Notes 2

Question 1

Usual and customary charge?

Answer 1

Providers decide how much they’re worth and set their own prices

Question 2

Blue Cross Global Budgeting Scheme?

Answer 2

Outcome-based payment. If you spend less money, and do a better job with quality stuff, then we’ll pay you more and you get to keep the money you saved.

Question 3

In the British movie, who had control?

Answer 3

Physicians - Act to control their work environment

Question 4

What did you learn about institutional cultures from the British movie?

Answer 4

Institutional cultures form relatively early in the life of the institution and tend to have massive inertia and are resistant to change. New people come in and USUALLY get absorbed into that culture. Change is possible, not easy.

Question 5

What was the British Policy change?

Answer 5

NHS changed from budgeting the hospital to having the money follow the patient. With patients able to go to other places, hospital is losing money because of ridiculous waiting times.

Question 6

Cost-sharing

Answer 6

Increased deductibles/copayments/coinsurance - insurance company pays less, subscriber pays more

Question 7

3 things that determine life expectancy?

Answer 7

Women > men, race plays a factor, education

Question 8

3 reasons to have a doctoral degree?

Answer 8

1) More money for fees 2) More autonomy 3) Ensures high professional standard

Question 9

Consequences for pushing towards a doctoral degree?

Answer 9

Greater access to primary care means higher total system costs!!

Question 10

Which med organization lobbies the most?

Answer 10

AMA= lobbies more than other people. Lots of good causes, lots of bad causes (monopolizing the MD profession)

Question 11

FTE?

Answer 11

Full time equivalent - like, generally 40 hours per day

Question 12

Problem with physician shortage?

Answer 12

While you have an increasing number of docs, FTE is actually not as much. Number of spots in med school and residencies is low, and we need to make up for difference in numbers. Also, there’s an aging population.

Question 13

Physician mismatches in the country?

Answer 13

People in south and west have fewer docs than necessary to treat the population

Question 14

What’s it called when private payers pay more for private insurance than MCARE/MCAID?

Answer 14

Redistribution (make up for lost money by using funds from private insurers. Money from well insured, wealthy to not so insured)

Question 15

2 ways docs make money?

Answer 15

Direct services AND ancillary services (own labs, CT Scanners, etc)

Question 16

Why is there an increased demand for nurses?

Answer 16

PCP shortage, aging US population AND aging nurses means more healthcare is needed, and creation of new jobs to do things like write rxs/notes, etc

Question 17

AS the economy gets better, nursing shortage may be worse. Why?

Answer 17

Cuz if nurses don’t have to work as much to support their lifestyle, they’ll just cut down hours

Question 18

Challenges to increasing nursing workforce?

Answer 18

Recruitment of new students, educational confusion, faculty shortage, and retention (cost of turnover)

Question 19

Educational confusion?

Answer 19

You can get a bachelors or an associates (half time), or a diploma. Same license, but in a saturated are you need a BS.

Question 20

Nursing faculty shortage?

Answer 20

Make much more money to be a nurse than to teach nurses.

Question 21

Why nursing lack of satisfaction?

Answer 21

Schedule (nighttime, blegh), mandatory OT, burnout. Bad workplace setup. High pts per nurse ratio.

Question 22

3 solutions for nursing?

Answer 22

Maximize scope of practice (equalize across states, cuz now different states require different oversight/authority despite same national licensing exam), increase level of education, and involve nurses in health care redesign

Question 23

What makes you eligible for MCARE?

Answer 23

1) Over 65 2) Under 65, and chronically disabled (you may have SS disability benefits for 2 years).

Question 24

What is covered as extra for dual eligibles?

Answer 24

MCAID covers gaps in MCARE coverage such as LTC, dental, eyeglasses, pays part of MCARE B premium, etc.

Question 25

Explain how the govt factors into employment-based health insurance.

Answer 25

Fed Gov views premium payments as a tax-deductible business expense. Cuz employer is paying for part of the premium, it’s like employee is getting tax-free income and the fed govt is subsidizing the insurance.