ASSIGNMENT INFORMATION

1.     
2.  Click the link above to submitAssignment 2: Funding the Rising Cost of U.S. Health Care
   Due Week 6 and worth 160 pointsIn light of the Affordable Health Care Act (ACA) and the myriad of citizens using the new health care insurance system, you, as a health care administrator for a hospital, are responsible for reporting to the hospital’s CEO regarding the new plan’s cost to the hospital and the issues with patients who can afford regular health care coverage.Write a four to six (4-6) page paper in which you:
   1. Give your opinion of the rising cost of health care’s overall impact on the U.S. economy. Justify your response.
   2. Compare and contrast at least two (2) areas of the economy that the new health care act impacts. Explain your rationale.
   3. Debate the main pros and cons of using private insurance versus using the new affordable health insurance system.
   4. Analyze the cost associated with implementing ACA and its impact on access to health care access for different demographic groups. Provide a rationale for your response.
   5. Use at least four (4) recent (i.e., last five [5] years), quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as academic resources. 
   Your assignment must follow these formatting requirements:
   • Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
   • Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length. 
   The specific course learning outcomes associated with this assignment are:
   • Analyze the different ways of financing the health care system and the impact on individuals.
   • Use technology and information resources to research issues in health services organization.
   • Write clearly and concisely about health services organization using proper writing mechanics.
   
   

Davis Health Care is dedicated to providing an excellent patient care experience. A recent survey indicated that they could improve their quality of service. Imagine you are charged with identifying an area of improvement for this organization.

Select one area of improvement from the following list to complete Part 1 and Part 2 of this assignment:

• Patient safety
• Staff development and team improvement
• Productivity management
• Patient education
• Another area of improvement – Needs faculty approval

You will focus on this area of improvement throughout the remainder of the course, which will lead to a quality improvement plan in the final week.

Write a 1,050- to 1,400-word paper in which you address the following prompts for the area of improvement that you selected from above:

Part 1: Data Collection Tools

• Explain data needed to monitor improvements.
• Explain at least three data collection tools you can use to collect performance information.
• Explain the types of information each tool collects.
• Explain the strengths and weaknesses of each data collection tool.
• Explain how the data collection tools are similar. Explain how the data collection tools are different. 

Part 2: Data Display, Measurement and Reporting

• Identify at least two tools that measure and display the QI data that can be gathered with the data collection tools identified in Part 1.
• Explain the types of information each tool measures, displays, and reports.
• Explain each measurement, display, and reporting tool’s strengths and weaknesses.
• Explain how the measurement, display, and reporting tools are similar and different from each other.
• Explain how the measurement, display and reporting tools are useful for health care organizations. 

Cite at least 3 sources according to APA guidelines to support your information.

Click the Assignment Files tab to submit your assignment.

Combine all three parts of the QI plan into one document, making sure to include instructor feedback. Organize the plan as you would present it to the organization’s board of directors for approval. Use the QI Plan Template as a guide. (950-word)

In the QI Plan Template, complete the following:

• Evaluate various data collection and display tools used in performance measurement.
• Evaluate tools used to measure and report data.
• Analyze various improvement methodologies for integrating quality improvement strategies into performance measurements.
• Analyze the impact of information technology applications on performance measures.
• Analyze the use of internal and external benchmarking and milestones in managing the utilization of quality indicators.
• Evaluate criteria and tasks for developing quality improvement plans.
• Analyze how performance and quality measures are aligned to the organizations mission, vision, strategic and operational plans.
• Evaluate strategies for meeting regulatory and accreditation standards within health care organizations.
• Evaluate measures used to monitor and revise quality program implementation.
• Evaluate barriers that can interfere with the implementation of quality measures.
• Evaluate strategies to ensure successful implementation of quality measures. 

Write a 600-word executive summary related to your QI plan which includes an evaluation of the  following:

• Evaluate the current state of QI at the organization, its organizational and operational QI structure, authority, mission, methodology, and tools used.
• Recommend how the organization will achieve its objectives over the long term.
• Evaluate challenges that may impact the future of health care quality improvement.
• Evaluate effect of health care quality improvement on operational and financial performance.

Format your paper according to APA guidelines.

Cite 6 peer-reviewed, scholarly, or similar references to support your paper.

