Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Healthcare Systems
| Question | Answer |
|---|---|
| Purporse | help others by providing healthcare services |
| structure | mission, vision, values; private or public profit vs. nonprofit; collective of rules and government |
| members | different workers throughout the organization |
| Examples of Healthcare organizations | hospitals, clinicals, ambulatory care, skilled nursing, hospice, specialty organizations (VA, IHS) |
| accountable care organizations (ACOs) | groups of doctors, hospitals and other organizations that come together to give, coordinated, high quality care to medicare Pt.; evidence based care, bulk of services to medicare Pt., must have defined processes and report dates, reg. CMS and Fed. trade |
| Goals of ACOs | ensure Pt. especially chronically ill, get the right care at the right time, while avoiding duplication of care and medical errors; receive share of savings if goals are met; promote prevention and decreased cost |
| Magnet Hospitals | adopt organizational practices that promote excellence nursing practice; empowers nursing staff to achieve higher levels of performance through engagement and participation; meant to retain and attract excellent nurses; nurses are a critical component |
| Healthcare economics | the study of supply and demand of resources and its effect on the allocation of health care resources in an economic system; represents availability of HC resources and financing to pay for resources |
| healthcare finance | arrangements made to pay for these goods and services |
| Healthcare economics human propositions | human behavior is purposeful or goal directed implying that persons act to promote their own interests human demands are unlimited |
| Characteristics of healthcare economics | price and cost, supply and demand, cost effectiveness, efficiency, value |
| value | cost effectiveness and outcomes achieved not volume of services delivered |
| Fee for service | basic fee for the services provided to patients and is not related to outcomes in any way, can result in unneeded procedures, amount paid is negotiated between HCP and insurance company |
| Pay for performance | attaches financial incentive or disincentive wo metric driven outcomes, best practices, and Pt. satisfaction; rewards quality of car over quantity of care, still a fee for service program |
| How can nurses contribute to pay for performance plans | Pt. education, documentation, collaboration, patterns of care |
| Healthcare policy | goal directed decision making about health result of authorized, public decision making processes, public health policy is established in laws and regulations at the federal and state level; enforceable by agency that implemented policy |
| Examples of health policy | decisions r/t federal subsidies for education of HCP, state regulations that cover insurance benefits, court decisions that overturn state regulations based on constitutional arguments |
| Healthcare Policy Process | 1) agenda setting 2) policy formulation 3) policy adoption 4) policy implementation 5) policy evaluation |
| agenda setting | health related issue identified, help frame the issue (creating a perspective on the issue) |
| Policy formation | different policy interventions considered |
| policy adoption | intervention is adopted |
| policy intervention | carrying out the intervention |
| policy evaluation | did the policy meet the goals |
| Federal agencies | oversee federal programs such as medicare |
| State agencies | oversee state programs; SBON, State Health Dept. |
| Local Agencies | administer state programs; may be in charge of food safety, sanitation, immunizations, other public health programs; City Health, County Health |
| International Organization | WHO |
| Accredidation | process of gaining recognition through peer review; evaluation of the quality of an organization based on the standards and criteria of the organization |
| Accrediting agencies influence | national quality and safety standards as well as advancement of healthcare policy; TJC, DNV |
| Nurses role in accredidation | help develop, revise, or facilitate use of policies and procedures that are current and evidenced based; participate in their organizations self review activities; participate in meetings and survey teams |
| Medicare | for 65 years and older, disabled, end stage renal disease, federal program has parts A-D |
| Medicaid | low income, LTC financing, state and federal, determined by income; state based |
| Affordable Care Act (ACA) | make affordable health insurance, premium tax credits, expand medicaid program, supposed to change way healthcare decisions are made, decrease costs, no limits on benefit, up to 26 y/o on parent policy |
| EMTALA | prevents denial of emergency service requires screening of Pt. |
| cost effectiveness | used to determine if the value is worth the cost |
| efficiency | reducing waste and utilizing resources to the best value for the money |
Created by:
melsniv