Allied Health Exam 2
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Late 1800's to the Early 1900's set the stage for health insurance due to the | show 🗑
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Health Insurance began as | show 🗑
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show | national health care plan.
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show | center stage.
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AMA & AHA opposed | show 🗑
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AMA & AHA 1948 | show 🗑
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show | first broad-coverage health insurance in the U.S., originally designed to make cash payments to workers for wages lost because of job-related injuries and disease
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private health insurance has prevented | show 🗑
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Group Hospital Plan and Birth of Blue Cross | show 🗑
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show | coordinated them into a Blue Cross network
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Blue Cross Network transformed insurance from a mechanism to reimburse for lost wages to one that | show 🗑
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Blue Cross was non profit and there were no | show 🗑
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show | Blue Cross Association.
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In 1946 Blue Cross was in | show 🗑
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Blue Cross was the birth of | show 🗑
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show | Blue Cross structure.
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show | hospital plans, and was AHA endorsed for ONLY hospital care.
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show | 9% to 57%
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In 1939, the California Medical Association started the first | show 🗑
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show | physician fees.
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show | medical profession's own financial interests.
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Blue Shield was AMA | show 🗑
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show | merged, today they are a joint corporation, and are in almost every state.
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During World War II, employees accepted employer-paid health insurance to | show 🗑
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Congress made employer-provided health coverage | show 🗑
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show | union-management negotiations
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show | health insurance.
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show | provide coverage.
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show | primary source of payment of healthcare services in the U.S.
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show | Collection of premiums
assumption of risk, responsibility for delivery of services, making of payments to providers
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Health Care Expenditures are | show 🗑
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show | cost of resources required to maintain a health care delivery system
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show | down.
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Cost is related to the charge to the patients and insurance companies | show 🗑
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Expenditures occur in 4 major areas | show 🗑
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show | source of money used to run a business
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show | price increase in economy, life expectancy increases (more medical care needed), technology and research increases (increased cost).
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Four main areas that account for health care spending include | show 🗑
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show | Demand is determined by the process of goods and services on the one hand and people's ability to pay on the other
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show | price of services.
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Effects of financing and insurance include | show 🗑
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Negative effects of financing and insurance include | show 🗑
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Moral Hazard + provider-induced demand = | show 🗑
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show | restricting the availability of expensive medical technology and care (i.e. insurance will only pay for some procedures)
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Demand-side rationing | show 🗑
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show | many payers, many forms of payment, many programs and many reimbursement options.
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show | patients (directly pay portion of the total cost of services) and the employers and government which are the primary financiers of health care.
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show | own care and pay for those who can't afford it.
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show | wages, medicare tax is also deducted from pay as a prepayment for when 65.
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General taxes subsidize health care for | show 🗑
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show | pay into catastrophic health for the uninsured.
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show | private insurance programs, public insurance programs, uncompensated or charity care.
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show | private (voluntary/personal) and public (government).
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Private health insurance includes | show 🗑
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show | medicare and medicaid, and state children's health insurance.
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Financing is | show 🗑
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show | have access to health care
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show | method of payment for health care services
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show | person for whom the policy is for
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Insurer (3rd party payer) | show 🗑
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show | individuals providing care or services
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show | plan that employee chooses; contains the conditions and services under which payment is made
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show | cost (usually by monthly fee) that is paid by the insured for coverage
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show | legally binding contract of the insurance plan
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Enrollment period | show 🗑
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Deductible | show 🗑
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show | at time of service; patient pays for a portion of the services up front
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show | clause that determines which insurance pays for services if insured has more than one
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show | patient pays provider directly from own savings – no insurance involved
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show | insured purchases insurance to cover certain benefits; pay provider at time service is provided
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show | insured pays fixed, predetermined amount for services rendered
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Coding | show 🗑
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Billing | show 🗑
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show | form sent to insurance company explaining charges incurred by the patient
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Explanation of Benefits (EOB) | show 🗑
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Risk | show 🗑
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show | protects against risk
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show | an individual protected by insurance
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show | an insurance agency that assumes the risk
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Underwriting | show 🗑
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A insurance policy premium is based on | show 🗑
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Four principles of insurance risk include | show 🗑
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Restriction of usage | show 🗑
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show | want to spread the risk
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show | health care costs.