Study Guide -Delivering Healthcare in America: A Systems Approach
Leiyu Shi & Douglas A. Singh
Chapter 1: A Distinctive System of Health Care Delivery

Multiple Choice Questions

1. The primary objectives of a healthcare system include all of the following except:
a. Enabling all citizens to receive healthcare services
b. Delivering healthcare services that are cost-effective
c. Delivering healthcare services using the most current technology, regardless of cost
d. Delivering healthcare services that meet established standards of quality

2. The U.S. healthcare system can best be described as:
a. Expensive
b. Fragmented
c. Market-oriented
d. All of the above

3. For most privately insured Americans, health insurance is:
a. Employer-based
b. Financed by the government
c. Privately purchased
d. None of the above

4. Medicare is primarily for people who meet the following eligibility requirement:
a. Elderly
b. Low-income
c. Children
d. Disabled

5. Medicaid is primarily for people who meet the following eligibility requirement:
a. Elderly
b. Low-income
c. Children
d. Disabled

6. The role of the government in the U.S. healthcare system is:
a. Regulator
b. Major financer
c. Medicare and Medicaid reimbursement rate-setter
d. All of the above
7. Which of the following is a characteristic of a socialized health insurance system?
a. Health care is financed through government-mandated contributions by employers and employees
b. Health care is delivered by government-employed providers
c. Both a and b
d. Neither a nor b

8. Which of the following is an overarching goal of Healthy People 2010?
a. Decrease health care costs
b. Create a more coordinated health care system
c. Establish a national health insurance program
d. Increase quality and years of healthy life

9. Which of the following is a dimension of social health?
a. Sociability
b. Community involvement
c. Marital satisfaction
d. All of the above

10. Supplier-induced demand is created by:
a. Patients
b. Providers
c. Health insurance companies
d. The government
Chapter 2: Beliefs, Values, and Health

Multiple Choice Questions

1. The elements of the Epidemiology Triangle of disease occurrence include all of the following except:
a. Environment
b. Agent
c. Society
d. Host

2. Which of the following factors is the leading cause of preventable disease and death in the United States?
a. High fat diet
b. Heredity
c. Smoking
d. Unsafe sex

3. Which of the following is not a behavioral risk factor?
a. Irresponsible motor vehicle use
b. Inadequate physical exercise
c. Unsafe neighborhoods
d. Alcohol abuse

4. What is tertiary prevention?
a. Early detection and treatment of disease
b. Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disability
c. Reduction of the probability that a disease will develop in the future
d. None of the above

5. According to the CDC, which factor contributes most to premature death in the U.S. population?
a. Lifestyle and behaviors
b. Lack of medical care
c. Social and environmental factors
d. Genetic makeup

6. Which of the following can be considered an environmental factor contributing to health status?
a. Air quality
b. Access to health care
c. Safety of neighborhoods
d. All of the above

7. Healthcare is considered a social good in:
a. Market justice
b. Social justice
c. Both a and b
d. The total number of cases at a specific point in time divided by the population at risk

8. Demand-side rationing is the same thing as:
a. Nonprice rationing
b. Price rationing
c. Both a and b
d. Neither a nor b

9. Prevalence is:
a. The number of new cases occurring during a specified period divided by the total population
b. The total number of cases at a specific point in time divided by the specified population
c. The number of new cases occurring during a specified period divided by the population at risk
d. The total number of cases at a specific point in time divided by the population at risk

10. Holistic health adds which element to the World Health Organization definition of health?
a. Physical
b. Mental
c. Spiritual
d. Social

Chapter 3: The Evolution of Health Services in the United States

Multiple Choice Questions

1. Which of the following forces remains relatively stable, and major shifts in this area would be necessary to bring about any fundamental change in the US health care delivery system?
a. Economic forces
b. Political change
c. Beliefs and values
d. Social forces

2. In its historical context, which of the following has played a major role in revolutionizing health care delivery?
a. Beliefs and values
b. Science and technology
c. Medical education
d. Economic growth

3. In the preindustrial era, _____ often functioned as surgeons.
a. butchers
b. tailors
c. clergymen
d. barbers

4. Hospitals in the United States evolved from
a. alms houses
b. sick homes
c. pest houses
d. inns

5. What was the function of a pest house in the preindustrial period?
a. To house people who had a contagious disease.
b. To provide refuge to those who were threatened by pests.
c. To eradicate pests.
d. To treat contagious diseases.

6. Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?
a. Urbanization
b. Educational reform
c. Science and technology
d. Dependency
e. licensing

7. Development of the hospital and ______ happened almost hand in hand in a symbiotic relationship between the two.
a. dependency of patients
b. growth of scientific knowledge
c. professionalization of medical practice
d. cohesiveness of the medical profession

8. Why did physicians remain independent of corporate settings even after the medical profession became well recognized?
a. Hospitals were unable to pay high enough salaries to physicians.
b. Physicians disliked salary arrangements.
c. Licensure laws had not yet been passed.
d. Physicians who took up practice in a corporate setting were castigated by the medical profession.

