PI Final Flashcards
5 exemplary leadership practice
- model the way
- inspire a shared vision
- Challenge the process
- enable other to act
- encourage the heart
PBL definition
this is any learning environment in which the problem drives the learning
Financing
payment for service
delivery
providing service/care
4 types of health care financing in the US
- out of pocket payment
- individual private insurance
- employment based group insurance
- government - social insurance model
individual private insurance consists of
a deductible and a co-payment
deductible
amount of medical charge that must be paid by the patient before insurance companies will pay for the remaining charge
Co-payment
amount of money patient pays provider directly at each visit
public/private insurance
medicare: private delivery, public payment; government pays private deliveries
public-public
like the military; the public money and public delivery
VA/civilian:
employee of the government or public servant
Government financing takes up what percent of all healthcare financing?
43%
this includes medicare, medicaid, CHIP, and other
what is the most abundant type of healthcare financing?
A Health insurance plan at 77.3%
Voluntary health insurance providers include:
- Blues (Blue cross and Blue shield)
- Private/commercial insurance
- HMOs
Blue Cross Blue Shield
Blue cross: hospital coverage; Blue shield: physician coverage
Private/commercial insurances
- UHC
- Anthem BC
- Aetna
- CIGNA
- Wellpoint
- Humana
HMO’s
- kaiser
2, GH - HIP
- Partners healthcare
T/F insurance is a state function
True- it is sold/regulated differently in each state
Social Health insurance
- Worker’s comp
2. medicare
Worker’s Compensation
- offered in all 50 states
- covers medical costs and cash replacement of lost wages
- only 66% of lost wages replace tax-free and gives incentive to get back to work
Medicare
- funded by SHI US trust fund and trust fund from Americans
- has two parts ( A and B)
Medicare Part A:
- Hospital Insurance
- funded by social security withholding payroll taxes
- copays: hospital deductable pay the first 1184 per benefit period
Medicare Part B
- Clinical services/physicians
- covers supplementary medical insurance (physicians, supplies, tests, out-pt services, health visits, preventative care, paps, mammograms, physicals, no copay, coinsurance
- funded by 64% general federal taxes
- 36% premiums of part A also funded
Medicare Modernization act
- Part D provides outpatient drug prescription through private companies
- part C is the Medicare Advantage
- Drugs discount cars preventative benefits