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show | physicals, denial for preexisting conditions, some may accept those with preexisting conditions but not cover costs related to those conditions.
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Due to risk management many people who are most in need of health insurance | show 🗑
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Cost Sharing | show 🗑
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Insurance requires some type of | show 🗑
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show | risk.
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Cost sharing reduces the misuse of | show 🗑
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show | cost share lowers utilization without lowering quality
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Three main type of cost sharing in private health insurance include | show 🗑
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show | both parties pay premium.
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show | payment before insurance pays
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show | out of pocket expenses patient contributes to care.
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show | percent of bill insurance pays after deductible.
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Stop loss provision | show 🗑
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Lifetime cap may be part of insurance | show 🗑
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show | insurance companies, managed care organizations, BlueCross BlueShield, government
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Reimbursement | show 🗑
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Types of reimbursements include | show 🗑
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Fee-for-service | show 🗑
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show | number of related services in one price, reduce provider induced demand because fees are inclusive of all bundle services.
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show | Under the omnibus budget reconciliation act of 1989, medicare developed the program to reimburse physicians according to "relative value" assigned to each service, based on time skill, intensity to provide service.
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show | used by PPOs
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Capitation | show 🗑
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Retrospective reimbursement | show 🗑
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Prospective reimbursement | show 🗑
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Four main prospective reimbursement methods are | show 🗑
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Diagnosis Related Groups (DRGs) | show 🗑
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show | Implemented August 2000, medicare's outpatient prospective payment system (OPPS) for services provided by hospital outpatient departments. Bundled rate, reimbursement rates are associated with each APC group.
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Resource Utilization Group (RUG) | show 🗑
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show | A fixed, pre-determined rate for each 60-day episode of care, regardless of services given. OASIS, outcomes and assessment information set used to rate a patient's functional status and clinical severity. Assessment measures translate into points.
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Patient Protection and Affordable Care Act (ACA) 2010 | show 🗑
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Two functions of financing are | show 🗑
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Sources of financing health care are | show 🗑
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When ACA is fully implemented in 2014, burden of HC spending will shift to | show 🗑
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show | private insurance, which is mostly employer based.
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Private or voluntary/personal insurance types include | show 🗑
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High deductible health plans can also be group or | show 🗑
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Managed Care organization can also be individual as well as | show 🗑
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show | medicare and medicaid, state children's health insurance.
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show | mandatory.
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Private insurance is available in single or | show 🗑
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show | employer based.
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There are many different types of private insurance providers such as | show 🗑
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show | the insurance company.
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Those covered by individual private health insurance can pick options of coverage based on | show 🗑
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Those with individual private health insurance may include | show 🗑
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show | individually determined.
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show | coverage picked.
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Within individual private health insurance high risk people are often unable to receive | show 🗑
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show | employer, union, or professional organization.
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Group insurance anticipates large numbers of | show 🗑
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show | equally among the insured.
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show | comprehensive coverage.
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Self Insurance is where the employer | show 🗑
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Self-insurance occurs when large employer's work forces are | show 🗑
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show | medical experience.
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show | pay all claims incurred by employees.
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Within self-insurance high losses are covered through reinsurance which is | show 🗑
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Consumer Driven Health Plans (CDHP) feature high | show 🗑
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Consumer Driven Health Plans gives consumers greater control and responsibility | show 🗑
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show | Pay less for health care but still covered for catastrophic illness.
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HDHPs feature low | show 🗑
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Within HDHPs preventative care is typically not | show 🗑
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Within HDHPs yearly cap is based on | show 🗑
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show | HSA or health savings account and HRA health reimbursement arrangement.
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show | health savings account, mainly the employee contributes to saving account on a tax-deductible bases, money in account is used to pay for health services until the high deductible is reached.
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In a HDHP/HSA there is a cap on out of pocket | show 🗑
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Within a HDHP/HSA there is a tax advantage because the account is | show 🗑
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show | exempt payments made for qualified medical expenses.
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Within a HDHP/HRA employees pay medical expenses, premiums, and LTC insurance and then the employee is | show 🗑
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A HDHP/FSA is a flexible spending account it is similar to an HSA but | show 🗑
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Managed Care Organization is a type of | show 🗑
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The three critical factors in differentiating between the types of MCOs are | show 🗑
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The most critical factor in differentiating between the types of MCOs is the | show 🗑
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show | health maintenance organization HMO, preferred provider organization PPO, exclusive provider organization EPO, and point of service organization POS.