9. Since the early 1900s, the burden of disease in developed countries has shifted
a. to underdeveloped countries
b. from infectious to chronic disease
c. from chronic to infectious disease
d. from the rich to the poor

10. The inception of _____ was used as a trial balloon for the idea of government-sponsored universal health insurance.
a. workers’ compensation
b. trade unions
c. public health
d. health care for the veterans
Chapter 4: Health Services Professionals

Multiple Choice Questions

1. A major factor influencing growth in the health care sector of the U.S. economy is:
a. The aging of the population
b. Increasing fertility rates
c. Declining death rates
d. All of the above

2. Which type of health care facility employs the most people in the U.S.?
a. Physicians’ offices and clinics
b. Hospitals
c. Nursing and personal care facilities
d. None of the above

3. When patients have multiple health problems, this is called:
a. Coaffliction
b. Comortality
c. Codependency
d. Comorbidity

4. The basic source of the physician distribution problem in the U.S. is:
a. Lack of health care coverage for all
b. The need-based model
c. Lack of awareness that there is a problem
d. A shortage of MDs

5. The Nurse Reinvestment Act of 2002 provides:
a. Grants and scholarships for nurses
b. Funding for nurse retention programs
c. Funding for further education for nurses
d. All of the above

6. Allied health professionals include:
a. Osteopaths
b. Dentists
c. Physician assistants
d. None of the above

7. Physician maldistribution occurs by:
a. Specialty
b. Geography
c. Both a and b
d. Neither a nor b
8. Primary care is:
a. Longitudinal
b. The portal to the healthcare system
c. Holistic
d. All of the above

9. The principle source of graduate medical education is:
a. Medicaid
b. Medicare
c. Private funds
d. State grant funds

10. Which of the following is a major criticism of managed care?
a. Quality of care may be sacrificed
b. Managed care is inefficient
c. Utilization may increase
d. Managed care will worsen the physician oversupply
Chapter 5: Medical Technology

Multiple Choice Questions

1. At a fundamental level, medical technology deals with
a. production of new equipment to provide more advanced health care
b. the application of knowledge produced by biomedical research
c. using discoveries made in basic sciences to improve health care
d. new drugs and devices

2. Telemedicine technology that allows a specialist located at a distance to directly interview and examine a patient is referred to as
a. telehealth
b. simultaneous
c. analogous
d. synchronous

3. The asynchronous form of telemedicine uses_____ technology.
a. store-and- forward
b. access-when-needed
c. delayed-access
d. forward-and-retrieve

4. The expectations that Americans have about what medical technology can do to cure illness is based on
a. the technological imperative
b. cultural beliefs and values
c. a higher rate of technology diffusion in the US compared to other countries
d. medical specialization

5. What is the main intent of the Stark laws?
a. Require that personal health information be kept confidential
b. Require demonstration of cost-efficiency of new technology
c. Prohibit self-referral by physicians to facilities in which they have an ownership interest
d. Disclosure of potential harm from a procedure or device

6. Supply-side rationing.
a. Curtailment in governing funding for medical research
b. Managed care
c. Curtailment in payments for new technology
d. Central planning

7. Certain allergy medications containing pseudoephedrine are available without prescription, but must be kept behind the pharmacy counter and sold only in limited quantities upon verification of a person’s identity.
a. Food and Drugs Act, 1906
b. Food, Drug, and Cosmetic Act, 1938
c. Kefauver-Harris Drug Amendments, 1962
d. Patriot Act 2006

8. The FDA was given the authority to review the effectiveness and safety of a new drug before it could be marketed.
a. Food and Drugs Act, 1906
b. Prescription Drug User Fee Act, 1992
c. Kefauver-Harris Drug Amendments, 1962
d. Food, Drug, and Cosmetic Act, 1938

9. This made additional resources available to the FDA, and resulted in a shortened approval process for new drugs.
a. Kefauver-Harris Drug Amendments, 1962
b. Food and Drug Administration Modernization Act, 1997
c. Orphan Drug Act, 1983
d. Prescription Drug User Fee Act, 1992

10. The Safe Medical Devices Act, 1990 requires
a. that injuries, illness, or death from any device be reported
b. premarket approval of devices
c. safety testing of devices before and after they have been marketed
d. that all problems and potential problems be reported to the FDA
Chapter 6: Health Services Financing

Multiple Choice Questions

1. What is the primary reason that a segment of the U.S. population is uninsured?
a. Medicare and Medicaid are the only public insurance programs
b. The U.S. has a voluntary system of health insurance
c. The poor cannot afford health insurance
d. U.S. health insurance is dominated by managed care

2. What is the central role of health services financing in the United States?
a. Fund health insurance
b. Underwrite medical risk
c. Support managed care
d. Balance the supply of health care professionals

3. What is the primary mechanism that enables people to obtain health care services?
a. Availability of services
b. Health insurance
c. Payment for services
d. Control of expenditures

