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Questions and Answers
What significant changes occurred in hospitals as health delivery sites from the early 19th century to the early 21st century?
Which act was NOT implemented to enhance healthcare delivery in the 20th century?
Which factor significantly contributed to the decline of infectious diseases at the turn of the 20th century?
What was a major consequence of the Flexner Report of 1910?
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Which of the following best describes the differences between orthodox and sectarian practitioners?
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What is one of the key components of the Patient Protection and Affordable Care Act?
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What is one way that the pharmacy profession pursued professionalization in the late 19th century?
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What term describes the era known as the 'golden age of medicine'?
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What significant change occurred in medicine during the 19th century concerning practitioners?
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How did hospitals evolve in the early 20th century?
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What was one of the key reforms regarding patent medicines around the turn of the century?
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What was a significant outcome of the National Hospital Survey and Construction Act of 1946?
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Which of the following accurately describes the hospital landscape in the U.S. during the 20th century?
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What impact did Medicare and Medicaid have on hospitals?
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What aspect of hospitals is highlighted in 'Crossing the Quality Chasm' report from 2001?
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How did the role of pharmacists change in the late 19th century?
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Which change did the Flexner Report implement for medical schools?
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What model did medicine adopt after World War II?
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What primary objective did the APA Code of Ethics emphasize in 1922?
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What significant curriculum change occurred for pharmacy students in 1990?
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What significant concept was advanced in pharmacy in 1975?
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What was one of the primary goals of the Health Insurance Portability & Accountability Act (HIPAA)?
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Which of the following services is included in the State Children’s Health Insurance Plan (S-CHIP)?
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Which of these was a focus in the healthcare field during the 1980s and 1990s?
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What was a noteworthy trend in healthcare by the end of the 20th century?
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What significant act created Medicare Part D in 2003?
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What approach to patient care has emerged in the 21st century?
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What type of health care reform includes employer mandates to provide health insurance?
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Which healthcare reform aimed to provide universal coverage through a single-payer system?
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What was a significant impact of the Patient Protection & Affordable Care Act (ACA)?
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What approach was taken in the failed Clinton Plan regarding managed competition?
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Continued dissatisfaction with the U.S. health care system in the 21st century is expressed by which group?
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What significant issue leads to variations in patient outcomes in healthcare?
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What is one of the provisions implemented to support aging and dependent populations in Medicaid?
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By what year is it projected that approximately 21% of the U.S. population will be aged 85 or older?
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What are the major gaps identified in the healthcare system for aging populations?
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Which of the following viewpoints reflects the belief that medical care is a service available for purchase?
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Study Notes
Paradoxes of the US Healthcare System
- The US healthcare system exhibits several paradoxes:
- Spend more on healthcare than any other high-income country but lags in life expectancy and health outcomes
- Has a complex system of public and private healthcare institutions that offer varying levels of care, leaving some individuals without adequate access
- Despite high spending, there are issues of quality, access, and affordability, revealing a mismatch between resources and results
- The healthcare system is characterized by innovation and technological advancements but continues to face challenges related to disparities in care, inefficient expenditure, and a lack of consistent national strategy
19th-Century Healthcare Practices
- The commercial manufacture of medicines became widespread in the 19th century, shifting practitioners' focus from making home remedies to prescribing compound formulations and proprietary preparations.
- Patent medicines, widely advertised in newspapers and available in pharmacies, grew in popularity, leading to concerns about safety and fraud.
- The Pure Food & Drug Act of 1906 was enacted to address concerns about misleading labeling practices and to promote transparency in product information.
The Evolution of Hospitals (19th-21st Centuries)
- Early hospitals in the 19th century served primarily the poor (almshouses) or isolated individuals with infectious diseases (pesthouses).
- Hospitals underwent significant changes beginning in the early 20th century. Adoption of the germ theory of disease led to advancements in antiseptic/aseptic techniques and surgical procedures.
- Technological developments, such as anesthesia and the discovery of X-rays, further revolutionized medical practices.
- The number of hospitals increased dramatically during the 20th century, with the emergence of general hospitals, specialty hospitals, and institutions sponsored by diverse groups.
- The National Hospital Survey & Construction Act of 1946 (Hill-Burton Act) played a significant role in planning and building new hospitals and public health centers.