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show | low premiums but less options, are copay driven rather than deductible, part of your premium goes to medical group whether you use or not, capitation is the primary method of reimbursement, increase in fee for service.
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Health Maintenance Organizations are restrictive meaning | show 🗑
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HMO's are referral based meaning they are | show 🗑
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show | preventive and screening services, "health maintenance" within the organization.
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HMO models include | show 🗑
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HMO staff model features fixed salaried MD on staff in a | show 🗑
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show | sometimes hospitals, that service only those enrolled in HMO.
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show | deliver care.
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show | MDs.
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show | utilization.
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In an HMO staff model you need a large number of enrollees to | show 🗑
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Enrollees in an HMO staff model are limited on the MDs | show 🗑
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HMO Group model contracts with a multi-specialty | show 🗑
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show | group practice.
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show | one or more hospitals for specialty services.
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show | control over utilization.
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In an HMO group model the HMO pays group practice to | show 🗑
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Independent practices can also treat | show 🗑
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show | one that is administratively tied to the HMO-service exclusive to HMO members.
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HMO network model contracts with | show 🗑
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HMO network model is suited for operations in large metropolitan areas and across widespread geographic regions where | show 🗑
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In an HMO network model the patient chooses | show 🗑
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show | capitation.
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show | all MD services.
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In an HMO network model doctors can make referrals to specialists but | show 🗑
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show | no central overseeing agency.
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show | HMO and providers.
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show | bearing entity.
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The IPA is paid a capitation fee by the | show 🗑
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show | directly with MDs
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An IPA establishes contracts with both independent solo pracitioners and | show 🗑
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show | MD groups.
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In an IPA HMOs may create and invite area | show 🗑
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An IPA is hospital based and structured so that only certain | show 🗑
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IPA assumes the responsibility for | show 🗑
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In an IPA MDs are responsible for providing services but logistics of arranging MD services are shifted to the | show 🗑
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Preferred Provider Organization or PPO is the | show 🗑
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In a PPO enrollees have more control over care decisions and are rewarded with | show 🗑
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show | referral based, patients manage and negotiate contracts with preferred providers in and out of network, more treatment options and no PCP.
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A PPO is more flexible but the premium is | show 🗑
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In a PPO group practice is paid by | show 🗑
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show | plan that is paid annually.
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In a PPO patients can use out of | show 🗑
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show | network, you can see specialist without referral or prior approval, leads to little control over utilization.
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show | reduced fees.
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show | service at an agreed upon reduced rate.
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show | patient population.
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show | HMO and PPO.
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show | of network benefits, choose at time of medical service who to seek care from, allows the enrollees to seek out of network care at a higher out of pocket cost.
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In a POS providers paid by | show 🗑
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In a POS gatekeepers may be used to | show 🗑
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In a POS it is referral based, pick your primary care practitioner and specialty care with referrals for | show 🗑
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show | driven model.
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COBRA | show 🗑
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COBRA is aimed to reduce gaps in | show 🗑
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show | 18 months.
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show | 36 months.
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In COBRA you must pay entire premium but it is still | show 🗑
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show | any form of insurance NOT subsidized by the government, includes individual and employer-based.
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show | employer driven.
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show | vary.
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show | financed.
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Accounts for 45.4 percent of total US health care expenditures | show 🗑
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Piecemeal was the addition of new programs and | show 🗑
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In 2010 31 percent are covered by | show 🗑
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Public financing supports categorical programs, not public in the sense that | show 🗑
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Categorical programs are each designed to benefit a | show 🗑
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Medicare and medicaid are categorical programs and were created under the | show 🗑
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show | widely available source of payment for health care.
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Before 1965 private health insurance was available primarily to | show 🗑
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show | government overseeing health care.
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Americans wanted reform initiative for the underprivileged whose | show 🗑
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show | opposed because it was a threat to the MD patient relationship, there was public debates that supported this bill resulted in compromise reform.
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1960 Medical Assistance Act also known as the Kerr-Mills Act | show 🗑
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show | implement, it was deemed ineffective.
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show | top priority.
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AMA urged congress to expand | show 🗑
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show | Medicare Part A which included hospital and nursing home, medicare part B MD premium based and medicaid which made poor eligible.