4. In national health care systems, total expenditures are controlled mainly through
a. cost shifting
b. underwriting
c. supply-side rationing
d. demand-side rationing

5. In a general sense, what is the primary purpose of insurance?
a. Predicting risk
b. Risk assessment
c. Protection against risk
d. Underwriting

6. What is the primary function of insurance?
a. Pay claims on behalf of the insured
b. Underwrite policies
c. Provide comprehensive coverage
d. Protection against catastrophic risk

7. What is the main advantage of group insurance?
a. More people can obtain insurance from a single insurer
b. Risk is spread out among a large number of insured
c. More comprehensive services can be covered than under an individual plan
d. The employer has to deal with only one insurance company

8. The majority of beneficiaries receiving health care through Medicare are
a. elderly
b. disabled
c. financially poor
d. those suffering from end-stage renal disease

9. For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed
a. 30 days
b. 60 days
c. 100 days
d. None of the above

10. The dependents of U.S. military personnel receive health care through
a. CHAMPUS
b. Military Health Services System
c. VHA
d. TriCare
Chapter 7: Outpatient and Primary Care Services

Multiple Choice Questions:

1. Typically, tertiary care:
a. Is highly specialized
b. Does not depend on technology
c. Takes place outside of traditional healthcare facilities
d. All of the above

2. What is gatekeeping?
a. The process by which patients are denied needed care
b. The process by which primary care physicians refer patients to specialists
c. The concept that specialists use more diagnostic tests than primary care physicians
d. The idea that patients should be allowed to choose their own doctors

3. Which country’s health care system is founded on the principles of gatekeeping?
a. UK
b. US
c. Australia
d. China

4. Countries whose health systems are oriented more toward primary care achieve:
a. Higher satisfaction with health services among their populations
b. Higher expenditures in the overall delivery of care
c. Worse health outcomes
d. None of the above

5. The most prominent reason for the decline in the number of procedures performed in hospitals is:
a. Most of these procedures were shifted to outpatient setting
b. Most of these procedures were deemed outdated
c. Most of these procedures were unsafe
d. Most of these procedures used technology that was too expensive

6. What does “PPS” stand for?
a. Preferred Provider System
b. Primary Physician System
c. Private Practice System
d. Prospective Payment System

7. One reason women’s health centers were created is:
a. Women have more money than men
b. Women seek care more often than men
c. Women have shorter life spans than men
d. None of the above

8. Hospice services are primarily for people with:
a. Chronic illnesses
b. Rehabilitative needs
c. Terminal illnesses
d. None of the above

9. What is palliation?
a. Pain and symptom management
b. Psychosocial support
c. A surgical intervention
d. Bed rest

10. Community health centers serve primarily:
a. High-income neighborhoods
b. Populations with insurance
c. Populations which are medically underserved
d. Both a and b
Chapter 8: Inpatient Facilities and Services

Multiple choice Questions

1. Inpatient care
a. Services delivered by a hospital
b. Treatment of acute conditions
c. Health care delivered in conjunction with an overnight stay in a facility
d. Care delivered in a licensed facility

2. The biggest share of national health spending is used by
a. hospitals
b. physicians
c. prescription drugs
d. nursing home care

3. The first hospitals in the United States served mainly
a. the poor
b. the wealthy
c. those needing surgery
d. government officials

4. What is the meaning of “excess capacity” in the health care inpatient sector?
a. Hospital consolidation
b. Few hospitals
c. Large institutions
d. Empty beds

5. The Hill-Burton Act was passed to
a. make it mandatory for private insurers to cover hospital services
b. relieve shortage of hospitals
c. curtail the utilization of hospital beds
d. have federal control over community hospitals

6. ALOS is an indicator of
a. use of hospital capacity
b. frequency of use
c. severity of illness
d. access

7. Which ownership type constitutes the largest group of hospitals and hospital beds in the United States?
a. Private for-profit
b. Federal
c. Private nonprofit
d. State and local government

8. In a hospital classified as short stay, the ALOS is less than
a. 5 days
b. 10 days
c. 15 days
d. 25 days

9. To be classified as a Critical Access Hospital, the number of acute care beds should not exceed
a. 20
b. 25
c. 35
d. 50

10. According to US law, nonprofit organizations
a. can make only a limited amount of profit
b. are tax exempt
c. cannot have a governing body
d. must pay taxes only if they are profitable

Chapter 9: Managed Care and Integrated Organizations

Multiple Choice Questions

1. The managed care phenomenon was welcomed mostly by
a. employers
b. workers
c. private insurance
d. the government

2. With the growth of managed care, the balance of power in the medical marketplace swung toward
a. providers
b. the supply side
c. the demand side
d. more regulation

