how health care is delivered

Question 1

socialized medicine for veterans, military, Native Americans.

is what model

Answer 1

Beveredge

Question 2

social insurance for most people with jobs

Answer 2

Bismark

Question 3

for Americans over the age of 65, some who are poor or disabled

Answer 3

National Health Insurance

Question 4

dispersed independent fee-for-service. Physicians admitted and cared for patients in hospitals - supporting hospital services. Dispersed, independent

Answer 4

physician offices

Question 5

Physicians salaried, practice collected fees-for-services.

Answer 5

Multispecialty Group Practices

Question 6

– team approach, comprehensive medical and public health care, targeting low-income populations.

Answer 6

Community Health Centers

Question 7

“under one roof”

Answer 7

virtual integration of HMO

Prepaid Group Practice/Health Maintenance Organizations (

Question 8

virtual integration refers to

Answer 8

networks; i.e. Independent Practice Associations (IPAs).

Question 9

this structure of medical practice tend to rank higher in measures of quality of care.

Answer 9

verticle HMO

Question 10

what is an IPA

Answer 10

Association of many physicians
Physicians maintain ownership of their practice
IPA negotiates and administers HMO contracts
The group can contract with many HMOs

Question 11

in integrated medical groups providers are

Answer 11

employees not owners of the practice

usually these are large cooperations hospitals and medical schools

Question 12

Providers contract with insurer to provide care at set rates and fees

pts pay less for providers that are in network

Answer 12

ppo

Question 13

What are Prepaid Group Practices

Answer 13

Combine insurance and health care services

Monthly or annual payments to health care provider organization to cover all (covered) medical treatments

Question 14

the modern HMO is based on

Answer 14

Prepaid Group Practices

Question 15

1st generation HMO

Answer 15

kaiser

Question 16

example of a second generation HMO

Answer 16

independent practice association or network HMO

Question 17

how are providers paid with Kaiser

Answer 17

salary

Question 18

three distinct but interdependent groups of entities that exist within Kaiser .

Answer 18

Kaiser Foundation Health Plan

Kaiser Foundation Hospitals-not-for-profit and rely on the Kaiser Foundation Health Plans for funding

Permanente Medical Groups

Question 19

physician-owned organizations, which provide and arrange for medical care for Kaiser Foundation Health Plan members in each respective region

Answer 19

Permanente Medical Groups these are regional

Question 20

what part of the Kaisers independent groups are for profit

Answer 20

Permanente Medical Groups

The medical groups are for-profit partnerships or professional corporations and receive nearly all of their funding from Kaiser Foundation Health Plans.

Question 21

how do the 2nd HMO differ from the Kaiser model

Answer 21

virtual networks are typically for profit

Panel of providers paid a capitated rate for a panel of patients (can also see non-HMO pts

Question 22

can IPAs contract with multiple HMOs

Answer 22

yes

Question 23

how is a bismark model funded

Answer 23

ulti-payer health care system paid for by a combination of statutory health insurance (Gesetzliche Krankenversicherung) officially called “sickness funds” (Krankenkassen) and private health insurance

Question 24

how is the Bevridge model financed in bRITAN

Answer 24

In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.
Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government

Question 25

do community health centers still exists?

who do they cover

Answer 25

In 2008, more than 1000 community health cen- ters at 7500 sites were serving 17 million people, three- quarters of them uninsured or covered by Medicaid

Question 26

how are community health centers funded

Answer 26

Receive federal funding (approx. 10-50% of budget), and special Medicaid/Medicare reimbursement rates (PPS)
Required to see all, regardless of ability to pay.

Question 27

Provider groups, hospitals, services share risks and rewards

Answer 27

ACA