Social, Economical...factors

Question 1

4 primary influences on health care:

Answer 1

Social
Economic
Cultural
Spiritual

Question 2

2 nursing movements that can help meet the needs of underserved areas:

Answer 2

Nurse practitioner

Parish nurses

Question 3

Capitation

Answer 3

Latin word “caput” meaning head.
Putting tax or fee on each head.
Monthly fee is paid to providers. It is the same fee for seeing a patient weekly or yearly.

Question 4

Health Maintenance Organizations

HMO

Answer 4

Example of HMO.
Kaiser permanente.
Members pay fixed monthly fee and then have copays.

Question 5

Preferred provider organization

PPO

Answer 5

Another type of capitated health program.
Must use providers who are contracted.
Providers benefit by getting a certain amount of patients.

Question 6

Prospective payment systems

Answer 6

Provider will be reimbursed for a service based on a predetermined and fixed amount.
2 kinds of payment systems:
diagnosis related groups(drg)
Resource utilization groups (rug)

Question 7

Diagnosis related group (drg)

Answer 7

Medicare uses this. Each service is the exact same price at each hospital.
These are based on diagnosis or procedure.

Question 8

Outlier

Answer 8

Person exceeding max length of stay at hospital on any DRG.

Question 9

Resource Utilization groups (RUG)

Answer 9

A type of prospective payment system for Nursing homes.
Medicare and medicaid uses.
Rates are based on care given and acuity of condition.
Case mix is the distribution of patients into categories related to severity of illness.

Question 10

Case mix is is distribution of severity in a Resource Utilization Group(RUG).
What are the 7 levels of acuity? Highest to lowest.

Answer 10

Highest to lowest
1-special rehabilitation
2extensive services
3- special care
4 clinically complex
5- impaired cognition
6- behavior problems 
7- reduced physical functions

Question 11

CMS

Answer 11

Center of Medicare and Medicaid services.

Federal agency that determines DRG and RUG rates and regulates and administers medicaid and medicare

Question 12

MDS - Minimum Data Set

Answer 12

Assessment tool used in nursing homes for care planning and reimbursement purposes.

Question 13

Medicare characteristics-(4)

Answer 13

1- coverage in home is limited to skilled nursing
2- covers people in end stage renal disease
3- part A is hospital insurance
4- title XVIII

Question 14

Medicaid characteristics (4)

Answer 14

1- title IX
2-jointly funded by federal and state governments
3-no age limit
4- third largest source of health insurance in US

Question 15

Capitation programs include (2)

Answer 15

1- HMO

2- private insurance companies

Question 16

Political Action Committee (PAC)

Answer 16

Groups that that raise $ to try to elect or defeat candidates. Formed by businesses, associations or organizations.

Question 17

Curanderismo

Answer 17

Mexican American folk healing

Spiritual and reflects Mayan, Aztec and Catholic traditions