3. A managed care organization functions like
a. a provider
b. an insurer
c. a regulator
d. a financier

4. What is the purpose of cost sharing with providers?
a. It makes providers immune to costs
b. It makes providers cost conscious
c. It rewards providers for quality
d. It keeps insurance premiums low

5. Capitation is best described as
a. monthly lump sum payment regardless of utilization
b. monthly lump sum payment regardless of cost
c. per member per month payment
d. payments capped to a maximum cost for delivering services

6. Under capitation, risk is shifted
a. from the insured to the employer
b. from the provider to the MCO
c. from the employer to the MCO
d. from the MCO to the provider

7. Under which payment method is a fee schedule used?
a. prospective payment
b. capitation
c. discounted fees
d. fee for service
8. The HMO Act of 1973 required
a. health care providers to contract with HMOs
b. managed care organizations to offer HMO alternatives
c. insurers to switch to managed care
d. employers to offer an HMO alternative to conventional health insurance

9. In the term, managed care, ‘manage’ refers to
a. management of utilization
b. management of premiums
c. management of risk
d. management of the supply of services

10. Under the fee-for-service system, providers had the incentive to
a. deliver more services than what would be medically necessary because a greater volume would increase their incomes
b. use less technology because they could increase their incomes by not using costly procedures
c. indiscriminate cost increases because they could get paid whatever they would charge
d. increase the level of quality in order to attract more patients
Chapter 10: Long-Term Care

Multiple Choice Questions

1. Low cognitive functioning places an elderly person at a high risk for
a. clinical depression
b. functional decline
c. chronic ailments
d. acute ailments

2. The elderly do not constitute a homogeneous group; hence
a. they have more chronic ailments than acute episodes
b. the LTC system must be integrated with the rest of the health care delivery system
c. most elderly people live independently
d. a variety of long-term care services are demanded

3. Which of the following plays a primary role in individualizing long-term care services to the patient’s needs?
a. Coordination of various services
b. Physician’s orders
c. An individual assessment
d. A discharge report from the hospital

4. In the delivery of long-term care, customized interventions are carried out according to
a. an individual assessment
b. a plan of care
c. weekly evaluations by the patient’s physician
d. the philosophy of total care

5. What is the key determinant of the need for long-term care?
a. A disabling accident
b. An acute episode
c. Presence of multiple chronic conditions
d. Limitations in a person’s ability to perform tasks of daily living

6. What is the goal of long-term care?
a. Promote functional independence
b. Return a person to independent living
c. Reverse the decline in activities of daily living
d. Cope with multiple chronic conditions

7. Which of the following can contribute positively to a person’s quality of life?
a. Palliation
b. Assessment
c. Plan of care
d. Total care

8. Why is the assessment of psychiatric illness particularly difficult in geriatric patients?
a. Mental illness cannot be ruled out
b. The elderly often fake mental illness.
c. Psychiatric illness can be intermittent
d. Comorbidities can obscure diagnosis

9. Personal care is
a. Individualized care
b. Basic assistance with ADLs
c. Services that are nurse-intensive
d. Long-term care provided by unpaid caregivers

10. Maintenance rather than restoration of functioning is particularly the domain of
a. custodial care
b. restorative care
c. skilled nursing care
d. personal care
Chapter 11: Health Services for Special Populations

Multiple Choice Questions

1. Which racial/ethnic group is most likely to drink alcohol?
a. White
b. Black or African American
c. Asian or Pacific Islander
d. Hispanic

2. Which racial/ethnic group is growing the fastest?
a. White
b. Black or African American
c. Asian or Pacific Islander
d. Hispanic

3. Which racial/ethnic group is least likely to use mammography?
a. White
b. Black or African American
c. Asian or Pacific Islander
d. Hispanic

4. Approximately how many Americans are uninsured?
a. 16 million
b. 26 million
c. 46 million
d. 66 million

5. Lack of insurance can result in:
a. Decreased utilization of lower cost preventive services
b. Increased need for more expensive, emergency health care
c. The spread of infectious diseases
d. All of the above

6. Which legislation created the State Children’s Health Insurance Plan (SCHIP)?
a. Balanced Budget Act of 1997
b. State Children’s Health Insurance Act of 1997
c. Kids First Act of 1997
d. Omnibus Reconciliation Act of 1997

7. What does “MUA” stand for?
a. Metropolitan Utilization Area
b. Medically Underserved Area
c. Metropolitan Underserved Area
d. Medical Utilization Area

8. What is the primary purpose of the National Health Service Corps?
a. To recruit physicians to provide services in physician shortage areas in the U.S.
b. To recruit physicians from abroad to work in the United States
c. To send U.S. physicians to developing countries to provide services to the indigent
d. To recruit physicians into the military
9. Among women, which racial/ethnic group has the highest percentage distribution of AIDS?
a. White, non-Hispanic
b. Black, non-Hispanic
c. Hispanic
d. American Indian

