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Health Policy
| Question | Answer |
|---|---|
| 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
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