9,10,11,13 Test 2 Flashcards
(58 cards)
Opportunity cost
Extra money that other countries saved from cheaper health care to spend on anything other sector
What types of things are there waste, fraud and abuse with?
- services
- Medicare disability fraud
Drivers for health care expenditures
- old age
- technology
- pharmaceuticals
- uninsured
- fee-for-service charging
How does Blue Cross Insurance work?
- community-rates Insurance: set rates based on age, gender etc.
- experience-rated Insurance: Insurance based on patients health care history
How did HMOs start?
There were cost increases and quality concerns so Nixon enacted HMOs with loans and grants.
-In late 1990s people hated HMOs.
Capitation
The doctors get paid, per member per month—instead of being paid for fee-for-service
What is the supply and demand for physicians? Nurses?
Physicians-we need more primary care doctors
Nurses-we will need more nurses
What did the Balanced Budget Act of 1997 do?
It reduced and slowed Medicare spending and growth by reducing money towards home health, skilled nursing, and enacted Medicare Part C.
Gatekeeper in health care
A healthcare professional, usually a primary care physician or a physician extender, who is the patients first contact with the healthcare system and triage is the patience for their access to the system
Compare HMOs vs. Indemnity Plans
HMOs- (health maintenance organizations): you have to go to providers on the list. Involves capitation: paying upfront for the health of your patient,
and (fee-for-service) indemnity pays the physician per visit.
Idaho Public Health Districts
- ID Uses multi county health and districts to give local public health
- Promote economic fairness
What is the problem with people living in such close proximity, only an airplane ride away?
It creates a fast transmission of diseases.
What is a financial cost for patients to share risk with healthcare providers?
Co-payment
What was the managed care ‘backlash’?
Managed care did not reduce costs, improve quality etc. so there were laws in place to protect consumers and providers against managed care restriction. This lead to more employee choice of health insurance.
Healthy people 2000. What are the 3 core functions?
10 year plan for health promotion, protection and prevention.
- Assessment of needs
- Policy development
- Assurance- delivery system is in place
Life/Death in Assisted Living
Not everyone SHOULD be in assisted living, some need more care
What is informal and formal long-term Care?
Informal: family & friends
Formal: institutionalized
What is the history of long term health insurance?
- Almshouses: people who were mentally ill, sick or orphans
- Depression-food stamps
- (1965) not-for-profit Nursing homes for Medicaid and Medicare
What were the abuses in Nursing homes in the 1970s?
- Low staffing and food quality
- over medicating
- physical restraints
- sexual abuse
Ombudsman’s program
Smoothing over tensions between residents and
What is a (SNF)?
Skilled Nursing Care
Funded by Medicare or Medicaid.
Care is provided by RNs and other staff
There is for-profit and not-for-profit SNFs
What is respite care?
Short term immediate care for the care-giver. No funding, unless someone does it for free.
Originally for respite for parents watching out for mental ill children
Medicare pays for it.
What is a (CCRL)?
Continuing Care Retirement Center-a community with housing, apartments, assisted living and nursing homes care all-in-one
What is a (NORC) ?
Naturally-occurring Retirement Communities: “aging-in-place”. It is a retirement community where many of the people are over 65 years.
