Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dynamics of Health Care > chapter 19 > Flashcards

chapter 19 Flashcards

1
Q

what are major reasons for the growing cost of healthcare (4)

A

rising drugs
technology
professional costs
aging population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is health care cost containment

A

measures designed to lower health care costs

aim to create affordable health care system for Americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

why is it important for HC providers to know economic aspects of health care

A

they can stay aware of how finances affect each patient’s experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the three classes of healthcare facilities

A

voluntary nonprofit institutions
proprietary institutions
government institutions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what community services to facilities offer (7)

A

emergency room treatment

clinical service

health screening

community health education class + material
medical education

medical education

financial contributions to community organizations

coordination of events and donations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a voluntary nonprofit institution

A

community facility that receives federal, state, and local tax exemptions in exchange for providing community benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do voluntary nonprofit institutions recieve

A

donations that are tax deductible for donors

-if they are operated for charitable purpose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is a proprietary institution

A

for profit health care facility owned by a corporation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does a health care corporation control

A

chain of facilities
hospitals
nursing homes
outpatient facilities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a government institution

A

public health care facility that receives local, state federal funding

includes

  • military treatment facilities
  • VA hospitals
  • public and gov funded hospitals
  • state mental hospitals and rehabilitation facilities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the three methods of paying for healthcare

A

private insurance
direct payment
government plans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do most patients rely on for medical bills

A

employer provided health insurance coverage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is private insurance

A

insurance obtained through place of employment

- because employers buy insurance for a group of people, they get better rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how do insurance companies benefit form employer insurance

A

collect payments from everyone in the group, even though not all people in group incur the expenses covered by the insurance plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how are companies lowering costs

A

placing financial responsibility on insured in the form of premiums, deductibles, co-insurance, co-pays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a premium

A

monthly amount paid to insurance company for heath insurance coverage

  • employers pay a portion or all
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a deductible

A

money person pays before the insurance policy provides benefits

  • allows control of health care costs
  • high deductibles = low premiums
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is co insurance or cooperative insurance

A

plans that require insured to share portion of the costs for health care services
(10-30%)
- lowers monthly premiums

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a co pay

A

a flat fee paid directly to service provider every visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is direct payment

A

patients pay for health care with own money

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

why is direct payment used (3)

A
  • private insurance does not cover ALL costs
  • do not have private insurance
  • do not qualify for government plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what does direct payment do (2)

A
  1. cause individuals to “shop around” for health care consumers
    - driving competition that drives down health care prices
  2. may lead to bankruptcy
    - 62% of bankruptcy in 2007 were linked to medical costs
    - 75% of bankrupted individuals had health insurance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is a governemnt plan

A

health care plan funded by a government agency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

who are government plans available for (mainly)

A

active military personnel and their dependents

low income and older americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is medicare

A

fedreally funded health care program for older Americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when was medicare established

A

amendments to the Social Security Act in 1965

27
Q

why was medicare established

A

to provide health care coverage for Americans 65+ regardless of income or wealth

28
Q

what happened to medicare in 1972

A

expanded to include permanently disabled workers who qualify for social security, and their dependents

29
Q

what happened to medicare in 1983

A

to control health care costs, medicare converted to a prospective payment system

pays provider fixed amount that is based on diagnosis or specific procedure ,rather than on the actual cost of hospitalization or care
- if actual cost is > fixed amount, provider absorbs additional expense

30
Q

differentiate btwn medicare part A and B

A

A = covers most inpatient care costs
- premium is already paid through payroll taxes

B = voluntary

  • monthly premium
  • covers most outpatient costs
31
Q

what do people choose as an alternative to the medicare

A

supplemental insurance policy offered by private insurance company

32
Q

what are two additional plan types to medicare

A

medicare advantage plans or medicare part C

  • provide coverage for part A and B but have extra benefits
  • lower copayment

D

  • prescription drug coverage
  • lower copayment
  • extra payment
33
Q

who does medicaid support

A

low income and disabled people

34
Q

when was medicaid established

A

1965
as part of social security act
recieve SSI or supplemental security income benefits

35
Q

what happened prior to 1996

A

people who recieved Aid to Families with Dependent Children (AFDC) were covered under medicaid