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show | title 18 of the social security act.
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show | title 19 of the social seurity act.
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show | select populations.
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Medicare and medicaid are financed by the government but delivered by | show 🗑
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Medicare and medicaid put a huge burden on | show 🗑
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show | people 65 years or older, disabled of any age who are entitled to benefits for at least 24 months, people of any age with end-stage renal disease, and Lou Gehrig's disease.
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show | Agency under the US department of health and human services that administers the program. Enrollees expected to grow.
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show | everything.
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Medigap policies cover | show 🗑
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show | Hospital insurance HI
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Medicare Part B | show 🗑
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show | Medicare advantage
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Medicare Part D | show 🗑
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show | social security tax and covers inpatient services, short term convalescence and rehab in a skilled nursing facility, home health, hospice, managed care, and administrative costs.
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show | primary care MD
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show | doctor, hospital, other providers and facilities but must be medicare approved.
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Medicare covers most | show 🗑
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Those with medicare may also have other coverage through | show 🗑
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Those with medicare pay | show 🗑
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show | benefit period.
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show | hospitalized.
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Benefit period ends when the beneficiary | show 🗑
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show | benefit periods.
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Medicare acute care hospital benefits include | show 🗑
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Medicare acute hospital benefits include all expenses paid for first 60 days after | show 🗑
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Medicare acute hospital care requires a copayment from | show 🗑
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show | 90 days.
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Acute care hopsital benefits includes a higher copay after | show 🗑
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show | 90 days.
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show | 190 days lifetime.
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Medicare acute care hospital benefits include private funds, medigap insurance and medicaid kicks in after | show 🗑
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Medicare certified SNF benefits eligibility begins after | show 🗑
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Medicare certified SNF benefits have a 100 days | show 🗑
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show | hospital and related to hospitilization.
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show | 20 days, then a copay from days 21-100.
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show | require intermittent or part-time skilled nursing care or rehabilitation care.
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show | 100 home visits after hospitalization.
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show | 80 percent.
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In order for those under medicare to receive the hospice benefit the patient must be | show 🗑
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Medicare hospice only need a token copayment required | show 🗑
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show | physician insurance/supplementary medical insurance SMI
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Medicare is financed partially by | show 🗑
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You are automatically enrolled in | show 🗑
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Medicare is voluntary enrollees pay monthly | show 🗑
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Medicare covers | show 🗑
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show | Medicare Advantage which was formerly the medicare + choice 1998.
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Medicare Advantage 1998 was part of the | show 🗑
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Medicare advantage does not specifically include additional | show 🗑
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show | Part A, B, and D
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Medicare Part C eliminates the need for | show 🗑
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In order to enroll in Medicare part C you must be | show 🗑
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show | private MCO, which must follow Medicare rules.
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show | captivated fee structure from Medicare, premiums that are set by MCO, may have copays deductibles and a gatekeeper depending on the plan, HMO, PPO, fee for service, etc.
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show | accept the plan coverage and fee terms.
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Medicare Part C provids all of Part A and B coverage, some offer | show 🗑
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show | Prescription Drug Coverage 2006
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show | Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003
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show | Part A and B, but you must apply.
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show | Stand alone prescription drug plans (PDPs) – for those in Part A & B
and Medicare Advantage Prescription drug plans (MA-PD) – part C beneficiaries
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Medicare Part D is | show 🗑
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show | comprehensive coverage, no vision, eyeglasses, dental, hearing aids, or routine exams.
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show | pap smears, glaucoma screenings, cholesterol and prostate screenings, and pneumonia vaccines.
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Medicaid is title 19 of the | show 🗑
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Medicaid is state financed health care for | show 🗑
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show | state and federal govt.
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show | federal funds according to the states per capita income, more income equals less funding, federal matching funds are dependent on services.
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show | Each state establishes its own eligibility criteria according to income and assets, covered services and payments to providers vary considerably from state to state.
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Medicaid Disabilities everyone is | show 🗑
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show | disabled with income above regular medicaid limits.
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show | is 15,000.
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Medicaid covers | show 🗑
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show | ACO
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Affordable Care Act of 2010 | show 🗑
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show | Created in 1997 under title 21 of the social security act to reduce the number of uninsured children in low income families.
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show | approved by congress and signed by President Obama
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show | not covered under private insurance.
