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Professional Nursing Concepts 4 > Healthcare Economics > Flashcards

Healthcare Economics Flashcards

1
Q

What is public insurance?

A

Government financed insurance that supports children, older adults, disabled people, and the poor.

EX: Medicare and Medicaid

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2
Q

What is private insurance?

A

Provided by companies such as Blue Cross Blue Shield or Aetna

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3
Q

Why is there a worldwide healthcare system crisis?

A
  1. countries are running out of ways to finance

2. costs must be contained

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4
Q

What are the four categories of financing and organizing healthcare?

A
  1. Socialized medicine
  2. socialized insurance
  3. Mandatory health insurance
  4. Voluntary insurance: no guarantee of universality
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5
Q

What is socialized medicine?

A

When the state owns it and controls healthcare services

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6
Q

What is socialized insurance?

A

Medically necessary services covered

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7
Q

What is mandatory health insurance?

A
  1. organized around employers, work-based associations

2. government-sponsored programs cover those not part of the fund

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8
Q

What is the perspective of healthcare in the United States?

A
  1. pluralism and choice
  2. individual accountability
  3. Abivalence toward government
  4. Progress, innovation
  5. new technology
  6. volunteerism
  7. Paranoia about monopoly
  8. competition
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9
Q

What healthcare perspectives do other countries have?

A
  1. universality
  2. equity
  3. acceptance of the role of government
  4. Skepticism about markets and competition
  5. global budgets
  6. rationing
  7. technology assessment
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10
Q

What would the imbalance of supply and demand lead to?

A

rationing

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11
Q

What happens when costs in healthcare increase?

A
  1. consumers have come to expect that nay and all services should be available and paid for
  2. Employers believe they cannot afford to cover at previous levels
  3. Increased employee payment
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12
Q

What can rationing cause?

A
  1. the government setting limits: allocating according to a particular criteria
  2. ration by the ability to pay (limit care for those who cannot afford it)
  3. Freedom of the individual to choose amount and type of healthcare (rationing will limit this)
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13
Q

What are two cost-containment strategies?

A
  1. competition

2. price controls

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14
Q

What is competition and does it help with cost-containment?

A
  1. regulations permit competition between companies
  2. led to walk-in clinics and urgent care clinics
  3. little reduction in costs however
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15
Q

What is the purpose of the Affordable Care Act of 2010?

A
  1. improvement of the quality of care provided
  2. redesign of healthcare delivery systems
  3. Appropriate payment for services provided
  4. Modernization of the financial systems used to pay for services
  5. Elimination of fraud and abuse
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16
Q

What do price controls do?

A
  1. freeze on physician fees for short periods
  2. state limited reimbursement for physicians, hospitals for services to Medicaid clients
  3. group self-insurance
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17
Q

What did the Tax Equity and Fiscal Responsibility Act of 1982 do?

A
  1. changed Medicare payment method to prospective payment system using DRGs
  2. May result in withholding unnecessary tests
  3. Earlier discharge and a decline in admissions
  4. Rise in number and type of outpatient services
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18
Q

What can nurses do to help contain costs?

A
  1. all nurses must be concerned about cost (budgeting, allocate resources, control, monitor expenditures)
  2. Nursing budget can be half of the total expenses
  3. Nurses must compete for resources
  4. Many evidence-based nursing interventions promote cost containment (search for more efficient methods of care delivery)
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19
Q

What is Medicare for?

A

Available to people 65 years of age or older, younger people with disabilities, those with end-stage renal disease

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20
Q

What are the different types of Medicare?

A
  1. Part A: premium free
  2. Part B: voluntary
  3. Part C Medicare Advantage
  4. Part D: Prescription drug coverages
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21
Q

What is included in Medicare Part B?

A

A premium, partial payment for physician visits, outpatient services, and a deductible and 20% copay

22
Q

What is included in medicare part C?

A
  1. out of pocket payments

2. Allows beneficiaries to enroll in private health insurance programs

23
Q

What population does Medicaid cover?

A

Available to certain lower-income individuals/families, elderly, and those with eligible disabilities

24
Q

What is Supplemental Security Income?

