Exam 18: Health Care Cost and Quality
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| Economic factors effecting health care | ↑ health Care cost.
Aging population.
Advancement in Technology.
Healthcare Insurance.
Malpractice Insurance.
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| With advanced age | comes increasing demand on health care resources.
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| Advancement in technology, what's the issue? | Research and development is costly.
Cost is passed to consumer.
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| Healthcare insurance, what's the issue? | Initially designed to defray cost to consumer.
Lacked incentives to control cost.
Providers and hospitals paid as they charged.
Lack of insurance denies access to care.
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| Malpractice insurance, what's the issue? | Very expensive.
Increased claims have resulted in:
-Over cautious approach to care
-Increased tests and procedures
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| Financing the cost of health care, what's the issue? | Healthcare reimbursement change has expanded the responsibilities and roles of the LVN/LPN because it is more cost effective.
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| Nursing case management | A nursing specialty.
Assigned to oversee care of patients.
Assures access to required services.
Coordinate and evaluate provided services.
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| Nursing Cross-training. | Method using manpower to its fullest
Individuals are trained to do a variety of duties depending on the needs
Defined by the individual institution
Practice can result ↓ of the number of employees while providing quality of care for the patient.
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| Types of Managed care systems | Health Maintenance Organizations (HMO's).
Preferred Provider Organizations (PPO's).
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| Health maintenance organizations (HMO’s) | Group insurance plan.
Fixed fee for services.
Provide ambulatory, hospitalization and home care services.
Utilizes “gate keepers” usually a primary physician who must authorize secondary care.
Member responsible for all costs of unauthorized care.
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| Preferred Provider Organizations (PPO”s) | Network of providers who discount their rates for plan members.
Members pay higher rates if treatment is provided outside the network.
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| Impact of positive Economic Changes | A reduction in the rate of growth in health care cost.
Reduced redundancy in health care services.
New and expanded roles for nurses.
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| Negative Impact of Economic Changes | Decision making power moved from providers to insurance companies.
Increased economic pressure on the consumer.
Desire for profit conflicts with access to care.
Hospital downsizing or closure.
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| Demand for evidence that hospitals and other health care providers provide quality, cost-effective care comes from | Insurers
Regulatory bodies (Joint Commission for Accreditation of Healthcare Organizations).
Consumers.
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