs are permitted by seniority despite effects it may have on minority employees.
Wyant v. Jackson Board of EducationLayoffs of white workers to establish racial or eth of balances are illegal; however, this case reaffirmed the use of affirmative action plans to correct racial imbalanceUnited States v. Paradisequotas may be used to correct significant racialdiscrimination practices.Sheetmetal Workers Local 24 v. EEOC (1987)racial preferences could be used in layoff decisions only for those who had been subjected to previous race discriminationJohnson v. Santa Clara County Transportation Agency (1987)Reaffirmed the use of preferential treatment based on gender to overcome problems in existingaffirmative action plans.Sexual Harassmentanything of sexual nature that creates a condition of employment, an employment consequence, or a hostile or offensive work environment.quid pro quo harassmentSome type of sexual behavior is expected as a condition of employmenthostile environment harassmentoffensive an unreasonable situations in the workplace that interfere with the ability to workcomparable worth
equal pay for jobs similar in skills, responsibility, working conditions and effort.Duke vs. Walmart StoreLawsuit brought on behalf of 1.6 million women who have worked at Walmart since 1998 claiming discrimination in pay and promotionglass ceilingthe indivisible barrier that blocks females and minorities from ascending into upper levels of an organization.
