Healthcare Delivery System Flashcards
(31 cards)
In 2021 the US government spent $ 4.5 billion on healthcare. Where did most of this money go?
- Hospital Services
- Physician Services
- Prescription drugs.
What is meant by defensive medicine, and why is it a problem?
The doctor will prescribe something or do a procedure because they are afraid of missing something or getting sued. This is money wasting.
What is the 3rd leading cause of death in the US?
Medical error.
How does medical error contribute to rising healthcare costs?
The hospitals needs to spend money on treatment when they are correcting medical errors. They stay in hospitals longer and the hospitals eats the cost.
What are other reasons for high healthcare costs?
Reduced staff availability in healthcare.
Technology costs.
Equipment costs.
To reduce cost, should our focus be on prevention or management of the disease?
Prevention
What is the reliable care accountability matrix?
C-diff prevention -Handwashing with soap and water, PPE use.
CAUTI prevention -Remove unnecessary catheters to reduce infections.
Surgical Site Infection Prevention - Antibiotics during surgery, proper hand hygiene
Length of Stay Management - Set appropriate hospital stay durations by diagnosis.
Readmission Prevention - Ensure patients don’t return for the same issue after discharge.
Mortality Reduction - Address serious symptoms promptly (e.g., ventilator bundles to prevent pneumonia).
Experience of Care -Use patient feedback to improve care quality
These are all Hospital Core Measures.
What are strategies we can take to reduce health care costs?
Prospective Payment System - Diagnosis- Related Group ( Hospital reimbursement based on diagnosis and specific stay durations ) and the Resource Utilization Group (Focuses on long-term care)
Capitation & Managed Care : Primary care providers manage care and refer to specialists when needed. Providers receive a fixed annual amount, motivating efficient care. Physician receive fixed amount per year for patients, less visits more money.
Bundled Payments : Tests and services are grouped into a single payment package.
Rate Settings : Uniform prices encourage hospitals to compete on customer service quality.
Comparative Effectiveness Analysis : Insurance companies choose cost-effective procedures (e.g., X-ray vs. CT scan).
Increasing Patient Cost Sharing : Deductibles, co-pays, and co-insurance reduce unnecessary doctor visits.
What happens to Hospitals with a high patient infection rate?
Hospitals with high patient infection rates may face reimbursement cuts from Medicare.
What are the goals of the affordable care act?
Improve patient satisfaction, reduce healthcare costs, and enhance healthcare delivery.
What is meant by expanded coverage in the affordable care act?
o Medicaid expansion.
o Children can remain on parents’ insurance until age 26.
o Coverage for pre-existing conditions.
o Subsidized premiums for affordability.
How can the Affordable Health Care act promote cost control?
o Early disease detection through Medicaid access prevents costly ER visits.
How are we able to Increase Primary Care Providers?
o More insured individuals require more healthcare providers.
o Nurse Practitioners can serve as primary care providers.
What is meant by Out of Pocket payments?
Patients pay cash for services without any insurance that aid in the cost.
What is Individual Private Insurance?
Healthcare is expensive, so purchasing health insurance can help with cost associated with healthcare expenses. If patients cannot afford the premium there is The Affordable Healthcare Act and Marketplace to assist (government will subsidize premium)
What is Employer-Based Insurance?
Employer will provide but person needs to pay a certain amount of the premium. It’s a share.
What is meant by Government Financed Healthcare - Medicare ?
Medicare for 65 yrs and above if you have contributed to Medicare for 10+ yrs.
Part A of Medicare is inpatient coverage – They pay most of your bills.
Part B Medicare is outpatient coverage – You need to purchase this insurance.
Part D Medicare is drugs – There is a premium.
Medicare advantage plus (C) which you purchase covers A,B, and D. Advantage plus also covers gym membership, hearing and vision aid.
What is meant by Government Financed Healthcare - Medicaid ?
For poor individuals. Low income and disabled people.
You can have Medicare and Medicaid at the same time.
What is meant by Government Financed Healthcare - Children’s Health Insurance Program (CHIP)?
For children of families of low income that have Medicaid. If Medicaid doesn’t cover the expenses then the Children’s Health Insurance Program (CHIP) will. CHIP is both federal and state.
What are the 3 levels of healthcare facilities?
Primary Healthcare
Secondary Healthcare
Tertiary Healthcare
Explain Primary healthcare.
For common ailments like a common cold.
You go to your primary care physician, PA or NP. These are clinics and urgent care. Here they can do injections, labs, prescribe meds and health teachings and screening tests.
When going to family planning center, they have prenatal care.
Explain Secondary healthcare.
Hospital services. Common diseases. Diabetes. Management of chronic diseases.
Explain Tertiary healthcare.
Hospital services. Common diseases and rare and complicated diseases. Ex worsening of Diabetes. Worsening of chronic diseases.
What are the roles of the nurses in hospitals?
Main employer of Nurses. Nurses provide the most direct care. There are also nurse managers, nurse educators, nurse researchers etc. that do not do direct patient care.
