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NUR 4837 Healthcare Policy and Finance FINAL Terms in this set (62) Including general internists and general pediatricians, what does the total supply of generalist amount to in the United States? How does this number compare with the UK? the total s$8.99
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NUR 4837 Healthcare Policy and Finance FINAL Terms in this set (62) Including general internists and general pediatricians, what does the total supply of generalist amount to in the United States? How does this number compare with the UK? the total s
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Course
GED - General Educational Development
Institution
GED - General Educational Development
NUR 4837 Healthcare Policy and Finance FINAL
Terms in this set (62)
Including general internists and general
pediatricians, what does the total supply of generalist amount to in the United States? How does this number compare with the UK? the total supply of generalists (including internists a...
NUR 4837 Healthcare Policy and Finance FINAL
Jeremiah
Terms in this set (62)
Including general internists and general the total supply of generalists (including internists and pediatricians) amounts to 1/3
pediatricians, what does the total supply of (33%) of all physicians in the US. In the UK it is about 50%.
generalist amount to in the United States?
How does this number compare with the
UK?
What is one action taken to fill the primary Some physicians at the secondary and tertiary care levels have also acted as PCPs for
care gap in the United States? their patients.
Who is more likely to work in primary care Nurse practitioners and physicians assistants
settings than physicians?
- The primary care provider is the gatekeeper
Example: Polly sees a nurse practitioner who discovers that the reason she is vomiting is
due to the medication she is taking. The NP consults with the oncologist to change her
Who is the Care Coordinator and medication/prescription
"Gatekeeper"?
Stories such as Polly's demonstrate the importance of having a generalist care
coordinator who can advocate on behalf of his or her patients and work in partnership
with patients to integrate an array of services involving multiple providers to avoid
duplication of services, enhance patient safety, and care for the whole person.
- Biomedical model among medical educators
What are the forces driving healthcare in the
- Financial incentive for physician specialization and hospital expansion
U.S.?
- Professionalism- acting in patient's best interest
Who benefits from Medicare? Medicare is for the elderly
Hospital insurance plan for the elderly financed largely through social security taxes
Part A of Medicare
from employers and employees
Insures the elderly for physician services and is paid for by federal taxes and monthly
Part B of Medicare
premiums from the beneficiaries
Offers prescription drug coverage and is paid for by federal taxes and monthly
NUR 4837 Healthcare Policy and Finance FINAL
A program run by the states and is funded by federal and state taxes, which pays for
Medicaid
the care of millions of LOW-INCOME PEOPLE
provided:
- the expansion of the role of private health plans (the Medicare Advantage program,
Medicare Modernization Act of 2003
Part C)
-establishment of a prescription drug benefit (Part D)
-Kaiser
What are the first generation health -HMOs (health maintenance organizations)
maintenance organizations?
Both are prepaid group practices
Part D of Medicare premiums from beneficiaries.
Enacted in 2003
1/7
, 8/8/24, 9:27 AM
-Independent Practice Association or IPAs (or network HMOs, integrated medical
What are the second generation health groups, Physician- Hospital Organizations (PHO))
maintenance organizations? -Health Maintenance Organization Act of 1973 based on second generation of network
HMOs that evolved from Kaiser- Permanente Medical Care program
allow patients to choose their own providers outside of a traditional HMO model
What is a Preferred Provider Organizations
there may be increased costs to the patient in this type of model compared with HMO
(PPO)?
models
-expansion of health insurance
What did the Affordable Care Act of 2010
-reform in how health care is organized and delivered through the concept of the
do?
Accountable Care Organization
A provider-led organization whose mission is to manage the full continuum of care and
can be accountable for the overall costs and quality of care for a defined population
What is an Accountable Care Organization
(ACO)?
Many ACOs contract with both Medicare and private plans. (private health insurers
changing PPO into ACO models emulating the Medicare Shared Savings Program
What did the Affordable Care Act of 2012 -authorized Medicare to initiate an ACO program beginning in 2012
authorize?
-out of pocket
-private insurance
What are the 4 modes of paying for care?
-employment based
-government based
-Fee for service practice with utilization review
What are the 3 forms of Managed Care? -PPO
-HMO
This is the traditional type of payment, with the addition that the third-party payer,
Fee- for- Service Payment with Utilization whether private insurance company or government agency, assumes the power to
Review authorize or deny payment for expensive medical interventions such as hospital
admissions, extra hospital days, and surgeries.
-Patients are able to see physicians not included within their insurer's physician network
if they desire, but have to pay a higher share of "out of pocket" costs as a result when
they use physicians/hospitals outside the "preferred" network.
Preferred Provider Organization (PPO)
-PPO's allow patients to choose their own providers outside of a traditional HMO
model. However, there may be increased costs to the patient in this type of model
compared with HMO models
-They are prepaid medical group services available through large businesses, instead
of the traditional fee-for-service model.
Health Maintenance Organization (HMO)
-Based off of early models such a Kaiser Permanente and Group Helath Cooperative of
NUR 4837 Healthcare Policy and Finance FINAL
What is the Nixon HMO Act of 1973 based the Kaiser Permanente Model
on?
-payment per procedure: fee-for-service
-payment per episode of illness
-per diem payments to hospitals
What are the different methods of payment?
-payment per patient: capitation
-payment for all services delivered to all patients within a certain time period
DRG's (Diagnosis Related Groups) - method for hospital care
Puget Sound
2/7
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