What is one benefit that different interests in the US HC system provide? –
ANSWER- It prevents any single entity from dominating the system (big business,
labor, insurance companies, physicians, and hospitals, administrators of health care
institutions).
The ACA is an example of what type of reform? – ANSWER- incremental not
comprehensive
What makes for an ideal organizing hub for continuous, coordinated health care
services? – ANSWER- Primary Care (but is still undeveloped)
primary care integrates health care in comprehensive, coordinated, and continuous
health care services through a seamless delivery referred to as – ANSWER\u0002Medical home or health home for patients
The key to the patient-provider relationship is? – ANSWER- Accountability
The uninsured have limited options for medical care. They can – ANSWER- (1)
pay physicians out of pocket at rates typically higher than those under insurance
plans, (2) seek care from safety net providers, or (3) obtain treatment for acute
illnesses at a hospital emergency department, for which hospitals do not receive
direct payments unless patients can afford them.
This act requires screening and evaluation of all patients, provision of necessary
stabilizing treatment, and hospital admission when necessary, regardless of ability
to pay. – ANSWER- Emergency Medical Treatment Act of 1986
the misuse of emergency departments results in cost-shifting, in which the costs of
emergency room care to the uninsured are covered by? – ANSWER- patients with
the ability to pay for services, privately insured individuals, employers, and the
government (i.e., taxpayers).
Excessive medical tests and procedures performed as a protection against
malpractice lawsuits, otherwise regarded as unnecessary. – ANSWER- defensive
medicine
Characteristics of a National Health Insurance system – ANSWER- Core of care is
delivered by private providers
There is tighter consolidation of financing, insurance, and payment, which are
coordinated by the gov’t.
Delivery is characterized by detached private arrangements
Ownership: Private\/public
Financing: Single-payer (taxes)
Reimbursement (hospital): Global budgets
Reimbursement (physicians): Negotiated fee-for-service
Consumer Co-Pay: Negligible
Ex: Canada
Characteristics of Socialized Health Insurance system – ANSWER- HC is financed
through gov’t mandated contributions by employers\/employees
HC is delivered by private providers
Sickness funds collect and pay for services
Insurance\/payment is closely integrated
Delivery is characterized by independent, private arrangements
Gov’t exercise overall control
Ownership: Private
Financing: Employer-employee(mandated payroll contributions\/taxes)
Reimbursement (hospital): Per diem payments
Reimbursement (physicians): Negotiated fee-for-service
Consumer Co-Pay: Negligible
Ex: Germany
Characteristics of National Health system – ANSWER- Gov’t manages the
infrastructure for the delivery of medical care
Most medical institutions are operated by gov’t
Most providers are gov’t employees
Financing through tax-supported national health insurance program
Ownership: Public
Financing: Single-payer (taxes)
Reimbursement (hospital): Global budgets
Reimbursement (physicians): Salaries and capitation payments
Consumer Co-Pay: Negligible
Ex: UK
Characteristics of Pluralistic HC system – ANSWER- Ownership: Private
Financing: Voluntary, multiplayer system (premiums or general taxes)
Reimbursement (hospital): Varies (negotiated fee for service, etc)
Reimbursement (physicians): RBRVs, fee-for service
Consumer Co-Pay: small to significant
Ex: US
Consist of a set of interrelated and interdependent components designed to achieve
some common goals. – ANSWER- Systems
3 components of systems framework – ANSWER- -Explains the structure of health
care services in the United States based on the foundations
-Provides a logical arrangement of various components
-Demonstrates a progression from inputs to outputs
Systems Frame outlines include: – ANSWER- -System foundations
-System resources
-System processes
-System outcomes
-System outlook
System foundations are explained by historical, cultural, social, and economic
factors. – ANSWER- historical, cultural, social, and economic factors
Human Resources include – ANSWER- direct, ancillary workers, and HC
managers
What type of health plan includes a list of covered health services and uses
selected providers, usually primary care general practitioners (the “gatekeepers”) –
ANSWER- Managed Care
The military medical care system is what? – ANSWER- Well organized, highly
integrated and offers comprehensive services, both preventative and treatment
oriented
What does the Bureau of Primary Health Care (BPHC) do? – ANSWER- -Provides
federal support for community health centers
-Programs for migrant farm workers, the homeless and public housing residents,
and children
ACOs are touted as a way to help fix an inefficient payment system that? –
ANSWER- Rewards more, not better care
Is a network of doctors and hospitals that shares financial and medical
responsibility for providing coordinated care to patients in hopes of limiting
unnecessary spending. At the heart of each patient’s care is a primary care
physician. – ANSWER- Accountable Care Organization (ACO)
For ACOs to work they have to what? – ANSWER- Seamlessly share information
How do ACOs make money? – ANSWER- ACOs don’t do away with fee for
service, but they create an incentive to be more efficient by offering bonuses when
providers keep costs down. Doctors and hospitals have to meet specific quality
benchmarks, focusing on prevention and carefully managing patients with chronic
diseases. In other words, providers get paid more for keeping their patients healthy
and out of the hospital.
While ACOs can include hospitals, specialists, post-acute providers and even
private companies like Walgreens, who serves as the linchpin of the program? –
ANSWER- primary care physicians
Difference between ACOs and HMOs – ANSWER- ACO patients are not required
to stay in the network
ACOs must meet a long list of quality measures to ensure they are not saving
money by stinting on necessary care
10 Public Health Objectives: – ANSWER- 1.Monitor health status to identify and
solve community health problems
2.Diagnose and investigate health problems and hazards
3.Inform, educate, and empower people about health problems and hazards
4.Mobilize the community to identify and solve health problems
5.Develop policies to support individual and community health efforts
6.Enforce laws and regulations to protect health and safety
7.Provide people with access to necessary care
8.Assure a competent and professional health workforce<\/p>\n\n\n\n