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CHIP is a low cost insurance for children in families who earn too much to qualify for | show 🗑
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show | medicaid coverage.
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States can use existing Medicaid, create a separate CHIP program, or use a | show 🗑
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CHIP covers | show 🗑
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show | Consolidated Omnibus Budget Reconciliation Act of 1985
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COBRA reduces gaps in coverage for | show 🗑
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In COBRA employer must extend benefits to | show 🗑
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show | spouse or dependent up to 36 months.
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show | cheaper than purchasing own insurance.
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show | meet eligibility criteria to become beneficiries.
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Public insurance includes | show 🗑
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Iron triangle | show 🗑
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Past attempts at universal health care access have failed because increasing access means more | show 🗑
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show | national.
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|
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show | compares medical inflation to general inflation, measured by annual changes in the consumer price index, also compares changes in the national health spending to changes in the gross domestic product.
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|
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show | providers and individuals.
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|
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show | employers who purchase insurance, providers who deliver services, consumers of health care.
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|
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show | the ACA.
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|
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The united states has a very high amount of health care expenditures as a percentage of | show 🗑
|
||||
Highest amount of health care expenditures is spent on | show 🗑
|
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Rising health care expenditures have been attributed to | show 🗑
|
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Third party payment leads to | show 🗑
|
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show | demand.
🗑
|
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show | competitive markets.
🗑
|
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show | true cost of production.
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|
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Growth and intensive use of technology have a direct impact on | show 🗑
|
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show | expensive to develop, once developed creates new demand for use, technology also raise the expectations of consumers about what medical science can do to diagnose, treat disease and prolong life.
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|
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show | 3.5 times the rate of other age groups.
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|
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With increased life expectancy and the aging of the baby-boomer generation there are | show 🗑
|
||||
Elderly drive up health care costs because chronic conditions | show 🗑
|
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show | medical intervention while, de emphasizing medical prevention.
🗑
|
||||
High cost is due to the medical model of health care delivery because health promotion and disease prevention | show 🗑
|
||||
Administrative costs are costs associated with | show 🗑
|
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show | 24-25% of all health expenditures.
🗑
|
||||
show | the US has many legal risks for providers, this leads to tests and service that are not medically justified, but are performed by physicians to protect against malpractice lawsuits.
🗑
|
||||
show | health care costs.
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|
||||
High cost in the health care system is also due to wast and abuse which involves | show 🗑
|
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show | billing claims or cost reports are intentionally falsified.
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|
||||
Fraud is a major problem in | show 🗑
|
||||
Practice variations are referred to as | show 🗑
|
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show | differences in practice patterns and have been associated with geographic areas of the country.
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|
||||
show | US delivery system.
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|
||||
Practice variations increase health care costs without better | show 🗑
|
||||
show | not been successful.
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|
||||
Implementing a system wide cost control initiative has | show 🗑
|
||||
show | where providers make up for lost revenues by increasing utilization or charge higher prices in other areas free of control.
🗑
|
||||
The strengths of the US health care system also contribute to | show 🗑
|
||||
show | the most expensive means of providing health care in the world.
🗑
|
||||
show | hospitals with PPS and physicians services with resource based relative value scales.
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|
||||
show | health planning, price controls, peer review, and competitive approaches.
🗑
|
||||
show | align and distribute health care resources that would achieve health outcomes for all, supply side rationing.
🗑
|
||||
Health planning does not fit well in the US due to | show 🗑
|
||||
show | price for inpatient hospital care.
🗑
|
||||
Price controls included the conversion of hospital Medicare reimbursement from a retrospective to a | show 🗑
|
||||
Peer review is the process of medical review of | show 🗑
|
||||
show | reasonable, necessary, of quality and provided in an appropriate setting, can deny payment if care does not meet with their standards.
🗑
|
||||
PROs are also referred to as | show 🗑
|
||||
Competition is | show 🗑
|
||||
show | providers of health care services try to attract patients who have the ability to choose from several different providers.
🗑
|
||||
Demand side incentives are | show 🗑
|
||||
show | antitrust laws in the United States, which prohibit business practices that stifle competition among providers such as price fixing, price discrimination and mergers.
🗑
|
||||
show | cost efficient.
