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M6 13-005

Exam 18: Health Care Cost and Quality

TermDefinition
Economic factors effecting health care ↑ health Care cost. Aging population. Advancement in Technology. Healthcare Insurance. Malpractice Insurance.
With advanced age comes increasing demand on health care resources.
Advancement in technology, what's the issue? Research and development is costly. Cost is passed to consumer.
Healthcare insurance, what's the issue? Initially designed to defray cost to consumer. Lacked incentives to control cost. Providers and hospitals paid as they charged. Lack of insurance denies access to care.
Malpractice insurance, what's the issue? Very expensive. Increased claims have resulted in: -Over cautious approach to care -Increased tests and procedures
Financing the cost of health care, what's the issue? Healthcare reimbursement change has expanded the responsibilities and roles of the LVN/LPN because it is more cost effective.
Nursing case management A nursing specialty. Assigned to oversee care of patients. Assures access to required services. Coordinate and evaluate provided services.
Nursing Cross-training. Method using manpower to its fullest Individuals are trained to do a variety of duties depending on the needs Defined by the individual institution Practice can result ↓ of the number of employees while providing quality of care for the patient.
Types of Managed care systems Health Maintenance Organizations (HMO's). Preferred Provider Organizations (PPO's).
Health maintenance organizations (HMO’s) Group insurance plan. Fixed fee for services. Provide ambulatory, hospitalization and home care services. Utilizes “gate keepers” usually a primary physician who must authorize secondary care. Member responsible for all costs of unauthorized care.
Preferred Provider Organizations (PPO”s) Network of providers who discount their rates for plan members. Members pay higher rates if treatment is provided outside the network.
Impact of positive Economic Changes A reduction in the rate of growth in health care cost. Reduced redundancy in health care services. New and expanded roles for nurses.
Negative Impact of Economic Changes Decision making power moved from providers to insurance companies. Increased economic pressure on the consumer. Desire for profit conflicts with access to care. Hospital downsizing or closure.
Demand for evidence that hospitals and other health care providers provide quality, cost-effective care comes from Insurers Regulatory bodies (Joint Commission for Accreditation of Healthcare Organizations). Consumers.
Created by: jtzuetrong
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