Exam 1: Module 3 Flashcards
uninsured vs underinsured
Uninsured: No healthcare insurance coverage
Underinsured: Have coverage but insuficient to meet needs; admit. health care needs must be paid for by teh individual
Statistics for 2018 people:
- more tha how many people had insurance through employee?
- how much percent is through medicaid
- how much obrained outside employment
- How much is military insurance
- more than half
- 30%
- 11%
- 4%
Outcomes of being uninsured
- Do you lose your savings
- Is it difficult affording necessities
- are there issues with facing persistent bill colection efforts?
- issue borrowing money?
- Is the needs for health insurance unimportant or critical for the well-being of children?
- savings, yes
- lots of difficulty afording necesities
- yes
- yes its difficult to borrow money
- VERY IMPORTANT
Children with health insurance:
- are they more likely to stay healthy and do well in school?
- do they have access to more well-child checkups ands meds
- are they less likely to be absent from school
- Yes because of access to needed services
- yes
- yes, less likely to be absent
How does ACA affect children favorably
- it prevents what?
prevents insurance companies from denying preexisting conditions
1/4 of people with chronic health problems had not filled prescription due to _____
COST
What are the 2 payment sources in the US
- insurance plans typically have what type of deductible requirement?
- Individuals may have to incur ____-____-____ insuranc costs
public insurance
- Medicare, medicaid
Private insurance
- privately or publicly owned companies
- Blue cross/shield, Aetna
Insurance plans typically have yearly deductible requirement
- may require co-pay
- individuals may have to incur out-of-pocket insurane costs expenses
Medicaid is for whom
- lower income individuals
- Families
- Older adults
- People with disabilities
Medicare is for whom
(4 types of People)
people >65 years old
<65 with disabilities
- end stage renal disease
- People with ALS
what are the 2 different parts of medicare
hospital and medical insurance
hospital insurance helps:
does it help to cover in patient care and home health/hospice?
- does it help to cover skilled nursing facilities for the long term?
- does it help for people under 65 years old?
- yes
- yes but only for the short term
- No, only over 65 years old
What does Medical insurance help to cover
- how about other out patient locations?
Helps to cover medically necessary services provided by MD’s NP’s home health, outpatient care and DME
- Covers office visits, screening exams, preventative services
Medicare advantage plans can approve what other insurance?
- Can it include prescription drug coverage?
- Can it also include what other 2 testings?
- it can include prescription drug coverage
- testing for hearing and vision
Prescription drug coverage:
- PRivate insurers need to be __________ with medicare
- can it protect against higher costs in the future
- presc. drug option are run by private insurance companies such as _____ and _____
- approved
-presc. drug option are run by private insurance companies such as HMO’s and PPO’s
For individuals who are self-employed, they must pay the entire…
- policies are typically…
- premium as well as copays and deductibles. Policies are typically a lot of money, cover only the policy holder and re more restricted
Types of private health insurance plans, (2)
- which is most restrictive and which is less?
- Which must stay within the network of care vs larger network for providers?
- which has broad range of benefits, costs are lower and which has incentives $$ to seek care from in network providers
- whih private health insurance have higher premium costs
- HMO and PPO
- HMo most restrictive, PPO less restrictive
- HMO must stay within network an PPO has larger network of providers
- HMO has broad range benefits and costs are lower, PPO has incentives to seek care from in network providers
- PPO has higher premium costs
The affordable care act was passed to …
- does it provide a new way to get health insurance?
reduce difficulty in securing insurance
- Yes
What is the importance of the health insurance marketplace?
- Designed to help people more easily find health insurance that fits their budget
What reforms are included in the ACA?
- New patients bill of rights
- Bundled Payments
- Accountable care organizations
- hospital value based purchasing
- The medial home
What is the Value Based Purchasing (VBP) designed to make?
- quality of care better for patients
- encourages hospitals to improve care for medicare beneficiaries by:
- eliminatin adverse effects
- using EB care standards
- recognizes hospitals thar provide high-quality care at a lower cost to medicare
Soceity vies of government in peoples lives influences development of its ________ systems and ________
- what are the 4 categories of financing and organizing health care
healthcare systems and policies
- socialied medicine
- socialized insurance
- mandatory health insurance
- Voluntary insurance
why do nurses have an imporant role in healthcare reform?
- what are the goals of healthcare reform
goal is cost containment with improved access and quality of services for everyone
What are 3 descrete steps for access to healthcare?
- Gaining entry into healthcare system
- Getting access to sites of care where patient can receive needed services
- Finding providers with whom patient can communicate, develop trusting relationship, have individual needs met
what are the factors in escalation of healthcare costs
- are poeple living longer?
- are there more chronic diseases?
- are pole living longer due to medical advances and technological advances
- do we have medicines that help defend patient from harher illness?
- can some poeple be paying too much
- yes
- yes
- yes
- yes
Nurses and Allocation of Resources
- where do nurses require to be aware and participate in discussion affecting allocation of resources?
- nurses may advocate by taking and/or writing to whom? paticipating in what?
- in workplace
- in communities
- At federal level
- engaging in discussions in neighborhood and social groups
- participating in national discussions through professional orgs
What are some cost-containment strategies?
- Price controls
- protective payment system (billing is determined based off of diagnosis/procedure)
- also includes diagnosis-related groups, this reimbursment with length of stay
ACA legally compels healthcare orangizations to adopt cost-containment measures to…
- improve quality of care
- to redesign healthcare delivery systems
- to determine appropriate payment for services
- to modernize financial systems used to pay for services
- to eliminate fraud, abuse
Number of factors affect staffing
- has expansion of profession led to more options or less?
- are there a high number of nurses leaving the profession?
- are salaries for services in some areas competitive enough or not?
- does staffing shortages combined with high patient acuity increase or decrease nurse stress levels?
- More options
- Yes
- Are not competitive enough
- Increases nurse stress levels
All nurses must understand hw costs asociates with ___________ afect nursing ________
healthcare; practice
what group in the hospital is the most expensive?
Nurses
True or false:
Nursing staff produce revenue for the hospital
No
- they do not produce revenue
true or false
- does clinical experience of RN help to improve patient outcomes
true
true or false
- EB resources will not help to support cost containment within clinical practice setting
False, it will help
