fundamentals-healthcare delivery systems Flashcards
health care delivery systems are comprised of interactions between ________________ and _______________ within the constraints of financing mechanisms and regulatory agencies.
health care providers and clients
health care systems are comprised of the individuals who participate, the settings in which healthcare takes place, the agencies that regulate health care and
mechanisms that provide financial support.
most _________ care is delivered within the context of health care systems.
nursing
as these systems continue to become more ___________ and less _________, the challenge to nursing today is to retain its caring values while practicing within a cost-containment structure.
more business-driven and less service-oriented
This agency ensures that health care providers and agencies comply with state regulations.
state licensing boards
This agency sets quality standards for accreditation of health care facilities.
the joint commission
what agencies monitor for appropriate diagnosis and treatment of hospitalized clients?
utilization review committees
Medicare is a public federally funded program for clients over ___________ and for those with permanent __________.
65 , disabled
Medicaid is for clients with _____________.
low incomes
how is Medicaid funded
it is federally funded
who determines Medicaid eligibility requirements
individual states determine eligibility requirements
Medicare premiums can be applied to one of two mechanisms:
Insurance program - reimburses providers based on diagnosis related groups (DRGs)
Managed Care organizations (MCOs) enrolled clients receive comprehensive care overseen by a primary care provider.
