Access and Reimbursement Flashcards
define access
ability to obtain health services when needed
reasons for financial lack of access
inability to pay
a. lack of insurance
reasons for nonfinancicla lack of access
lack of availability clsose to where ppl live
care which is not culturally acceptable (i.e abortion)
unable to be provided in a timely manner (needing a transplant
not provided in a language spoken
uninsured trends
PPACA decreased amount of uninsured ppl
poor ppl more likely to be uninsured
hispanics are more likely to be uninsured
effects of being uninsured
more avoidable hospitalizations later dx of life threatening conditions more seriously ill when hospitalized fewer preventative services higher mortality
impact of medicaid on access
medicaid has low reimbursement rates
so sometimes physician will limit the number of medicaid pts they accept
impact of underinsurance on patients
bankruptcy due to unpaid medical bills. TOP CAUSE OF BANKRUPCY
cost sharing reduces ambulatory care utilization, especially among poor
disparities in access to care
Gender: women more likely to report leaving a physician because of dissatisfaction to care
Race: minorities less likely to receive pain meds, more likely to be uninsured,
general reimbursement models
Fee for service per diem (per day) per episode per patient models unique to each HCP group
fee for service
bills for services offered
over utilization incentivized
per diem
reimbursed money for each day patient is hospitalized
per episode
more common
reimbursement based on diagnosis
most common reimbursement model in a pharmacy
fee for service
AMP
average manufacturing price
WAC
whole saleaquisitoin cost
