Chapter 11 Flashcards
Patient Protection and Affordable Care Act (PPACA)
- Expand coverage and control health care costs
- Provide Medicaid or coverage to qualifying people with income up to 400% poverty
- Provide new way to get Health insurance (Health Insurance Marketplace)
- ACA put place to allow all people to afford healthcare
Primary Healthcare
Improve common health problems (such as sore throat, diabetes, arthritis, depression) and preventive measures (vaccinations mammograms) that account for 80-90% of visits
Secondary Healthcare
Improve problems that require more specialized clinical expertise, such as hospital care for a patient with a myocardial infraction or stroke.
Tertiary Healthcare
Improve management of rare and complex disorders such as tumors and malformations
HMO
Health Maintenance Organization (HMO): Prepaid, group managed care plans that allow clients to receive all medical services they require. The client has no choice in the healthcare provider they use.
PPO
Preferred Provider Organization (PPO): Third-party payer, that contract with a group of healthcare providers to provide services at a lower fee. (Facilities pay healthcare providers for services provided for people, such as health insurance companies)
Ways of paying for health care
out of pocket (rare), third-party, employer-based, government finance (medicare/medicaid)
Pay per performance
strategy using financial incentives to reward providers for the achievement of a range of payer objectives, including delivery efficiencies, submission of data and measures to the payer, and improved quality and patient safety
Medicare
Given to people 65+. Plan pays the hospital a fixed amount that is predetermined by the medical diagnosis rather than by the actual cost of hospitalization
Part A of Medicare
Pays mostly inpatient hospital costs by federal government
Part B of Medicare
Voluntary, paid by monthly premium, covers outpatient costs
Medicaid
Given to people who have low incomes
Hospitals
Focus on Acute care. Include inpatient care (person enters overnight and then stays in hospital from days to months) and outpatient care (Not hospitalized overnight but require diagnosis and treatment)
Primary Care centers
Advance practice registered nurses (APRNs), nurse practitioners, midwives, and clinical nurse specialists work independently or with physicians to make assessments and care for clients
Home Health Care
One of the most rapidly growing area of the health care system. They may be provided through community health departments, visiting nurse association, hospital-based case managers and home health agencies
