C425 - Healthcare Delivery Systems, Regulations, and Compliance

This kind of medicine treats the whole person. (Physical, Mental, Spiritual)

Holistic

Relatively severe, episodic (short duration) and often treatable

Acute

Less severe, but long and continuous. Can be controlled but can lead to serious complications

Chronic

The market tells us what type of healthcare we need. If a service is not being used, there will not be a lot of that particular service.

Market Justice

Individual responsibility for health.
Benefits are based on individual purchasing power.
Rationing based on ability to pay.
Limited obligation to the collective good.

Market Justice

Healthcare viewed as a social resource.
Requires active government involvement.
Single payer system.
Highly controlled by government.

Social Justice

Ability to pay is inconsequential to receiving medical care.
Right to free medical care.
Everyone entitled to basic package of benefits.

Social Justic

Three distinct time periods of health care's evolution

-Preindustrial Era
-Postindustrial Era
-Corporate Era

Quality care and Access to care is very low in -

Rural Areas

Quality of care is lower than typical but access to care is pretty standard in -

Urban Areas

Covers only the very poor.

Medicaid

Covers all elderly persons, nonelderly disabled persons, and nonelderly persons with end-stage renal disease.

Medicare

For hospitalization and short-term nursing home stay. Financed through social security taxes.

Part A Medicare

For physician and other outpatient services. Subsidized through general taxes, but participants pay part of the premium costs.

Part B Medicare

Nationally uniform program

Medicare

Program varies from state to state. Income criteria established by states.

Medicaid

Both ___ and ___ provide financial support to private and public institutions for biomedical research.

AHRQ
NIH

A mechanism of providing health care services where a single organization takes on the management of: Financing, Insurance, Delivery, Payment. (Supply side rationing)

Managed Care

The provider is paid a fixed monthly sum per enrollee, often called a per member, per month (PMPM) payment.

Capitation

Care rendered to patients who come to the physicians office, clinics, or outpatient surgery

Ambulatory Care

A hospital that has achieved specialization and offers a wide scope of services. These centers often engage in teaching and research.

Medical Centers

Creation of medicare and medicaid

1965

Curtailed inpatient utilization. Emphasizes early discharge and outpatient services.

Managed Care

50% of all U.S. hospitals are

private nonprofit

____ Garned enormous buying power by enrolling a large segment of the insured population

MCOs (Managed Care Organizations)

Who are stakeholders?

Anyone who is impacted by the organization. Physicians, healthcare professionals, managers, insurers and more

The 4 Ps (Major Stakeholders)

Patient (Most important)
Provider
Payer
Policymaker

Difference in wants and needs between the 4 P's

Conflict of Interests

Allows the market to determine when services are rendered.

Market Justice

Quality can be improved while reducing costs. Cookie cutter diagnoses. Eliminate ambiguity in treatment.

Evidence Based Care

Absence of illness and disease. Person free of symptoms, does not require medical treatment.

Health

Emphasizes illness rather than wellness

Medical model

__ Concepts of healthcare, along with ___ and health promotional efforts, need to be adopted to significantly improve the health of Americans

Holistic
Preventive

_._._'s hold the promise of encouraging patient-centered care and further developing the patient-centered care model.

ACO

____ _____ requires : Management of utilization. Limit reimbursement to providers. Supply side rationing

Cost Control

An issue with the ACA system is it's primary focus on ____ illnesses.

Acute

An issue with the ACA system is it's inadequate access to _______ care. (Overuse of ERs)

Primary

Patient-centered care that emphasizes chronic care by employing evidence-based guidelines. (While being accountable for the quality of care provided)

Medical Home Model

Blending primary care delivery with a population-based approach to identify and address community health problems.

Community Oriented Primary Care

T/F - Nurses should not be allowed to practice to the full extent of their education and training and take on more to handle the deficit.

F - They should take on more.

T/F Unifying license requirements across states for advanced practice nurses is a good idea for the growing issues with future healthcare.

T - Very good idea

_____ Need to be trained in community health, public health and ______

Nurses
Geriatrics

_____ Need training to function as comprehensivists as well as preparation to manage complex pharmacology, understand end-of-life issues and medical ethics, and lead health care teams.

PCP's

_____ and _______-_______ changes to clinical and organizational practices will drive greater efficiency and quality in healthcare.

Technological
Evidence-Based

The US ______ _________ is increasingly influenced by and modeled after systems and practices in other developed countries.

Healthcare Market

Practitioners, payers and policy makers need to become _______.

Stakeholders

Computer-based models will help incorporate ____ into medical decision making.

EBM (Evidence Based Medicine)

The vulnerability model is ______. It focuses on the total population rather than on the traits of _______.

Comprehensive
Subpopulations