A
  1. funded by general taxes
  2. designed to help aged, blind, disabled people with little or no income
  3. cash for basic needs
25
Q

What is the Children’s Health Insurance Program?

A
  1. coverage to children under age 19 whose families earn more than Medicaid limits but cannot afford to purchase private health care coverage
  2. each state determines the design of the program
  3. routine checkups, immunizations, dental and vision care, inpatient and outpatient hospital care, and lab and x-ray services
26
Q

What is an HMO?

A

Health Maintenance Organization

  1. A member selects their primary care provider (gate keeper)
  2. great range of services for lowest cost
  3. Restrictive because it offers a limited choice of providers
27
Q

What is a PPO?

A

Preferred-provider organization

  1. No primary care provider
  2. larger network of providers
  3. Less restrictive
  4. Greater copayments
28
Q

What is a POS?

A

POS

  1. hybrid of PPOs and HMOs
  2. in or out of network
  3. may have higher copayment, coinsurance, and deductibles
29
Q

What are CDHPs?

A

Consumer-driven Healthcare Plans

  1. health savings account or health reimbursement account
  2. greater payment toward healthcare expenses
  3. lower premiums
  4. HSA, HRA to save money to pay expenses
30
Q

What is a Medigap policy?

A
  1. designed to supplement Medicare

2. Helps pay some uncovered costs

31
Q

What is a personal payment?

A
  1. client pays insurer directly
  2. not covered by any type of insurance
  3. higher overall healthcare expenses
  4. Individuals sicker than those who pay a lower percentage of healthcare costs
32
Q

What is the purpose of Healthy People?

A
  1. Sets and monitors national health objectives
  2. Encourages collaboration across communities and sectors
  3. guides individuals toward making informed health decisions
33
Q

What are the Healthy People 2020 new initiatives?

A
  1. dementias
  2. healthcare-associated infections
  3. early and middle childhood
  4. lesbian, gay, bisexual, and transgender health
34
Q

What is health promotion?

A

The process of enabling people to increase control over health and improve health

35
Q

What is the nurse’s role in primary prevention?

A

teaching patients how to remain healthy

36
Q

What is the goal of primary prevention?

A

ensure that patients understand the importance of setting health goals and that patients can assess, implement, evaluate, and modify goals

37
Q

What topics identified by Healthy People 2020 and individual locales are part of primary prevention?

A
  1. childhood obesity and nutrition
  2. physical activity across the lifespan
  3. dental/oral health
  4. tobacco use and smoking cessation
  5. Health screening
38
Q

What is secondary prevention?

A
  1. focuses on diagnosis and treatment of disease
  2. aimed at early disease detection, treatment to prevent progression of the disease and associated symptoms
  3. screening is a means of early detection
39
Q

What is tertiary prevention?

A
  1. focuses on restoration of healthy after an illness or accident
  2. involves restoring function, decreasing disease-related complications of already established disease
  3. Care focused on controlling symptoms when restoration to previous level of functioning is not possible
  4. Includes rehabilitation and palliative care
40
Q

Where is primary care delivered?

A
  1. physician’s offices
  2. hospital-based clinics
  3. community health centers
  4. public health service organizations
41
Q

where is secondary care typically delivered?

A
  1. hospital
  2. outpatient surgical center
  3. specialist’s offices
42
Q

Where is tertiary care typically delivered?

A
  1. hospital
  2. rehabilitation center
  3. extended care facility
43
Q

What are some factors that affect the delivery of healthcare?

A
  1. changing demographics
  2. advances in technology
  3. healthy literacy
44
Q

What is case management?

A

Collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet health needs

45
Q

What is functional nursing?

A

Task-oriented approach to healthcare delivery

46
Q

What is health literacy?

A

The capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions

47
Q

What is managed care?

A

Method of delivering cost-effective and high-quality healthcare

48
Q

What is patient-focused care?

A

Healthcare delivery model organized around the expressed physical and emotional needs of the patient

49
Q

What is primary nursing?

A

one nurse has 24/7 authority and responsibility for the care of an assigned group of patients

50
Q

What is resource allocation?

A

The distribution of resources among competing groups of people or programs

Professional Nursing Concepts 4 (11 decks)

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