The Flexner Report & Medical Education
- The Flexner Report of 1910 transformed medical education in the US and Canada:
- Established higher accreditation standards for medical schools
- Increased admission requirements, leading to a reduction in student enrollment, particularly affecting disadvantaged groups
- Introduced a standardized four-year curriculum, consisting of two years of didactic learning and two years of clinical training
- The Flexner Report effectively abandoned the prior apprenticeship-based model and acknowledged only allopathic physicians as legitimate practitioners.
Medicine in the 20th Century
- After World War II, the biomedical model became the dominant approach to research and practice, emphasizing molecular and subcellular processes.
- A shift in focus from infectious diseases to chronic diseases occurred during the 20th century.
- In the 1970s, concerns about social inequities in healthcare delivery gained prominence.
- The 1980s and 1990s saw a growing emphasis on managed care and the impact of physician autonomy and patient care quality.
- In the 21st century, efforts to develop more patient-centered care models are underway.
The Role of Pharmacy in Healthcare
- Pharmacy underwent professionalization throughout the 20th century.
- Increased emphasis on dispensing pharmaceutical preparations, coupled with the establishment of pharmacy stores, transformed medicine distribution.
- The American Pharmaceutical Association code of ethics emphasizes patient service and the safe handling of medications.
- The development of the Pharm.D. curriculum, and later changes to the code of ethics, emphasized the role of the pharmacist in the patient-provider relationship, promoting medication therapy management and patient-centered care.
Public and Private Health Insurance Policies
- The Health Insurance Portability & Accountability Act(HIPAA) of 1996 focused on patient privacy, reducing healthcare fraud, job-related insurance portability, and accessibility to information.
- The State Children's Health Insurance Plan (S-CHIP) of 1997 provided health insurance coverage for children in low-income families who might not qualify for Medicaid.
- The Medicare Prescription Drug Improvement & Modernization Act (MMA) of 2003 created Medicare Part D, a prescription drug benefit for Medicare beneficiaries.
Health Care Reform Approaches
- Incremental reform approaches include:
- Employer mandates for health insurance
- Medicaid and Medicare expansion (e.g., S-CHIP)
- Managed competition initiatives
- Health Savings Accounts
- Comprehensive reform models include:
- Single-payer healthcare systems
- Health care vouchers
- Dissatisfaction with the healthcare system continues to be a prevalent concern among Americans.
The Patient Protection & Affordable Care Act (ACA)
- The ACA is considered the most impactful policy change since Medicare and Medicaid in 1965.
- The ACA significantly affects virtually all Americans by expanding health insurance coverage, introducing new regulations, and promoting preventative care.
- The ACA addressed several key issues like insurance coverage for pre-existing conditions, young adults remaining on their parents' insurance plans until age 26, and the elimination of lifetime coverage limits.
Problems in the US Healthcare System
- Despite technological advances, the US healthcare system struggles with:
- Conflicting objectives between governmental and private sector market reforms
- Varying patient outcomes, efficiency, and effectiveness across providers and regions
- A fragmented and confusing infrastructure for patients and healthcare providers
ACA Provisions for Aging and Dependent Populations
- Programs such as "Medicaid Money Follows the Person," "Community First Choice Option in Medicaid," and the "State Balancing Incentive Program" aim to assist individuals with aging and disabilities by enhancing access to community-based services and home care.
Access to Healthcare
- Persistent debates exist regarding the right to healthcare, with differing perspectives on the roles of government, private practices, and individual choice in healthcare access.
Emerging and Continuing Concerns
- Key areas of ongoing concern and challenge within the healthcare system include aging populations, access to quality care, conflicts of interest, and the financial sustainability of healthcare programs.
Aging Population Trends
- The US population is rapidly aging, with significant increases anticipated in the older adult population by 2040 and 2050.
- As the population ages, challenges related to healthcare access, cultural diversity, and financial gaps in programs like Medicare and Medicaid need to be addressed to ensure adequate care for all older adults.
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Description
Explore the intricate paradoxes inherent in the US healthcare system, where high spending does not correlate with positive health outcomes. This quiz examines access disparities, inefficiencies, and the complex interplay between public and private institutions. Dive into the challenges faced in achieving equitable healthcare for all.
