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 |