Health systems : The basics of healthcare Flashcards
what are the components of the healthcare systems
- service delivery
- health workforce
- health information systems
- access to essential medicines
- financing
- leadership or governance
what are the contributing factors to the rising cost of healthcare
- malpractice and defensive medicine
- ineffective and inappropriate care
- higher prices and medical inflation
- administrative waste
- pressures of profit in medical care
US healthcare coverage
- out of pocket payment
- individual private insurance
- employment based private insurance
- government financing
Affordable Care Act
- affordable health care
- expand Medicaid to cover all adults with income below 133% of FPL
- support medical care methods that lower the cost of heath care
What are the challenges of paying out of pocket for patients
- cant afford
- total bill not known
What are the challenges of paying out of pocket for doctors
- difficult in getting paid
- fluctuation in demand
pros of employment based private health insurance
- costs less than individual insurance
- part of employment package
cons of employment based private health insurance
- costs rise steeply
- not all employers are required
- employer can require you to pay the greater % of the premium
Community Rating
- based on human need not the ability to pay
- insurer sets premiums evenly
Experience rating
-insurer sets premiums based on the experience of each groups
who is eligible for Medicare
the elderly over 65(must have paid 10 years into social security) and the disabled
who is eligible for medicaid
the poor and children in need
Medicare Part A
- Hospitiliaztion
- Skilled nursing facility
- home health care
- hospice care
expectations of the waiting period for medicare
- ESRD
- ALS
Medicare Part B
- services covered
- it doesn’t cover eye refractions , hearing aids , dental services
Who is eligible for Medicare part B
people who are eligible for part a and elect to pay the medicare part B monthly premium
How is medicare part A financed
-Social security tax payers
How is medicare part B financed
- general federal revenues
- payment of part B monthly premiums
Medicare part C
- all in one alternative tp original medicare
- offered by private companies
- Part A,B and D
Medicare D
- This is for drugs and for prescriptions
- financing through monthly premiums and yearly deductible
what is the donut hole
medicare stopped paying for prescriptions once you reach the drug coverage
limit
-
what services are covered in medicaid
- inpatient and outpatient hospital services
- physcian servis
- labs and x ray services
- Home health services
CHIP
covers the children that are in families with income more than 200 percent of the federal poverty level
-usually free and may have copayments
