Module 5 lecture, part 1 Flashcards
What is the broad definition of a HC system?
Major components of the system and processes that enable ppl to receive healthcare
What is the restricted definition of a HC system?
The act of providing healthcare to pts (i.e., in a hospital or physician’s clinic)
What are the primary objectives of a HC system?
To deliver services that are cost-effective and meet established standards of quality
What are the four components of the quad-function model?
Financing
Insurance
Delivery
Payment (to provider)
What is the purpose of financing?
To obtain health insurance or to pay for HC services
Who finances HC as a fringe benefit?
Employers
Who is the financier in public programs?
The gov’t
What does insurance do?
Protects the insured against catastrophic risks
Determines the package
What is delivery?
The provision of HC services by various providers
In the US, where does most HC delivery come from?
Private providers
The amount to pay is determined by who?
The insurer
From what sources do providers get paid?
Co-pay by the pt and the remainder paid by the insurance company
The revenues used to pay providers in gov’t plans
Where do the funds come from?
From premiums paid to the MCO or insurance company
Who can function as a claims processor and mange the distribution of funds to the HC providers?
MCO or insurance company
Definition of provider
Any entity that delivers HC services and receives insurance payment directly for those services
