10-2b Healthcare Delivery Systems Flashcards
What are healthcare delivery systems?
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.
What are the three major factors for healthcare delivery systems?
access, cost, and quality of healthcare.
Where do systems get access/financing?
Public: government access (federal, state, and local)
Private: for-profit and non-for-profit
What is access?
the ability to obtain health services when needed
What is the public sector composed of? What are its goals? What is it governed by?
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
What is the private sector composed of? What are its goals? What is it governed by?
organizations not owned by the government
(small business, corporations, charities, etc.)
Overtaking their competitors and maximizing profit
governed by shareholders
What is the private sector composed of? What are its goals? What is it governed by?
organizations not owned by the government
(small business, corporations, charities, etc.)
Overtaking their competitors and maximizing profit
governed by shareholders
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?
half
greater involvement of public sector, greater need for public health policies/more hands on govt.
What are the main funding sources for the private sector?
employer funded
consumer cost sharing (OP payments)
What is a copayment?
flat fee the person consuming the healthcare good or service has to pay OP in addition to what the health insurance pays
What is a deductible?
How much the person consuming healthcare services has to pay OP before the insurance company pays their share
Is healthcare in the free market?
no
What does more private sector consumption lead to for consumer payment?
more OP payments to consumer
What does more public sector consumption lead to for consumer payment?
less OP payments for consumer
What does more public sector consumption lead to for consumer payment?
less OP payments for consumer
In 2006, what were the national health expenditures per capita?
$7,026 per capita
In 2017, what were the national health expenditures per capita?
$10,739 per capita
When we talk about healthcare expenditures, what are we talking about?
When someone receives healthcare, how much is it costing the system?
What is financing?
The flow of dollars (premiums or taxes) from individuals and employers to the health insurance plan (private health insurance or government programs).
How is healthcare largely financed?
health insurances
How does the provider get paid for service?
Reimbursement via
How does the provider get paid for service?
OP payments
Individual Private Insurances
Employer-Based Private Insurance
What is reimbursement?
The flow of dollars from insurance plans to physicians, hospitals, and other providers.
How much health spending goes to Private health insurance? Medicare? Medicaid? OP payments?
34
20
17
10
How much health spending goes to Private health insurance? Medicare? Medicaid? OP payments?
34
20
17
10
How does individual private insurance money flow?
individual pays a premium to health plan, who finances and reimburses the provider
How much do outpatient and hospital care consume of national health expenditures?
50%
PDPM? How are long-term care centers being reimbursed for patients?
nursing-driven payment model/true patient driven needs
What is the ACA
increase access to more individuals through medicaid expansion
Increased quality care to those that wouldn’t normally be able to
What are ACOs?
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
What are ACOs? Benefits?
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
