Health Care Delivery System Flashcards
1
Q
Medicaid
A
- federally funded program for people of any age who have low incomes; low income, blind, older adults who receive supplemental security benefits; and beneficiaries of Aid to Families with Dependent Children
2
Q
Medicare
A
Available to those 65+ and contributed for 10+ years
Part A: Inpatient care; medical surgical, and psychiatric care
Part B: Outpatient; Voluntary medical insurance
Part C: Medicare Advantage Plus (a choice of 3 insurance plans - extra coverage)
Part D: Voluntary Prescription Drug coverage
3
Q
CHIP (children’s health insurance program)
A
- $20 billion allocated over 10 years to help states insure children who do not qualify for medicaid but cannot afford private insurance
- Also federally funded
4
Q
Reliable care accountability matrix
(RCAM)
A
- C-diff prevention, CAUTI prevention, surgical site infection prevention, hand hygiene, length of stay management, readmission prevention, mortality reduction, experience of care
5
Q
Strategies to reduce health care costs
A
- prospective payment system
- capitation & managed care
- bundled payments
- rate setting
- increasing patient cost sharing
6
Q
Primary health care
A
- treatment of common health problems
- PCPs or NPs
- primary care centers, urgent care, family planning centers, employment health centers
- prenatal care, family planning, immunization, screenings & diagnostic tests, health education, medications
- ex: cold, flu, HTN, broken bone
7
Q
Secondary health care
A
- treatment of problems requiring more specialized clinical expertise
- physicians with specialties
- hospital based clinics, emergency departments, psychiatric institutes, same day surgery units
- disease identification & management
- ex: oncologist, endocrinologist
8
Q
Tertiary health care
A
- management of rare and complex disorders
- subspecialist physicians
- medical centers
- rare & complex disease management
- ex: dialysis, burn treatments, organ transplants, heart surgery
9
Q
Palliative Care
A
- focuses on providing relief from pain and other symptoms r/t disease
- for people suffering from complex, often terminal illnesses
- helping people have the highest quality of life possible
10
Q
Respite Care
A
- short term care arrangement that provides temporary relief for primary caregivers
- several hours to a couple of weeks
- takes place in home, healthcare facility, or center specifically for adults
11
Q
Hospice
A
- provides physical and emotional comfort for patients nearing the end of life
- designed for when patients choose to not undergo any more treatment
12
Q
Specialized care centers
A
- homeless shelter, rehab, parish nursing, daycare, mental health centers, rural health centers, schools
13
Q
Trends and issues in the health care delivery system
A
- changing demographics
- technology explosion
- increasing diversity
- costs of health care
- shortages of key health care professionals and educators
- educated and engaged consumers
- increasing complexity of patient care
14
Q
Nurses role in healthcare reform
A
- stronger voice in addressing health related problems
- greater number of nurses are increasing their education
- focus of all nurses is providing holistic care essential to promoting health and preventing illness
15
Q
What were the goals of the Affordable Care Act?
A
- Expand coverage (increase in medicaid coverage, pre-existing conditions covered)
- Control health care costs (encourage primary care visits vs ER visits)
- Improve the healthcare delivery system (increase # of primary care providers… NPs)
- Provide Medicaid to qualifying people with up to 400% of poverty beginning in 2014
- Provide a new way to get health insurance: The Health Insurance Marketplace