🗑
|
||||
Quality is defined as | show 🗑
|
||||
The institute of Medicine in their evaluation of quality leave out the roles of | show 🗑
|
||||
The institute of medicines definition of quality has implications that | show 🗑
|
||||
According to the institute of medicines implication of quality professional consensus is used to develop | show 🗑
|
||||
Quality indicators can be both | show 🗑
|
||||
Micro perspectives of quality focus on | show 🗑
|
||||
show | quality from the population's standpoint such as cost and access, reflect the performance of the entire health care delivery system.
🗑
|
||||
US spends more of its national income on | show 🗑
|
||||
US has tremendous advances in | show 🗑
|
||||
US trails far behind in | show 🗑
|
||||
Donabedian in 1980 proposed three domains in which health care quality should be examined which are | show 🗑
|
||||
Structure includes | show 🗑
|
||||
show | The relatively stable characteristics of the providers of care, of the tools and resources they have at their disposal, and of the physical and organizational setting in which they work
🗑
|
||||
Deficiencies in structure lead to | show 🗑
|
||||
show | delivery of health care, the specific way in which care is provided.
🗑
|
||||
show | correct diagnostic test, correct prescriptions, accurate drug administration, communication, and compassion.
🗑
|
||||
CPGS are | show 🗑
|
||||
CPGS are also called | show 🗑
|
||||
show | clinical problem based on evidence, in order to guide physicians clinical decisions.
🗑
|
||||
CPGS intentions are to | show 🗑
|
||||
Cost efficiency is referred to as | show 🗑
|
||||
Cost is efficient when benefits received are | show 🗑
|
||||
show | benefits received are greater than the cost incurred.
🗑
|
||||
show | outcome based and patient centered case management tools that are interdisciplinary and facilitate coordination of care among multiple clinical departments and caregivers.
🗑
|
||||
Critical pathways provide a timeline that identifies planned medical interventions along with | show 🗑
|
||||
Critical pathways improve quality by | show 🗑
|
||||
show | prevent adverse events related to clinical care and facilities operations, focusing on avoiding medical malpractice.
🗑
|
||||
show | the effects or final results obtained from utilizing the structure and processes of health care delivery.
🗑
|
||||
Outcomes are viewed as the measure of | show 🗑
|
||||
show | improvement in health stats.
🗑
|
||||
show | infection rates, rate of re hospitalizations and patient satisfaction.
🗑
|
||||
show | quality of care.
🗑
|
||||
show | legislation that mandated the collection of national data on legal actions against health care providers, this information allows people to know actions brought against physicians in other states.
🗑
|
||||
Research can influence health policy through | show 🗑
|
||||
documentation includes | show 🗑
|
||||
show | program evaluations and outcomes research, look for what does and does not work
🗑
|
||||
show | course of action that has a desirable consequence.
🗑
|
||||
show | ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner.
🗑
|
||||
show | health status, environment, lifestyle, and heredity factors.
🗑
|
||||
The National Health Interview survey or NIHS and the Medical Expenditure Panel Survey or MEPS are both leading data sources used to | show 🗑
|
||||
show | surveys that have data on health care use and expenditures.
🗑
|
||||
Federal and state govt. also collect | show 🗑
|
||||
show | lower overall health care usage and access.
🗑
|
||||
Racial/ethnic minorities are less likely than their white counterparts to have a specific source of | show 🗑
|
||||
show | primary care provider
🗑
|
||||
Nonwhite medicare beneficiaries have fewer | show 🗑
|
||||
Access to care also relies on having available | show 🗑
|
||||
show | providers and that their geographic distribution is desirable.
🗑
|
||||
show | rural health clinics to expand access.
🗑
|
||||
The National Health Service corp has student assistance programs to | show 🗑
|
||||
The National Health Service corp establishes community health centers in | show 🗑
|
||||
Two main concerns about the medicare policy are | show 🗑
|
||||
show | face access problems,
🗑
|
||||
show | access problems.
🗑
|
||||
Access policies should encourage | show 🗑
|
||||
In rural communities making medical care available to residents is difficult because | show 🗑
|
||||
show | a limited time.
🗑
|
||||
show | create incentives for permanent practices in rural areas
🗑
|
||||
Low income mothers and their children have problems accessing the health care system because | show 🗑
|
||||
SCHIP | show 🗑
|
||||
show | obtaining health care.
