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Health Policy

Actions & decisions by government bodies & professional organizations that affect whether or not healthcare organizations & individuals working within the healthcare system can achieve their healthcare goals Health Policy
What does successful policy development require? Collaboration & Partnership
The population that will benefit The cost of implementing the policy Support for the policy Availability of evidence supporting the need for the policy Concepts Related to Health Policy feature
The phases of Policymaking? Formulation Implementation Evaluation
The phrase that is similar to assessment & planning phase of the nursing process? Formulation --data & ideas are collected
Types of federal government agencies that develop & administer health policies? Department of Health & Human Services Occupational Safety & Health Administration
Sources of payment or reimbursement for healthcare services? Federal Programs Private Health Insurance programs Personal payments
Covers inpatient care, home health care, skilled nursing facilities & hospice Medicare Part A (Hospital Insurance)
Outpatient care, durable medical equipment & preventive appointments (Pap, flu shots, etc) Medicare Part B (Medical Insurance)
Run by private insurance, includes Plan D prescription drug coverage, & services such as hearing and vision testing Medicare Part C (Medicare Advantage plans like an HMO or PPO)
Prescription drug option/Help lower prescription drug costs Medicare Part D (Medicare prescription drug coverage)
Eligibility for Premium Part A? Over age of 65, spouse who has paid Medicare taxes >10yrs
Voluntary where consumers pay a premium. Partial payment due during office visits, annual deductible & 20% copayment Medicare Part B
Allows beneficiaries to enroll in private health insurance programs, medicare makes a payment to the insurer, insured must cover out-of-pocket expenses Medicare Part C
Medical expenses Medicare does NOT cover LT care, routine dental/eye care, hearing aids & cosmetic surgeries
People age 65 or older Younger people with disabilities People with end-stage renal disease Qualifications for obtaining Medicare --federally funded
Available for lower income individuals and families, the elderly & people with disabilities Medicaid
A STATE administered program Medicaid
A federal assistance program funded by general taxes SSI, Supplemental Security Income
Aged Blind Disabled Those who have little to no income All qualify for SSI -provides cash for "basic" needs
Provides health insurance to children under 19yrs of age whose families earn more than the Medicaid limits
The three basic private insurance plan types Employment-Based Plans Self-Employment-based plans Direct-Purchase Plans
Usually purchased by large employers Offer coverage to employees Employee pays premium Group Health Insurance
Extends coverage to include the spouse, dependents or domestic partner Employment-Based Coverage
Benefits of Group Health Insurance Lower costs & availability of coverage
Available only to individuals who are 'self-employed' Self Employment based health insurance --only the policy holder is insured
A set amount paid at the time of service Co-Payment
Most restrictive type will not cover 'out of network' services & patients must select a primary care provider (PCP) HMO, Health maintenance organizations
The advantage of Point-of-Service (POS) Flexibility and Freedom of choice it offers
Allows insured to self-select healthcare providers Indemnity
A Employer-Sponsored Coverage that combines private plans with HSA or HRA Consumer Driven Healthcare Plan, CDHP
Ways to classify healthcare systems? Examining the types of prevention activities Look at the environment (types of health) Look at the models for healthcare delivery
What is the government officials roles in Health Policy? Hearing Citizens concerns Gathering info about reported issues Forming solutions Identifying political considerations Choosing the best solution Drafting Laws
Government officials evaluate proposed solutions based on what factors? Cost & Benefits Anticipated effectiveness Efficiency & Safety
Created by: 3jmomshellb