exam 2 Flashcards
coinsurance
amount you are required to pay for medical care for certain types of health plans after you have met deductible. expressed as a percentage
copayment
a way for sharing medical costs. you pay a flat fee every time you receive a medical service. insurance pays the rest
deductibles
amount of money you must pay each year to cover your medical expenses before your insurance starts paying
premiums
amount you pay for your health insurance each month
max out of pocket
maximum amount of money you pay each year for deductibles, coinsurance, and copays. stated dollar amount set by insurance company in addition to premiums
medicare
federal health insurance plan for Americans 65 and older and certain disabled persons
medicare
health care coverage for low income persons who are aged, blind, disabled, or for families with dependent children
retrospective payment types
fee for service. physician was primarily responsible for health care decision making, providing the “best” care for patients. lead to out of control medical costs
prospective payment types
based on diagnosis related groups (reimbursement for health care services based on a predetermined fixed price-per-case or diagnosis)
issues associated with being uninsured and underinsured
less likely to use preventive health services, more likely to be hospitalized for preventative illness, sicker when they arrive, misuse resources, generate bad debt due to uncompensated health care, increased cost of everyone via cost shifting
how is health care paid for in america
cost shifting (the people who can pay end up paying for those who cant via increased premiums)
explain pay for performance in terms of never events, value based purchasing, and reduced readmissions
pay for performance is a way or insurance to get reimbursed on quality of care. never events is a medicare policy that prevents reimbursement for extra costs associated with medical errors that are preventable. value based purchasing rewards hospitals for providing quality care (two main incentives are patient experience and clinical processes of care). reduced readmissions is aimed to reduce the amount of 30 day readmissions
discuss the implications of the patient protection and affordable care act for nursing and health care
patient protection is an insurance reform that introduced new insurance standards and essential benefits. ACA is a hybrid system
pros and cons of the ACA
new standards include children staying on parents insurance plan until 26, insurance cannot drop people with expensive diseases, cannot deny preexisting diseases, caps high deductibles and max out of pocket costs, 100% prevention is covered
define nursing ethics
system of principles that govern the actions of the nurse in relation to patients, families, other providers, policymakers, and society
discuss the role of ethics in nursing
serve vulnerable persons, promise to protect patients, impact pt well-bring, depend on public trust, have moral relationship with pts that gives rise to ethical obligations
examine how personal and professional values impact health care
personal values guide behavior and the process of decision making. professional values consist of altruism, autonomy, human dignity, integrity, and social justice
provision 1
(autonomy) practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person
provision 2
(fidelity, loyalty) primary commitment is to the pt, whether an individual, or group
provision 3
(protecting, advocating) promotes, advocates for, and protects the rights, health and safety of pt
provision 4
(accountability) authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care