🗑
|
||||
AIDS patients have difficulty getting insurance because | show 🗑
|
||||
show | universal access.
🗑
|
||||
show | increasing costs, lack of access, and concerns about quality.
🗑
|
||||
Health care costs in the US are the | show 🗑
|
||||
show | health status, demographics and ability to pay.
🗑
|
||||
Quality is assessed through | show 🗑
|
||||
Cost containment efforts are n place to | show 🗑
|
||||
The US does not have a centrally controlled system of health care delivery however | show 🗑
|
||||
The three roles of the government in health care delivery are | show 🗑
|
||||
The role of the govt. as a payer of health care includes | show 🗑
|
||||
The role of the govt. as a provider of health care includes | show 🗑
|
||||
show | involvement in the political process to make laws, as well as controlling licensure.
🗑
|
||||
Public policies are | show 🗑
|
||||
The Legislative branch is known as the congressional branch and they | show 🗑
|
||||
The executive branch is known as the presidential branch and they | show 🗑
|
||||
The judicial branch of government is known as the supreme court and they | show 🗑
|
||||
show | actions, behaviors, and/or decisions of others.
🗑
|
||||
show | public policies that pertain to or influence the pursuit of health.
🗑
|
||||
Health policies are also principles that | show 🗑
|
||||
Health policies are often the result of | show 🗑
|
||||
show | health care at all levels including policies affecting the production, provision, and financing of health care services.
🗑
|
||||
Health policies can affect | show 🗑
|
||||
Health policies are used to | show 🗑
|
||||
Regulative health policies ensure | show 🗑
|
||||
Allocative health policies relate to resources for health care such as | show 🗑
|
||||
show | behavior of particular groups.
🗑
|
||||
show | medical education.
🗑
|
||||
States license health professionals as well as oversee the | show 🗑
|
||||
States control the administer workers | show 🗑
|
||||
States also govern consumer | show 🗑
|
||||
Some states regulate control over | show 🗑
|
||||
Allocation involves the direct provision of | show 🗑
|
||||
show | distributive and redistributive.
🗑
|
||||
Distributive allocation policies | show 🗑
|
||||
show | take money or power from one group and gives it to another such as in medicare or medicaid.
🗑
|
||||
show | subsidiary to the private sector.
🗑
|
||||
The US health care policy features a decentralized role for the | show 🗑
|
||||
show | pluralistic meaning it has special interest.
🗑
|
||||
The US health care policy has an impact of | show 🗑
|
||||
show | development and evolution of health policy.
🗑
|
||||
Health care is not seen as a right of citizenship or a | show 🗑
|
||||
show | government intervention.
🗑
|
||||
show | informed decisions.
🗑
|
||||
show | privilege.
🗑
|
||||
Role of the government in health care has grown incrementally in response to | show 🗑
|
||||
Government is left to fill the gap for the | show 🗑
|
||||
Health policy concerns regarding medical technology include | show 🗑
|
||||
show | cost of development and access to it.
🗑
|
||||
show | cost efficient and accessible.
🗑
|
||||
The government regulates drugs and | show 🗑
|
||||
show | uniform, smooth running system.
🗑
|
||||
show | complex and fragmented system of health care financing.
🗑
|
||||
show | contributions that they and their employers pay.
🗑
|
||||
show | tax revenues such as medicare part a and b, and medigaps.
🗑
|
||||
The poor are covered through medicaid via | show 🗑
|
||||
Special populations such as veterans, native americans, and the armed forces have coverage provided directly by the | show 🗑
|
||||
Process of legislation regarding policy development and enactment is | show 🗑
|
||||
show | subcommittees.
🗑
|
||||
show | pass through both to be a law.
🗑
|
||||
Medicare and medicaid revisions are not | show 🗑
|
||||
States are left to interpret and enact medicare and medicaid revisions | show 🗑
|
||||
Current health care reform was divided on what | show 🗑
|
||||
show | health care policy
🗑
|
||||
States develop and implement health care policies involving financial support for the poor and disabled | show 🗑
|
||||
States develop and implement health care policies involving Quality assurance, practitioner and facility oversight | show 🗑
|
||||
States develop and implement health care policies involving regulation of health care | show 🗑
|
||||
States develop and implement health care policies involving health personnel training and authorization of local | show 🗑
|
||||
States have broad, legal authority to | show 🗑
|
||||
The state can license and regulate health care | show 🗑
|
||||
show | health insurance.