10. What does the federal Ryan White CARE Act fund?
a. Care for underserved rural and urban populations
b. Skin cancer screening programs
c. School-based health services in predominantly minority neighborhoods
d. Development of treatment and care options for persons with HIV and AIDS

Chapter 12: Cost, Access and Quality

Multiple Choice Questions

1. What is Gross Domestic Product (GDP)?
a. A measure of all the goods and services produced by a nation in a given year
b. A measure of all the goods and services produced by a nation in a given year, divided by the population
c. A measure of all the goods and services produced by a nation in a given year, minus the amount of money spent by the government
d. A measure of all the goods and services produced by a nation in a given year, divided by the amount of money spent by the government

2. What is a PRO?
a. Price Rationing Organization
b. Political Review of Outcomes
c. Peer Review Organization
d. President’s Review of Organizations

3. What is meant by the term “health care costs”?
a. The price of health care
b. How much a nation spends on health care
c. Cost of producing health care
d. All of the above

4. Medical cost inflation is influenced by all of the following factors except:
a. Waste and abuse
b. Increase in elderly population
c. Decrease in uninsured
d. Growth of technology
5. What are administrative costs?
a. Costs associated with management of the financing, insurance, delivery, and payment functions of health care
b. Costs associated with financing and insurance only
c. Costs associated with delivery and payment functions only
d. None of the above

6. What is the main reason for the lack of success of health care cost control efforts in the U.S.?
a. Malpractice lawsuits
b. Cost shifting by providers
c. Dislike of the practice by consumers
d. Growth of technology

7. Fill in the blank: The distinction between predisposing and enabling conditions can be applied to assess the _______ of a health care system.
a. cost
b. equity
c. efficiency
d. effectiveness

8. What is the purpose of clinical practice guidelines?
a. To provide a plan to manage a clinical problem based on evidence or consensus
b. To lower costs
c. To improve outcomes
d. All of the above

9. What is the Health Plan Employer Data and Information Set (HEDIS)?
a. A quality report card
b. A cost report card
c. A government database on health plans
d. None of the above

10. What are the main activities of risk management?
a. Proactive efforts to prevent adverse events related to clinical care and facilities operations
b. Retrospective studies of adverse events
c. Both a and b
d. Neither a nor b
Chapter 13: Health Policy

Multiple Choice Questions:

1. Which major public insurance program was legislated in 1965?
a. Medicare
b. Medicaid
c. Both a and b
d. Neither a nor b

2. Health policies are used in what capacity?
a. Regulation of behaviors
b. Allocation of income, services, or goods
c. Both a and b
d. Neither a nor b

3. What is incrementalism?
a. The fact that in the U.S., health care is financed by multiple entities
b. The fragmented, uncoordinated delivery of health services
c. Small policy changes that reflect a compromise amongst different groups’ demands
d. None of the above

4. Which of the following branches of government is a supplier of policy?
a. Executive
b. Legislative
c. Judicial
d. All of the above

5. What is an interest group?
a. A group of lawmakers within Congress with a particular area of interest
b. A group of appointed judges with a particular political view point
c. An independent, non-governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers
d. None of the above

6. What was the main purpose of the Kerr-Mills program (1960)?
a. Provision of federal grants to state government programs assisting the elderly
b. Provision of federal grants to state government programs assisting the poor
c. Provision of federal grants to state government programs assisting children
d. None of the above

7. For what is the National Health Planning and Resources Development Act of 1974 noted?
a. The shift from cost containment to improvement of quality as the principal theme in federal health policy
b. The shift from cost containment to improvement of access as the principal theme in federal health policy
c. The shift from improvement of access to cost containment as the principal theme in federal health policy
d. The shift from improvement of quality to cost containment as the principal theme in federal health policy
8. What does “CON” stand for?
a. Certificate of Need
b. Certificate of Nursing
c. Certificate of Naturopathy
d. Certificate of Nationality

9. In what way does research influence policymaking?
a. Prescription
b. Documentation
c. Analysis
d. All of the above

10. All of the following were identified by the Institute of Medicine (Crossing the Quality Chasm, 2001) as areas for quality improvement, except:
a. Timeliness
b. Safety
c. Efficacy
d. Patient-centerednessView less »

Practicum Journal Entries

Student’s Name

Institutional Affiliation

Practicum Journal Entries

Practicum: Journal Entry Week 5

Week five involved a lot of activities creating an opportunity to acquire practical knowledge on behaviors that increase risks to diseases and health complications. The practicum took place in Harris County. The county has a population of 4,337,000 dominated by Whites (CDC, 2014). In December 2014, the unemployment rate of the county stood at 7 percent and median household income was 54,100 dollars. The use of alcohol, drugs, and tobacco is common in the county. Similarly, Harris is home to a number of fast food outlets because of the readily available market created by its population. According to the 42 percent of 11th graders and below reported using alcohol and other drugs between 2009 and 2011 while 31 percent of the adults drink alcohol (Finkel, 2011). With respect to smoking, the county has 18 percent of its population smoking. Most significantly, the report revealed that physical activity (walking and exercise) is rare among children and adults of Harris. There are many producers and sellers of fresh produce in the county. However, the low income of many households limits their ability to purchase such produce consistently. Nonetheless, the county has limited incentives to promote production and distribution of fresh produce in different corners of the county (Begley et al., 2008).

