Health Care Policy Flashcards
What is health policy?
The planning, development, and implementation of interventions designed to maintain and improve the health of a group of individuals.
Which factors considered positive to primary care physicians? Which factors are considered negative?
Positive
- Increased use of health information technology
Negative
- Increased use of metrics to assess provider performance
- Programs that include financial penalties for unnecessary hospital admissions or readmissions
Insurance complexity and restrictions create concerns for patients and doctors. How do these complexities affect patients and physicians, respectively?
Patients
- Insurance did not cover as expected/spent a lot of time on paperwork
- Adults spent a lot of time on paperwork or disputes over medical bills and/ or insurance denied payment or did not pay as much as expected in the past year
Physicians
- Insurance coverage restrictions pose major time concern
- Amount of time doctor or staff spend getting patients needed medications/treatments because of coverage restrictions is a major problem
What are the components of the heath care system?
- Delivery
- Payment
- Financing
- Insurance
What is the purpose of insurance?
To protect against catastophic risk
Health Care Transaction
The Flow of Funds in U.S Health Care
Where does the nation’s health dollar come from?
-
Health insurance- 73%
- Private health insurancde- 33%
- Medicare- 20%
- Medicaid-16%
- VA, DOD, and CHIP- 4%
- Out of pocket- 11%
- Other third-party payers and programs- 8%
- Investment-5%
- Public health activities- 3%
Where does the nation’s health dollar go?
- Hospital care- 32%
- Physician and clinical services- 20%
- Other spending- 20%
- Prescription drugs- 10%
- Government administration and net cost of health insurance- 8%
- Other health, residential and personal care- 5%
- Nursing care facilities and continuing care retirement communities- 5%
Medicare represents _____ % of the federal budget.
13
What does each part of medicare cover?
A: Hospital and skilled nursing care
B: Outpatient, physician visits when medically necessary
C:“Medicare Advantage” plans, approved by Medicare but run by private companies. Provides A, B, and D benefits
D: Drug plan. Voluntary and not automatic
NOTE: Rising health care costs and the increasing aging population presents a situation for concern for medicare.
True or False. Both Medicare and Medicaid are funded equally by the state and federal govement.
False.
*Medicare is federally- funded only and medicaid is funded by both state and federal govement.
Who qualifies for medicare?
- >65 years old
- Disabled
- In need of hemodialysis
- Eligible for social security
Who qualifies for medicaid?
- Poor
- Children
- Parents of dependent children
- Pregnant women
- Disabled
Who is eligible for bothe medicaid and medicare?
Chronically ill, long-term care
How are services used?
Rethinking the Organization of Delivery Care
