Exam 3.4 Flashcards Preview

HEP 3600 > Exam 3.4 > Flashcards

Flashcards in Exam 3.4 Deck (63):
1

Public health professionals

usually financed by tax dollars, available to everyone, primarily serve economically disadvantaged, public health physicians, environmental health workers, epidemiologists, health educators, public health nurses, research scientists, clinic workers, biostatisticians

2

Health care facilities

physical settings where health care is provided, inpatient care and outpatient care

3

Inpatient care facilities

hospitals, nursing homes, assisted living

4

Clinics

two or more physicians practicing as a group, do not have inpatient beds, for and not-for profit, tax funded

5

Outpatient care facilities

care in a variety of settings but no overnight stay, practitioner's offices, clinics, primary care centers, ambulatory surgery centers, urgent care centers, services offered in retail stores, dialysis centers, imaging centers

6

Rehabilitation centers

work to restore function, may be part of a clinic or hospital, or freestanding facilities, may be inpatient or outpatient

7

Long-term care options

nursing homes, group homes, transitional care, day care, home health care

8

Home health care

growing due to restructuring of health care system, technological advances, and cost containment

9

Affordable Health Care Act

goal to put American consumers back in charge of their health coverage and care

10

Structure of the health care system

US structure, complex, expensive, many stakeholders, intertwined policies, politics, major issues: cost containment, access, quality

11

Major goal of ACA

to increase the number of Americans with health insurance and decrease costs, unfortunately premiums are going up dramatically for most Americans as a result

12

Quality health care should be

effective, safe, timely, patient centered, equitable, efficient

13

Sources of health care payments

consumers, third party payments

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1st party payment

consumer pays the provider for services rendered using cash, flex plans, medical savings plans

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3rd party payment

government or private insurance pays the provider for services rendered

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Fee for service

patient pays a % of care

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Packaged pricing

bundled services

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Resource based relative value scale

Medicare's scale for reimbursement

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Capitation

prearranged agreement made between provider and insurer

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Prospective reimbursement

payments made ahead of need

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Premiums

regular periodic payments

22

Deductible

amount of money that the beneficiary must pay before the insurance company begins to pay for covered services

23

Co-insurance or co-payment

the portion or % of an insurance company's approved amounts for covered services that the beneficiary is responsible for paying

24

Fixed indemnity

maximum amount an insurer will pay for a certain service

25

Exclusion

a specified health condition that is excluded from coverage, the Health Insurance Portability and Accountability Act of 1996

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Pre-existing condition

a medical condition that has been treated six months before starting a health policy

27

Health Insurance Portability and Accountability Act (1996) and ACA (2010)

insurance companies can't make a pre-existing condition an exclusion for coverage

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Types of health insurance coverage

hospitalization, surgical, regular medical, major medical, dental, disability

29

The ACA mandates that

employers with 50 or more employees provide insurance coverage or pay a tax

30

Trends due to ACA

employers reducing full-time jobs, increasing part-time jobs, increased worker share of premium, raising deductibles, increasing prescription co-payments, increasing number of exclusions

31

Self-funded insurance programs

created for/by employers rather than using commercial insurance carriers, many benefits to employer, generally for larger companies unless low-risk employees

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Health insurance provided by the government

medicare, medicaid, CHIP, VA, IHS, federal employees, uniformed services, prisoners

33

Medicare

covers more than 47.5 million people, 65+, permanent kidney failure, certain disabilities, through FICA tax

34

Four parts of medicare

hospital insurance (A), medical insurance (B), managed care plans (C), prescription drug plans (D)

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Medicare part A

hospital, inpatient, mandatory, 100% coverage for hospital stays, hospice, and some health care, no premium, deductible, some co-pays

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Medicare part B

medical, voluntary but those with part A automatically enrolled, coverage for doctor services, outpatient hospital care, physical therapy, durable medical supplies, ambulance, diagnostic tests, blood screening, and preventive care, premium, deductible, copays

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Medicare part C + Choice plans (Medicare Advantage)

alternative to A & B and medigap plans, managed care plan, preferred provider plan, private fee-for-service plan

38

Mediare part D

prescription drug coverage, voluntary, 2 parts: discount card based on income, prescription insurance with premium, deductible

39

Medicaid

for the poor, costly budget item for states, noncontributory

40

Medicaid under ACA

eligibility based solely on income, extended to more low-income people, nearly everyone under 65 with income below 133% of poverty level could qualify, increases burden on states

41

CHIP

joint state-federal program, created in 1997, funding by increase in federal excise tax rate on tobacco, 8 million children enrolled

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Problems with medicare and medicaid

some providers do not accept, fraud, cost of programs escalating and will become insolvent unless tax revenue increased or benefits reduced, many concerned federal government overextended

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Supplemental health insurance

helps cover out of pocket costs, medigap, specific disease insurance, long-term care insurance

44

Managed care

goal to control costs by controlling health care utilization, provider panels, limited choice, gatekeeping, risk sharing, quality management, utilization review

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Types of managed care

PPO, HMO, Independent practice association (IPA), POS, medicare advantage

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National health care

a system in which the federal government assumes responsibility for health care costs of entire population, primarily paid with tax dollars, US only developed country without

47

National health service model

entire system owned and operated by government, UK, Spain

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Social insurance model

government is the only 3rd party payer, Canada, Germany

49

Consumer directed health plans

responsibility for health care decisions lies with the individual

50

High deductible health plan

brings down monthly payments, pay more out of pocket, incentive not to seek needed care or preventive care

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Health savings accounts

individual invests and the account grows tax free, money withdrawn tax free to pay for care

52

Health reimbursement arrangement

employer funded health savings account for employees

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Flexible spending account

employers allow employees to set aside tax free money for medical expenses in a given year

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Archer medical savings accounts

account funded by both individual and small business employer

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Affordable Care Act

1000 pages and passed without any bipartisan support, very controversial, goals to reduce costs and increase number insured, step toward national healthcare, profoundly increases the authority of DHHS

56

President's 8 principles of reform

protect families' financial health, make health coverage affordable, aim for universality, provide portability of coverage, guarantee choices, invest in prevention and wellness, improve patient safety and quality care, maintain long-term fiscal sustainability

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You can't have everything

pick two: good, fast, cheap

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Why costs are increasing

increasing population, aging population, increasing technology, changing patient expectations, service/cost detachment

59

For every dollar spent on newer medicines in place of older medicines

total healthcare spending is reduced by $6.17

60

Every additional dollar spent on healthcare in the US over the past 20 years

has produced health gains worth $2.40 to $3.00

61

Medical malpractice suits

encourage defensive medicine

62

Chronic illness

75% of health care spending, receive 56% of all clinically recommended care, substantial share of growth in healthcare spending

63

Nearly 60% of healthcare spending

happens during the last 2 weeks of life