🗑
|
||||
The state can set and enforce environmental | show 🗑
|
||||
The state can enact controls on health care | show 🗑
|
||||
show | services.
🗑
|
||||
show | health policy decisions.
🗑
|
||||
show | enact policy at the federal level .
🗑
|
||||
The fact that states vary in implementation of service leads to inadequacies in | show 🗑
|
||||
show | original policy.
🗑
|
||||
show | differently.
🗑
|
||||
show | groups needs.
🗑
|
||||
Groups involved in health care policies include | show 🗑
|
||||
show | most effective demanders of policies.
🗑
|
||||
show | resisting any major change.
🗑
|
||||
Interest groups combine and concentrate the resources of their members to | show 🗑
|
||||
Examples of health care interest groups include the | show 🗑
|
||||
Employers concerns are about health care insurance | show 🗑
|
||||
show | the cost.
🗑
|
||||
Health policies affect labor practices and how | show 🗑
|
||||
The interest of consumers are not | show 🗑
|
||||
Consumers do not have sufficient financial means to | show 🗑
|
||||
Consumer groups advocate and represent | show 🗑
|
||||
show | alliances among themselves and with members of the legislative body to protect and enhance the interests of those receiving benefits from government programs.
🗑
|
||||
show | benefits.
🗑
|
||||
show | identification of a problem where markets fail, or do not function well.
🗑
|
||||
Government regulates and allocates resources of health care through | show 🗑
|
||||
show | legislative branch of the US govt.
🗑
|
||||
show | idea becomes a law, and how the law is implemented.
🗑
|
||||
The legislative process of health care law making is known as the | show 🗑
|
||||
Policy cycle | show 🗑
|
||||
show | issue raising/ awareness of a problem, policy design/drafting the bill, building of public support, legislative decision making, building of policy support within the house and senate, and policy implementation.
🗑
|
||||
show | congress and interest groups.
🗑
|
||||
show | propose or sponsor a new law.
🗑
|
||||
An idea is drafted as a bill, the legislators may ask other legislators to become | show 🗑
|
||||
show | number, title, and are listed.
🗑
|
||||
show | committee by the authorizing body.
🗑
|
||||
show | combine it with other bills, refer to another committee for review, or hold hearings to get testimony and possible amendments.
🗑
|
||||
show | full committee.
🗑
|
||||
The full committee reviews the deliberations and recommendations of the subcommittee and may | show 🗑
|
||||
show | die in the committee, which many do.
🗑
|
||||
The legislative process is repeated until the | show 🗑
|
||||
A full committee reporting involves a passed bill and the full committee | show 🗑
|
||||
show | report about the bill is written and published, includes purpose of the bill and its impact on existing laws, budgetary considerations, and any new tax increases required by the bill.
🗑
|
||||
show | public hearings, opinions of the committee for and against the proposed bill
🗑
|
||||
Full house or senate review involves the bill being added to the | show 🗑
|
||||
show | the other chamber, both legislative chambers follow the same procedure however, if amendments are added in one chamber it goes back to the other for approval. Back and forth movement occurs until the bill is approved by both.
🗑
|
||||
The legislative chambers may forward the bill to a | show 🗑
|
||||
show | members of similar committees in both house and senate, and are charged to reconcile differences between the senate and house versions of the bill. If no agreement the bill dies, if a agreement on a compromised version they prepare a report detailing.
🗑
|
||||
show | the bill will be sent back to them for further work.
🗑
|
||||
show | forwarded to the president for a signature.
🗑
|
||||
show | approving and signing the bill, which becomes the law, vetoing the bill which sends it back to the house or if he does not sign it after 21 days it becomes law if not vetoed.
🗑
|
||||
If less than 21 days left in congressional session and the president does not take action congress can | show 🗑
|
||||
Once legislation is signed into a law, it is forwarded to the | show 🗑
|
||||
show | implemented.
🗑
|
||||
show | rewrites regulations.
🗑
|
||||
show | enabling legislation.
🗑
|
||||
show | shape the final outcome.
🗑
|
||||
show | serve the public's interests.
🗑
|
||||
National health care is supported, but the idea of federal government running the system is | show 🗑
|
||||
The challenge is finding a balance between government provisions and control and | show 🗑
|
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