Health Risk Behaviors

Binge drinking is a common practice among many adults in Harris County. Such activities promote the prevalence of alcohol thus causing many health risks to users. Logically, most binge drinkers tend to smoke tobacco or use drugs during binge activities. Accordingly, use of alcohol, drugs, and tobacco poses a serious threat to users, their families, and unborn babies. For example, these substances enhance the risks for cancer, diabetes, and lung diseases among others (CDC, 2014). Based on the 2013 Data Report on Harris, residents’ preference to drive to work or board public transport over short distances robs them the chance to engage in physical activities needed for fitness. The county has only three major recreational parks located across the county. However, a significant number of residents do not use these parks effectively, for recreation, exercise, and other physical activities (Begley et al., 2008). Lack of physical activity coupled with many restaurants for fast food creates a platform for lifestyle diseases such as obesity, diabetes, hypertension, and heart complications. Finally, residents in rural settings as well as a significant number in urban settings do not visit physician offices regularly for medical checkups or consultations that can enable them live healthy lives.

Practicum: Journal Entry Week 6

During week six, I met a number of patients suffering from or complaining of different diseases and symptoms respectively (Finkel, 2011). Many of the patients visiting the facility for the first time had felt sick or seen their symptoms for at least four days, before they decided to visit a medical officer. With respect to age, there was reasonable representation of teenagers, adults, and the elderly. Parents or elder siblings brought their younger brothers and sisters to the facility.

Health Determinants

With respect to health determinants, a number of factors played out in the population I worked with during this week (ODPHP, 2015). The main determinants of health in the county include age, alcohol, smoking, and other drug use, physical activity, diet, accessibility to health care services, and environment (ODPHP, 2015). Based on these determinants, it is clear that lack of public awareness as well as education is a serious contributor to the many diseases and ailments reported in the county. For example, proper information on the significance of physical activity and nutrition requirements for families can improve the health and physical fitness of residents of the county (ODPHP, 2015). Nonetheless, public awareness campaigns should enlighten people on the dangers of smoking, binge drinking, and drug abuse. Many health facilities exist in the region but lack of insurance coverage is a major impediment to access (Williams et al., 2008). In addition, high costs of services prevent many people from seeking health services when they become sick or develop symptoms. For instance, many people prefer to wait until sickness develops fully. In some cases, others wait for the condition to become critical then visit emergency rooms for services (Begley et al., 2008).

Modifiable health determinants are controllable to have different impact on people’s health (ODPHP, 2015). The local government, schools, health facilities, and social organizations can modify the health determinants of Harris County by enabling people acquire information, providing locals with skills on health, and managing situations proactively. Schools and hospitals can teach locals about nutrition and diet to enable them eat healthy (ODPHP, 2015). Campaigns against alcohol and drug abuse can discourage people from abusing these substances if they understand the effects. Other health improvement strategies can take place in informal settings such as churches and meetings among locals in designated places (CDC, 2014).

Challenges to Improving Health

First, lack of public awareness or education on health limits ability to improve health. A population informed and interested about their health will always take personal initiatives towards improving their health. Therefore, lack of public awareness and education is the topmost challenge.

Second, health coverage in Harris is average. For example, 25.1 percent of persons aged below 65 years old do not have health plans (Williams et al., 2008). Since these people constitute the majority of the population, it implies that many adults and young people cannot access medical services easily.

Third, widespread availability of fast food restaurants promote an unhealthy lifestyle in which people prefer quickly prepared meals or meals rich in calories, sugars, salts, and fats (Finkel, 2011). Many families no longer take time to prepare healthy meals at home. Accordingly, the popularity of these outlets and their products makes it challenging to address issues of obesity, diabetes, and heart diseases among others (Begley et al., 2008).

Teachable Moments

The actual location of this practicum had Whites as the majority and Blacks as the minority group. Accordingly, the dominant language in this place is English. While handling a sick boy from the African American community I imparted various skills and knowledge on how to remain healthy. For example, I took the little boy through the process of washing hands and fruits before eating. Similarly, I encouraged him to avoid unhealthy food in restaurants and roadside joints (CDC, 2014). He promised to teach his friends the same as well as start preferring food made at home.

