(CD) Helth Care Systems Flashcards
For care design midterm *in sg
*Federal agency regulating healthcare for Native Americans, veterans and residents in undeserved areas.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
e. HHS (Health and Human Services agency)
*Researches healthcare quality and cost issues based on the best evidence/science.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
d. AHRQ (Agency for Healthcare Research and Quality)
*Third party payer establishes limit on reimbursement for a particular service.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
f. Prospective reimbursement
*Financial assistance that pays for medical services for the poor, blind, disabled.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
g. Medicaid
*Agency involved in prevention of disease and emergency preparedness.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
a. CDC (Center for Disease Control)
*Third party payer establishes a set amount for delivery of care to a client regardless of services provided.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
c. Capitation
*Provides insurance coverage to qualified beneficiaries for doctor visits and preventative screenings.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
h. Medicare part B
*Federal regulatory agency for overseeing spending for Medicare and Medicaid.
a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B
b. CMS (Center for Medicare & Medicaid services)
- Requires a monthly premium be paid by the beneficiary
a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare
c. Medicare Part B
*Health care jointly funded by state and federal government for the poor and medically needy
a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare
a. Medicaid
*Covers individuals permanently disabled & those with end-stage renal disease
a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare
e. Medicare
*Covers prescription drugs
a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare
b. Medicare Part D
*Covers hospital care, home care and limited nursing home care
a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare
d. Medicare Part A
Current issues/problems with american Health care systems? per class discusion
high cost/co-pay
not enough info on what it covers
confusing
Current issues in health care
Limited resources
Emphasis on cost-people get kicked out faster
New roles (increased specialization and turf battles)
Reorganized delivery
What is meant by reorganized delivery (current issues I health care)
hospital stays are shorter (have to get in and out)
Inc. dependency on technology
Patients more acute (wait before going in)
Define Health Care organization
System developed for the delivery of health care services by a specialized workforce to defined communities, populations or markets
Examples of Health care organization(S)
hospitals out-patient centers Urgent cares PCP office Home health agencies County health departments rehab facilities assisted living
Private health care subsystem
Provides direct care to individuals and families and includes nonprofit and for-profit sectors
ex/hospitals, nursing homes, clinicas
Public health care sub-systems
Concerned with the health of populations and provision of a healthy environment; composed of programs at the federal, state and local levels.
ex/ military family services, jails, county health department
Declaration of Alma Ata
Goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives.
What organization was started with/bc of the Declaration of Alma Ata
WHO
Healthy People 2020
“Road map” to improve the health of all people in USA
Examples of policies or organizations at the federal systems
HIPPA
CDC, FDA, NIH, AHRQ
Center for Medicare and Medicaid Service (CMS)
Overseer of medicare and medicaid spending
Federal
Medicare
Who is eligible?
65yr+
Disabled
End staged renal disease (ESRD)
Medicaid
Who is eligible?
poor older adults
blind
dialed
low income families with dependent children
Proportion of/percentage of people in each category Employer-provided health insurance Medicaid Medicare Un-insured
Employer-provided health insurance: 60
Medicaid: 17
Medicare: 13
Un-insured: 10
Social Security Act of 1935
Was supposed to supplemental income to pension and retirement savings
for/ retirees, older low-income, disabled
Medicare Part A
Covers?
What all have
Covers; hospital care, home care, skilled nursing-lmiited)
Medicare Part B
covers/adds
For physician services, outpatient care
Medicare Part C
covers/adds
Allows access at a wider ranges of offices/services
Medicare Part D
covers/adds
prescription drugs
What is a benifit period?
Period in which medicare is being used.
admit-discharge at the hospital
Each new stay/admit is a new benifit period
Medicaid
what it covers
Minimally: hospital care, lab and radiology, physician services, skilled nursing care at home or nursing home, screening
Additional: determined by the state
Children’s Health Insurance Plan (CHIP)
Coverage for low income children not covered my medicaid
part of medicaid????
What is prospective reimbursement?
When a third party (insurance) payer establishes the amount of money that will be paid for a service
Scope of services at the state level
collect vital statistics
communicable disease control and prevention
participate in research projects
develop health plans
set standard for local health agencies
license health professionals/institutions/organizations
environmental safety
