Health Systems Flashcards
What requirements does a PT need for a temporary license?
- Applied for NPTE or are awaiting the results of the NPTE
- Licensed in another state
- meets conditions under the board’s discretion
- expiration of a temporary license
A licensed physical therapist shall maintain professional liability insurance in the minimum amount of $_______ per occurrence or claims as made as a condition of practicing as a physical therapist.
$1,000,000
What are examples of preventative care?
- wellness programs
- immunizations
- health screenings
- education
Who makes up a primary care team?
- PCP
- pulmonologist
- psychiatrists
- practical nurses
- PT
- social workers
Definition/examples: Specialized medical management, lab tests, rehab services, daycare, sports medicine, hospice, etc
specialty care
Type of setting: Public health departments, Wellness and health education settings, imaging and surgical care clinic
ambulatory care
Type of setting: Acute care, post or subacute care, skilled nursing homes
inpatient
What is the fastest growing segment of the health care delivery system?
home care
What year was the first hospital prepayment plan founded?
1929
Standards of performance in healthcare were developed by who?
American Hospital Association
- BCBS was one of the first
Who paid their premiums up until WWII with BCBS?
the patient – health care premium payments were offered by employers as an alternative to wages after WWII
What healthcare titles of the social security act improved the accessibility of healthcare to the elderly and poor?
Title XVIII (18) and Title XIX (19)
What is the most significant piece of health care legislation ever passed by Congress health care for the elderly?
Medicare (1965)
definition: Established in 1965 by title XIX of the Social Security Act, the state administered to the poor, elderly, and disabled to what healthcare plan?
Medicaid
Medicaid expenses are shared between who?
State and Federal government
(true/false) Medicaid benefits vary among states
true
Medicaid was amended in ____ to include people with certain disabilities and chronic renal disease.
1972
The reasonable cost payment method of Medicare, Medicaid, and others were financially rewarding for health care providers making the cost of health care (increase, decrease).
increase (The increase is passed along to the employers or to the taxpayers in the case of Medicare)
definition: Comprehensive health care service coverage of hospital and physician services for a FIXED fee that must be provided by a plan provider.
Health Maintenance Organization (HMO)
Who acts as the primary gatekeeper of HMO?
PCPs
definition: Network of health care providers who have contracted with a managed health insurance plan to provide services to plan members.
- Members have discounted rates and comply with pre-authorization and utilization review requirements
- there is a gatekeeper for specialist access
Preferred Provider Organization (PPO)
definition: Network of providers who have contracted with a managed health insurance plan to provide services to plan members BUT an Additional fee is paid for use of providers outside the network or for specialists
- Typical to see copay for primary care physician office in network and increased difference for out of network primary care physician office visits and specialists
Point of Service organization
definition: Uses the patient’s primary diagnosis to categorize them into diagnosis related group
Case payment rate is preset
Prospective Payment System (PPS)
definition: Practices and processes employed to influence use of healthcare services by a patient
- Care management: Clinical management of healthcare resources
Utilization Management
What percent of the population is covered by some form of managed care?
41%
What is used to control service utilization and cost?
utilization costs
(true/false) Primary care gatekeepers do not have a second opinion requirement when coordinating and controlling the amount of care given to a patient.
false (they do)
The Clinton Administration failed in its efforts for healthcare reform but it changed the way in which SNFs and HHAs are paid as part of the ____ Act of 1997
Balanced Budget Act of 1997
What were the three primary goals of the Affordable Care Act (ACA)?
- Make affordable health insurance available to more people
- Expand the Medicaid program to cover all adults with income below 138% of the Federal Poverty Level
- Support innovative medical care delivery methods designed to lower the costs of healthcare generally
(true/false) Most people believe that their government is responsible for the well-being of their citizens.
true
(true/false) The degree of a government’s involvement in healthcare varies between nations.
true
Who owns/operates the health services in the soviet union?
government
(health care is divided regionally)
Does the soviet union believe the healthcare is a right? How much is it?
yes, it is free
A feldsher is a combination of what healthcare providers in the soviet union?
NP and physician –> PT services are provided by a physician
definition: political system that recognized the right of limited private ownership however certain services, products, institutions that benefit all of society are organized by government
socialist
Who regulates healthcare in Germany?
state and federal government
Who has health insurance in Germany?
Everyone… whether they are a citizen or not
Who plans health services in Germany?
Central government (Doctors and providers are assigned regions and setting/type of work)
Who establishes payment of healthcare services and drug cost in Germany? Is there a co-pay?
Government; yes
What system is unique to the UK?
comprehensive health
What model is the comprehensive health plan of the UK based on?
socialist –> extensive government control
Comprehensive health in the UK is a ____-supported national health care system.
tax-supported
All healthcare providers part of comprehensive health are ____ employees.
government; salaries are periodically adjusted for healthcare staff
(true/false) Comprehensive health in the UK does not provide universal access to all citizens.
FALSE (they do)
What are the challenges of the comprehensive health plan in the UK?
- longer wait time
- fewer physicians per patient
Welfare health in Canada is under whose control?
Central government
Universal health insurance in Canada is what?
Medicare
(true/false) Canada believes that healthcare is a right
true
What must each providence in canada provide to get federal funding?
core services that has set standards of care and delivery determined by the federal government
What covers healthcare through medicare in canada? How much?
taxes; 70%
(true/false) Private insurance is available in canada
true
What is the two sectors of entrepreneurial health (US)? What is the largest sector?
private (Largest sector) –> commercial insurance
Public –> payroll tax and federal funding
What is the only industrial nation that does not see health services as a right?
US
(true/false) The US has central control on healthcare
false
Who sets the regulations for medicare and medicaid in the US?
Health and human services (HHS)
What is the most costly healthcare system in the world?
USA
What is the most complex system with multiple payers and different processes for each?
USA
What healthcare system has the best response time?
USA
Health service systems evolve differently due to what 3 factors?
culture, beliefs, economics
definition: Characterized by the voluntary exchange between the buyer and the seller that is not planned or controlled by any central authority
market economy
What is the relationship between quality and price?
value
The relationship between supply and demand (does/does not) effectively control the healthcare prices and limit market growth
DOES NOT –> US healthcare does not follow the rules of a market economy
What type of relationship does a buyer and consumer have?
indirect
Usually, the person requesting the healthcare service (is/is not) the consumer of the service
is NOT
(true/false) Often the consumer does NOT know the price of the services they are receiving
true
(true/false) Consumers have difficulty determining quality
true
(true/false) value, price, and payment are not always related
true
Poor quality of healthcare can (increases/decrease) cost
increase
Who owns private for-profit health systems?
1+ individuals
Who owns public for-profit health systems?
shareholders
Medicare (is/is not) tax-supported
is
Medicare is for those over age ____.
65
Those eligible for medicare must pay into the system through ______.
payroll taxes
What does Medicare A cover?
hospital
What does Medicare B cover?
outpatient (has a co-pay)
What does Medicare C cover?
managed care (hospital and outpatient)
What does Medicare D cover?
drugs/medications
Who manages medicaid?
state and federal govt –> expansion varies by state
definition: Helps low-income families who do not meet Medicaid eligibility get coverage for children with a joint effort from federal and state govt
SCHIP (tax-supported)
SCHIP covers how many children?
8 million
Rate of Healthcare spending has (decreased/increased) with ACA but will still continue to grow
decreased
(true/false) healthcare is one of the causes of inflation
true
Burden of govt coverage = (lower/higher) taxes
higher taxes