Practicum: Journal Entry Week 7

The clinic for this practicum had already adopted and installed electronic health record systems. Accordingly, records for all patients visiting the clinic must be stored into the system, as per the regulations of the facility. When handling a patient, the information collected and stored by the caregiver about the patient includes personal background in terms of name, age, sex, parents, siblings, and occupation among others. Thereafter, caregiver must collect information concerning complaints, symptoms, with reference to when they started. Other critical information include subjective data, history of present illness (HPI), drugs used before, allergies or preexisting conditions, past medical history (PMH), past surgeries, and immunizations among others depending on the patient (Amugi-crouch & Meurier, 2011).

General include Skin HEENT, Neck, chest, and lungs. Respiratory information entails Cardiovascular: Gastrointestinal: Peripheral vascular: Musculoskeletal: Psychiatric: Neurological: Hematologic: Endocrine: Objective Data, which includes the Vital Signs: BP HR RR Pulse Ox, Temperature, BMI. If applicable (Pediatric) BP %, Weight %, Height %. Neurological assessment including differential diagnosis, lab, imaging plan, health promotion and disease prevention (Amugi-crouch & Meurier, 2011).

Lastly, I did the behavioral and psychosocial assessment then stored the information in the EHRs system (Amugi-crouch & Meurier, 2011). The EHRs system facilitates coordinated care because all caregivers in the facility can access the information from their offices. Accordingly, it prevents redundancy of services and at the same time provides a platform to base future visits by patients.

Practicum: Journal Entry Week 8

One of the patients handled during the practicum needed specialized care thus I had to refer him to a place where she could obtain help. Mrs. Jenny is a 23-year-old single mother who has experienced a lot in her short life. She gave birth at the age of 17 years to a baby girl suffering from brain deformities. The problem has caused a rift between Jenny and her 25-year-old boyfriend. Jenny does not work but the boyfriend works in a local supermarket. Financial problems limit Jenny’s ability to provide good care and medical services to the young girl. In addition, the problems with the boyfriend have taken an emotional and psychological toll on her life. Without specialized help, I believe Jenny may continue suffering and do something bad to herself or the baby.

Based on these observations and conclusions, I decided to refer jenny to a specialized pediatrician who can help her with the complications affecting the baby. Accordingly, I wrote a letter to the pediatrician and made a follow-up call to explain further about the issue. The pediatrician promised to offer help or refer Jenny to a better place. In addition, I introduced Jenny to a social worker in the clinic. She has worked with many women to help them overcome domestic problems that affect their health and wellbeing (Amugi-crouch & Meurier, 2011).

Jenny deserved these referrals because of the urgent need for specialized rather than generalized care. Nonetheless, Jenny appeared demoralized and hopeless in finding a solution to these problems. Without effective help, she could harm the baby or herself in the process (Amugi-crouch & Meurier, 2011). In my opinion, Jenny appreciated my concerns for the problems she faced. Accordingly, she accepted the recommendations and promised to follow some of the tips I gave her concerning the baby as well as her relationship with the boyfriend.

In my effort to ensure that Jenny visits the specialists recommended and open up about her problems, I will use the following strategies. First, I will accompany Jenny to the specialists and give her the moral support needed to talk with these people. I will encourage her to explain everything in detail and avoid leaving anything she may consider immaterial. Second, I will make follow-up calls to both Jenny and the specialists to check on the progress. Follow-up calls will make Jenny feel it is important to visit these specialists so that she can find proper help (Amugi-crouch & Meurier, 2011).

References

Amugi-crouch, A., & Meurier, C. (2011). Vital Notes for Nurses: Health Assessment. Oxford: John Wiley & Sons.

Begley, C. E., Hickey, J. S., Ostermeyer, B., Teske, L. A., Vu, T., Wolf, J., … & Rowan, P. J. (2008). Integrating behavioral health and primary care: the Harris County Community Behavioral Health Program. Psychiatric services (Washington, DC), 59(4), 356.

CDC (2014). Harris County, Texas Retrieved from http://ift.tt/2Cb4Zpz

Finkel, M. L. (2011). Public health in the 21st century. Santa Barbara, Calif: Praeger.

Office of Disease Prevention and Health Promotion, ODPHP (2015). Determinants of health. Healthy People. Retrieved from http://ift.tt/2cNHKrV

Williams, P., Hacker, C. S., Hewett-Emmett, D., & University of Texas Health Science Center at Houston. (2008). How health care delay and avoidance decisions are affected by finances and health insurance. (Masters Abstracts International, 46-5.)

The post Reflect on health risk behaviors you have identified in your practicum setting. Explain why these health behaviors put patients at risk for disease or health complications. Provide evidence-based support for your explanation.