Flashcards in 9,10,11,13 Test 2 Deck (58):
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?
-Medicare disability fraud
Drivers for health care expenditures
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.
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?
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.
1. Assessment of needs
2. Policy development
3. 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
What is the history of long term health insurance?
-Almshouses: people who were mentally ill, sick or orphans
-(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
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.
What is (ORT)?
Operation restore trust: (Federal and State agencies working together to protect health care trust funds and enhance quality.) Targeted quality control of Medicare billing practices
What is (OASIS) ?
Outcomes and assessment information set: reporting patient condition and satisfaction
What are social factors impacting long-term Care?
Social things like single parenting, divorce, small family size and geographic distance can prevent someone getting care from their family
Top health care expenditures.
2. Physicians & clinical services
3. Prescription drugs
Is health insurance really insurance?
No, because you’re not putting in in case of an insident, you know you will do it.
What is HEDIS ?
(Health care effectiveness data and information set): HOSPITAL COMPARE. Data collection tools to publish value satisfactoring of public.
How was Medicaid and Medicare enacted?
It started in (1965) with for-profit nursing home care. Part A:(hospital insurance)-If you work 10 years you can get it and put it towards your retirement. Part B: (Medical insurance)-Funded by general taxes. You pay a premium. Part C (HMO) Part D (prescription drugs.)
What is CHIP?
(Children’s Health Insurance Program)- If the child’s family is on Medicaid the (uninsured) child can qualify. Largest expansion of Medicaid coverage.
Health Insurance Exchange?
(In Idaho) you can go onto this website if you don’t have health insurance and buy the one that’s right for you.
What do Institutional Long term care facilities have in them?
Many different types of staff
Coordinated care for terminally ill w/ palliative care for physical and emotional care.
Can be in many different settings
Why older adults don’t want to get help for their mental illness?
-substance abuse is involve and hard to treat medical conditions w/ substance abuse
-fear of stigma
-stereotypes about aging
Is prayer used as a form of medical treatment? Is it right?
Yes prayer is. No, it isn’t.
What is a large population of people you see in jail?
The mentally ill or behaviorally challenged.
What happened to institutionalized peoples in 1970s-1980s?
People were deinstitutionalized. They were like nursing homes and people couldn’t get out of them. People had to assess their rights and then let them out into the community.
Relationship between insurance deductibles and premiums?
The higher the deductibles the lower the premiums.
(National Committee for Quality Assurance). QUALITY, QUALITY, QUALITY. They accredit MCOs and PPOs. Publishes health care data for businesses.
Parity Health Insurance
It gives more coverage for mental health coverage through a persons health insurance plan.
Parity*- we treat them equally
Non- Parity*-we don’t treat them equally
Canada physicians pay
Canada physicians get paid a lot and they are even saying they should give some of their money back to go towards the public.
What is Staff model? IDA Model? MCOs? PPOs? Point of service?
Kaiser. Physicians bind together. Within system. Only go to physicians on list-w/ discounts. Allows patients to go outside of service w/ copays.
People weren’t able to pay off ambulances because of what?
What allows doctors to get paid off of the probe of living?
What made it so that patients didn’t have to pay for a 2nd time problem, caused by the hospital?
What program bundled physicians together?
What did the readmission reduction program do?
Reduced the amount of people that were deadlifted to the hospital in a certain period of time.
What is a caregiver need, that allows the caregiver to have a family medical leave?
Is Adult day care, money out of pocket?
Have coats gone up for mental health?
What is co-morbidity?
People have more than one disorder at once.
What is ROSC?
A community holistic approach to managing mental health disorders.
What are “carve-outs” and “recovery model”?
“Carve-outs” are managing mental health
“Recovery model” is client developed goals
What does (DHHS) have to do with community health?
It is Department of Health and Human Services. It is for disease, children, prevention, FDA etc.
What is the overarching goal of healthy people 2020?
Link to healthy people website.