Introduction to Nursing--Unit 4 Exam Healthcare Delivery Financing Questions with Correct Answers
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Course
UHC Certification
Institution
UHC Certification
History of healthcare financingCorrect Ans 1847: Massachusetts Health Insurance of Boston offers group policy
: Insurance plans available during Civil War
1929: First group health coverage for a monthly charge for teachers in Dallas, Texas; beginning of Blue Cross/Blue Shield
1950s: Employee be...
Introduction to Nursing--Unit 4 Exam Healthcare
Delivery Financing Questions with Correct Answers
History of healthcare financingCorrect Ans ✓✓ 1847: Massachusetts
Health Insurance of Boston offers group policy
1861-1865: Insurance plans available during Civil War
1929: First group health coverage for a monthly charge for teachers in
Dallas, Texas; beginning of Blue Cross/Blue Shield
1950s: Employee benefit packages initiated to attract workers
1965: Creation of Medicare and Medicaid programs, making
comprehensive health care available to millions of Americans
1980-1990: Managed care plans emerge
1993: Hospitals come under DRGs
2003: Medicare Prescription Drug Improvement and Modernization Act
of 2003; most significant expansion of Medicare since its enactment
2006: Pay-for-performance introduced
2008: Medicare no longer pays hospitals for treating preventable errors
known as never events
2010: Congress passes sweeping health care reform legislation: Patient
Protection and Affordable Care Act
Themes that have driven healthcare financingCorrect Ans ✓✓ -
Physician was primarily responsible for decision making
-Physicians controlled all access to health care services
-Tests or procedures were provided if physician determined that any
marginal benefit might be obtained
,-Objective was to provide the best care to everyone
-Sophistication and cost of medical technology rapidly increased
Physician's made decisions and along with the fee for service method
this contributed to a lack of being cost conscientious on the part of the
provider. The provider never discussed cost with the patient so cost
never really came up until the bill arrived.
Why did healthcare costs rise?Correct Ans ✓✓ -Fee-for-service
payment method and economic incentives contributed to increased costs
-The more tests or procedures performed, the greater the physician's
earnings because earnings tied to procedures
-Economic incentives to provide as much care as possible
-Patients insulated from costs because insurance was paying the bill
-Instead of allocating resources to those with the highest medical need,
providers took on the thought that provide as much care possible, this
caused an overuse of services and rapidly rising cost. Most patients did
not care at the time because they had insurance to brunt the cost.
Why did healthcare costs rise (part 2-dealing with patients)?Correct Ans
✓✓ -Lack of cost consciousness contributed to increased costs
-Patients not aware of costs
-Providers had little incentive to be concerned about costs
-Providers received more income for using more services
-Providers incurred no financial risk for using additional resources
, Who is eligible for Medicare?Correct Ans ✓✓ -65 and over eligible for
social security (must live at home!!!)
-End stage renal disease
-Disabled
What is Medicare based on and what are the different parts of Medicare?
Correct Ans ✓✓ Part A - Hospitalizations
Part B - Outpatient Services
Part C - Medicare Advantage
Part D - Drugs
With the overuse of healthcare resources and a growing elderly
population, Medicare became overtaxed with expenses. This lead to
relooking at how the Medicare payment system was being run and things
changed. So Medicare in 1983 moved from a fee for service system to a
prospective payment system that was based on diagnostic related groups
or DRG's. Medicare does not require the individual to meet certain
financial and need for care criteria like Medicaid.
A: Hospital insurance
B: Supplemental medical insurance- covers outpatient and is optional
C: Medicare advantage plan
D: Outpatient drug coverage
What is a DRG? How do they work?Correct Ans ✓✓ DRG is a
diagnostic related group.
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