36
Q

what was the AFDC program replaced by

A

Personal responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996

  • provides states with block grants
  • provide cash and services to low income families with children
  • dependent on individual state regulations
37
Q

what government health care plan is available for military personnel

A

the U.S department of defense administers
TRICARE

  • provides medical coverage for active and retired service personnel and dependents
38
Q

What is SCHIP

A

the State Children’s Health Insurance Program
- establishsed in 1997

provided states with matching funds to expand health care coverage to over 6 million insinsured children

39
Q

what happened to SCHIP in 2007

A

was set to expire

legislation was going to expand the program by 35 billion but was vetoed by George W. Bush

40
Q

What happened in 2009 about SCHIP

A

Obama signed in Children’s Health Insurance Program Reauthorization Act (CHIRPA)

  • added 33 billion in funds for children’s coverage through 2013
41
Q

describe health care costs in the US

A

grown at nearly twice the rate of inflation

- US spends more for health care services than any other nation as a percentage of GDP and per person

42
Q

What is one response to rapid escalation in health care costs

A

managed care

- healthcare providers manage a patient’s use of healthcare

43
Q

What are the 3 categories of managed healthcare

A

health maintenance organization (HMO) plan
preferred provider organization (PPO) plan
point-of-service (POS) plan

44
Q

what is health maintenance organization (HMO) plan

A

plan provides coverage only if care is delivered by a member of it hospital, physician, or pharmacy panel

45
Q

what is the preferred provider organization (PPO) plan

A

allows patients to receive care from a non-plan provider, but requires them to pay a higher out-of-pocket price if they do so

46
Q

what is the point-of-service (POS) plan

A

physician coordinated plan combining characteristics of HMO and PPO

47
Q

what are providers in managed care plans called

A

in-network providers

- cost is less than out of network

48
Q

what are providers not in managed care plans called

A

out of network provider

49
Q

what are 6 char. of managed care plans

A

consist of select group of hc providers

broad range of services to emphasize primary and preventive care

eliminate duplicate services

encourage cost containment

provide profit for HC provider and insurance company

include utilization review

50
Q

what is utilization review

A

a process in which an insurer reviews decisions by physicians and other providers about how much care to provide

51
Q

what is a gatekeeper

A

physician who delivers primary care services AND makes referrals for specialty care

52
Q

describe time spend with managed care patients versus others

A

healthcare professionals spend 2 minutes less with managed care patients than other patients

53
Q

what is the leading form of health care coverage for Americans

A

managed care

- 50% of insurance coverage provided by are managed care plans

54
Q

what is the driving force behind effort to contain healthcare costs

A

diagnostic related group (DRG) classification system

55
Q

what is DRG

A

patients with similar medical payments are assigned to DRG

  • payment amount of DRG is based on average of all patients
  • patients care is paid in standard fees, regardless of actual cost of care
56
Q

what is assigning of DRG based on (4)

A

diagnosis
surgical procedure
age
other information

57
Q

are DRGs good or bad for hospitals

A

incentive for hospitals to operate more efficiently as they still receive full payments

58
Q

what are 3 good results of DRgs

A

shorter hospital stays
more outpatient services
focus on early intervention and prevention

59
Q

what is resource utilization

A

the best way to use health care resources

60
Q

what are two good ways of resource utilization

A

conscientious time management
information technology
- electronic documentation

61
Q

wha is a flexible spending account (FSA)

A

offered trough employer
paired with traidtional health insurancep olicy
common medical savings account option

money is put into FSA through payroll deductions, before it is taxed
- can be withdrawn for qualified medical expenses not convered by insurance policy

remaining funds are not transferred and must be spend each year

62
Q

What is a HSA or health savings account

A

paired with high-deductible health insurance plan
- low premuims and high deductibles

offered through employer benefit program or arranged individually

use tax-free HSA dollars until deductible is met; to pay for qualified medical care

once deductible is met –> health insruance company pays for medical costs for the reaminder

left over funds are used in the future

63
Q

what happens when you reach 65 with HSA

A

cna withdrawn the money for no expense

64
Q

what is an advanctage of HSA

A

more involved with health care decisions

- less likley to undergo unecessary or exessive tests and doctor visists as money is coming out of savings account

Dynamics of Health Care (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions