10-2b Healthcare Delivery Systems

Question 1

What are healthcare delivery systems?

Answer 1

A system is defined as several parts working together such that their interaction produces something greater than could be produced by the individual parts working independently.

Question 2

What are the three major factors for healthcare delivery systems?

Answer 2

access, cost, and quality of healthcare.

Question 3

Where do systems get access/financing?

Answer 3

Public: government access (federal, state, and local)
Private: for-profit and non-for-profit

Question 4

What is access?

Answer 4

the ability to obtain health services when needed

Question 5

What is the public sector composed of? What are its goals? What is it governed by?

Answer 5

organizations which are owned and operated by the government.

Supplies services to the public, and they are not competing with any other institution for profit

Governed by law

Question 6

What is the private sector composed of? What are its goals? What is it governed by?

Answer 6

organizations not owned by the government
(small business, corporations, charities, etc.)

Overtaking their competitors and maximizing profit

governed by shareholders

Question 7

What is the private sector composed of? What are its goals? What is it governed by?

Answer 7

organizations not owned by the government
(small business, corporations, charities, etc.)

Overtaking their competitors and maximizing profit

governed by shareholders

Question 8

How much money spent on health services comes from the public sector? What is the correlation b/w govt. involvement with the health service sys. and the need for public health policies?

Answer 8

half

greater involvement of public sector, greater need for public health policies/more hands on govt.

Question 9

What are the main funding sources for the private sector?

Answer 9

employer funded

consumer cost sharing (OP payments)

Question 10

What is a copayment?

Answer 10

flat fee the person consuming the healthcare good or service has to pay OP in addition to what the health insurance pays

Question 11

What is a deductible?

Answer 11

How much the person consuming healthcare services has to pay OP before the insurance company pays their share

Question 12

Is healthcare in the free market?

Answer 12

no

Question 13

What does more private sector consumption lead to for consumer payment?

Answer 13

more OP payments to consumer

Question 14

What does more public sector consumption lead to for consumer payment?

Answer 14

less OP payments for consumer

Question 15

What does more public sector consumption lead to for consumer payment?

Answer 15

less OP payments for consumer

Question 16

In 2006, what were the national health expenditures per capita?

Answer 16

$7,026 per capita

Question 17

In 2017, what were the national health expenditures per capita?

Answer 17

$10,739 per capita

Question 18

When we talk about healthcare expenditures, what are we talking about?

Answer 18

When someone receives healthcare, how much is it costing the system?

Question 19

What is financing?

Answer 19

The flow of dollars (premiums or taxes) from individuals and employers to the health insurance plan (private health insurance or government programs).

Question 20

How is healthcare largely financed?

Answer 20

health insurances

Question 21

How does the provider get paid for service?

Answer 21

Reimbursement via

Question 22

How does the provider get paid for service?

Answer 22

OP payments
Individual Private Insurances
Employer-Based Private Insurance

Question 23

What is reimbursement?

Answer 23

The flow of dollars from insurance plans to physicians, hospitals, and other providers.

Question 24

How much health spending goes to Private health insurance? Medicare? Medicaid? OP payments?

Answer 24

34
20
17
10

Question 25

How much health spending goes to Private health insurance? Medicare? Medicaid? OP payments?

Answer 25

34
20
17
10

Question 26

How does individual private insurance money flow?

Answer 26

individual pays a premium to health plan, who finances and reimburses the provider

Question 27

How much do outpatient and hospital care consume of national health expenditures?

Answer 27

50%

Question 28

PDPM? How are long-term care centers being reimbursed for patients?

Answer 28

nursing-driven payment model/true patient driven needs

Question 29

What is the ACA

Answer 29

increase access to more individuals through medicaid expansion
Increased quality care to those that wouldn’t normally be able to

Question 30

What are ACOs?

Answer 30

Accountable care organizations
groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients

Question 31

What are ACOs? Benefits?

Answer 31

Accountable care organizations
groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients
Better outcomes for less cost