Unit 2 Lesson 4: Analyzing a Complex System

Question 1

What is Health Maintenance Organization (HMO)

Answer 1

A type of insurance plan that only pays if you use doctors or facilities that have contracts with the plan.

Question 2

What is Preferred Provider Organization (PPO)

Answer 2

With a PPO plan, you will pay less for health providers that are in the plan’s network. You can also use out-of-network providers and pay a higher percentage of the bill.

Question 3

What is Exclusive Provider Organization (EPO)

Answer 3

This type of plan will only pay for doctors, specialists, and hospitals that are in the network.

Question 4

What is Point of Service (POS)

Answer 4

Similar to a PPO, a POS plan will have you pay less for providers that are in the network. In a POS plan, your primary care provider must give you a referral to see any specialists.

Question 5

What is catastrophic health insurance

Answer 5

These plans have very high deductibles that the person has to pay before the plan will pay anything. The upside is that the monthly premiums will be lower.

Question 6

When do catastrophic health insurance protect you

Answer 6

These plans can protect someone in the event of a catastrophic illness or injury but doesn’t help much with day-to-day health problems.

Question 7

What is Accountable Care Organization (ACO)

Answer 7

An Accountable Care Organization (ACO) is a group of practitioners and facilities that have banded together to provide quality care efficiently and appropriately, and they are paid based on outcome rather than quantity of treatments.

Question 8

What is Primary Care Medical Home (PCMH)

Answer 8

A Primary Care Medical Home (PCMH) model is a patient-centered, team-based approach to the health of the whole person and focuses on primary care providers performing about 75 percent of the care.

Question 9

What do PCMH teams

Answer 9

These PCMH teams can include advanced practice nurses, physicians, physician assistants, and others who work to prevent and quickly treat problems in the most efficient way. Relationships between patient and provider are seen as a key to PCMH success.

Question 10

Have to costs of medical care rising or lowering

Answer 10

The costs of medical care have been rising faster than other parts of the economy in the United States, although the speed of cost increases seems to be slowing down.

Question 11

Describe how US healthcare is expensive

Answer 11

. Healthcare accounts for a large share of the economy. It is a big expense for the government, businesses, and individuals. The United States spends more on healthcare for each person than any other country in the world—more than double the average for developed countries.

Question 12

There are three factors that have been identified as contributors to the rising cost of healthcare; what are they

Answer 12

new technologies and prescription drugs; the rise of chronic diseases like obesity; and high administrative costs in healthcare.

Question 13

What are the bad things healthcare in US have done

Answer 13

Healthcare is part of what has contributed to a higher national debt, state government budget problems, and financial problems for individuals. The high cost of healthcare can make it hard for lower income people to get adequate medical care. High cost can also cause bankruptcies for individuals who end up having a major health crisis in the family.

Question 14

What are some of the benfits of the healthcare

Answer 14

On the other hand, the health sector of the economy is also a driver of the economy. Demand for healthcare creates jobs, and jobs that pay living wages. Plus, new technologies and pharmaceutical products can add money to the economy. So healthcare has a complex relationship with the economy.

Question 16

Three things are desirable in healthcare:

Answer 16

affordability, quality, and accessibility.

Question 17

Describe healthcare affect on econmy

Answer 17

If healthcare is too expensive, then it is hard for people to get access to quality care. If not enough money is spent to maintain and improve the healthcare system, the quality will suffer. If people don’t have health insurance, then they often cannot access care because of high cost, and if they do get healthcare, it may be of poorer quality. If the economy is not doing well, fewer people will have jobs with healthcare benefits, and more people will be poor and unable to afford care. It’s a bit of a feedback system—all these factors need to be in balance to keep the healthcare system healthy. Healthy economy equals a strong health system, and vice versa.

Question 18

Healthcare is affected by the investment that government and private entities designate towards quality. Elaborate

Answer 18

New, more efficient technologies are also bringing advances in the ability to cure diseases and bring more efficient testing and care to more people.

Question 19

What happens as healthcare improves

Answer 19

As healthcare has improved, people are living to older ages, meaning that a larger percentage of our population is over the age of 65. This older population needs more care than their younger counterparts, and this is driving more demand for healthcare and more spending as a part of the economy.

Question 20

. There is also a trend toward patient-centered health, what does that mena

Answer 20

There is also a trend toward patient-centered health, which means that the patient is included in health decisions and is seen as an integral part of the system; this changes the ways that medical staff relate to patients.