5. Economics of Health Care Delivery Flashcards
addresses health care disparities; places a greater emphasis on access to health care which leads to improvements in prevention of illness, patient outcomes, and population health; also provides a means to provide health insurance to more Americans
Affordable Care Act (ACA)
Key provisions of ACA
- eliminate lifetime limits on benefits
- expand coverage for children on their parent’s health plans until 26
- prohibit discrimination due to pre-existing conditions
- increase medicaid coverage by states
- increase payment to rural health providers
- strengthening community health centers
- increased medicaid payment to PCPs
- link payments to quality not quantity
- mandate minimum coverage for certain conditions and prevention services
What is the health care system turning to for future care?
primary prevention
Benefits of primary prevention
- reduce money spent on health care
- increases quality of life
Challenges of 21st century
- emergence of new and old communicable and infectious diseases
- chronic disease prevention programs
- complex technology (more expensive)
- hospital intensivists
- more care provided at home
- DNP
- emphasis on prevention and wellness
What are the largest portions of health care spending
- hospital care and physician services
- home health care is expected to rise dramatically
Factors that influence health care costs
- demographics
- technology and intensity
- chronic illness
How is patient demographics affected health care
- aging population -> demands on medicare and medicaid increase
- with aging -> experience more chronic conditions that may be disabling
most common medical condition treated
hypertension
Why do chronic conditions cost more money
- number of bed days
- number of work-loss days
- activity impairments
2 forms of public support to finance health care
Medicare and Medicaid (1965)
Criteria for Medicare
- 65 y/o and older
- permanently disabled (24 months or longer)
- persons w/ ESRD
Medicare Part A
everyone pays for this
- inpatient hospital care
- skilled nursing facility (must be getting skilled care; not long term nursing home)
- home health agency
- hospice
Medicare Part B
services (tests, doctors, etc)
Medicare Part C
medicare advantage (HMO)
Medicare Part D
prescription plan
Challenges of Medicaid
- recipients half as likely to obtain needed services
- lack of willing physicians
- reliance on emergency departments
traditional health care payment where fees set after delivery and negotiated by payer and provider
retrospective reimbursement
health care payment where price is set by organization and billed; client pays what insurance does not
charge method
health care payment where third-party payer establishes fee before offering service; requires pre-approvals
prospective reimbursement
