how health care is delivered Flashcards
socialized medicine for veterans, military, Native Americans.
is what model
Beveredge
social insurance for most people with jobs
Bismark
for Americans over the age of 65, some who are poor or disabled
National Health Insurance
dispersed independent fee-for-service. Physicians admitted and cared for patients in hospitals - supporting hospital services. Dispersed, independent
physician offices
Physicians salaried, practice collected fees-for-services.
Multispecialty Group Practices
– team approach, comprehensive medical and public health care, targeting low-income populations.
Community Health Centers
“under one roof”
virtual integration of HMO
Prepaid Group Practice/Health Maintenance Organizations (
virtual integration refers to
networks; i.e. Independent Practice Associations (IPAs).
this structure of medical practice tend to rank higher in measures of quality of care.
verticle HMO
what is an IPA
Association of many physicians
Physicians maintain ownership of their practice
IPA negotiates and administers HMO contracts
The group can contract with many HMOs
in integrated medical groups providers are
employees not owners of the practice
usually these are large cooperations hospitals and medical schools
Providers contract with insurer to provide care at set rates and fees
pts pay less for providers that are in network
ppo
What are Prepaid Group Practices
Combine insurance and health care services
Monthly or annual payments to health care provider organization to cover all (covered) medical treatments
the modern HMO is based on
Prepaid Group Practices
1st generation HMO
kaiser
example of a second generation HMO
independent practice association or network HMO
how are providers paid with Kaiser
salary
three distinct but interdependent groups of entities that exist within Kaiser .
Kaiser Foundation Health Plan
Kaiser Foundation Hospitals-not-for-profit and rely on the Kaiser Foundation Health Plans for funding
Permanente Medical Groups
physician-owned organizations, which provide and arrange for medical care for Kaiser Foundation Health Plan members in each respective region
Permanente Medical Groups these are regional
what part of the Kaisers independent groups are for profit
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.
how do the 2nd HMO differ from the Kaiser model
virtual networks are typically for profit
Panel of providers paid a capitated rate for a panel of patients (can also see non-HMO pts
can IPAs contract with multiple HMOs
yes
how is a bismark model funded
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
how is the Bevridge model financed in bRITAN
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
do community health centers still exists?
who do they cover
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
how are community health centers funded
Receive federal funding (approx. 10-50% of budget), and special Medicaid/Medicare reimbursement rates (PPS)
Required to see all, regardless of ability to pay.
Provider groups, hospitals, services share risks and rewards
ACA
