PBH Q4

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Author:
MelodyRodsuwan
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164871
Filename:
PBH Q4
Updated:
2012-08-08 20:26:51
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PBH Q4
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PBH Q4
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  1. inpatient facilities 
    • stay at least 24hrs 
    • short term 
    • long term: nursing home
  2. outpatient facilities
    • less than 24hours
    • like clinics, ED, tx facilities 
  3. academic health center
    organization with med school and affiliated hospital 
  4. provider
    • no just dr. office
    • all ranges
  5. healthcare system
    healthcare delivery system AND financial system, to fund care
  6. health system
    • healthcare AND PUBLIC HEALTH system 
    • connect in/out patient
  7. health care delivery system
    delivery of services to defined population 
  8. JCAHO
    • joint commission on the accreditation of healthcare organizations
    • for accrediting hospitals
  9. MUA 
    • medically undeserved area
    • deficiency of health care resources like beds, equipment, personnel 
  10. MUP
    • medically underserved population
    • areas/population that have limited access thru all kinds of barriers
  11. community health center7
    • -aka neighborhood health centers-empowerment/funds to nonprofit thru bypassing state govt
    • -'65 as Johnson's war on poverty 
    • -must be in MUA or serve MUP
    • -tax exempt status
    • -other healthcare services needed to facilitate access like case mgmt, translation, transp
    • -governing board (most have to be pts of CHC)
    • -regardless of pay, they need to help and give sliding fee
  12. medical malpractice 
    • -"ultimate guarantor of quality" 
    • -civil law NOT CRIMINAL LAW soo based on PREPONDERENCE OF the evidence 
    • -on negligence law: protect the individual from harm 
  13. 4 criteria of med malpractice 
    • duty was owed-need to care
    • duty was breached-fail to meet standard of care
    • breach caused injury-causation
    • damages-direct like expenses/indirect like pain distress/punitive-negligent 
  14. cap 
    limit of total amount that insurance will pay 
  15. copayment
    amount that the injured still has to pay even if they are covered
  16. deductible 
    family has to pay before eligible for insurance 
  17. eligible 
    • income-Mediaid
    • age in SS system of Medicare
    • employment 
    • health status-not for group but for individual 
  18. premium
    price paid by purchaser on monthly or yearly 
  19. Medicare4
    • '60s for 65+ and now disabled and end stage renal disease
    • prescribed drugs are partially covered
    • preventative services 
    • paid thru payroll tax
  20. Medicare p.A
    • hospital care and hospice 
    • by payroll tax and no need premium
  21. Medicare p.B (3)
    • -voluntary supplementary insurance cover diagnostic/therapeutic by outpatient 
    • -75%tax revenues/25%monthly premium
    • -copay of 20%
  22. Medicare p.C
    special program to encourage Medicare beneficiares to enroll in prepaid plans
  23. Medicare p.D (6)
    • -new/for P.A and P.B
    • -new premium, deductible
    • -based on private plans 
    • -75% of drugs
    • -Donut hole above 2500
    • -5000 then Medicare takes over>>>>>CATASTROPHIC 
  24. Mediaid
    • -fed plus state program for poor through preventive services
    • -pays 50-83% based on per capita income state
    • -helps disabled, children, pregnant with income less 133% of level aka $20,000
    • -most dont qualify like men 
    • -NURSING HOMES
  25. community rating***
    cost of insurance was the same regardless of the health status of group of employees>>>now experience rating
  26. experience rating***
    employees insurance coverage based on use of services in previous years
  27. capitation
    fixed number of dollars/month to provide services to an member regardless number of services
  28. fee for service***
    charges paid for specific services provided>>encourages services/accused before/'90s
  29. HMO (5)
    • -health maintenance organization>>>POS
    • -charged patients a monthly fee designed to cover a package of services
    • -clinicians were paid based on number individuals who enrolled 
    • -staff model 
    • -compensation based on capitation>>underuse to reduce cost
  30. PPO
    • preferred provider plans
    • fee for service>>>PPO
    • only with limited number of clinicals aka preferred providers
  31. POS
    • point of service plans
    • ORIGIN: HMO
    • choose to get care outside system
    • mixed models
    • MOST COMMON 
  32. SCHIP
    • state child health insuranc program '90s
    • Medicaid for children/help eligibility
    • increase tax on cigarettes
  33. universal coverage
    least basic for entire pop
  34. afforable care act
    • legistaltion of 111th US congress
    • increase insurance of pre existing condition and expands access
    • incrases project national med spending

    cost free preventive, teens on parent til 26, choose dr, go to ER without penalty
  35. licenses hospitals
    Joint Commssion on the Accrediation of Healthcare Organizations
  36. hospital dividied by their source of financial
    • nonprofit vs profit
    • 90% are non
    • 50% are private nonprofit
  37. skilled nursing/rebahb vs. nursing home
    • skill: short term, specific like strong
    • nursing: long term, custodial
  38. nursing homes in us
    16,000
  39. quality of healthcare services assessed
    • avaiblitiy of operation rooms
    • technicals
    • perosnal
    • prevents
    • structure
    • procession
    • outcome measures
  40. national committe for quality assurance***
    • access and service
    • provides
    • staying healthy
    • getting better
    • living with illness
  41. health centers conslidation act '96
    combined community health centers with healthcare services for migrants, homeless, and public housing
  42. Medicare vs Medicaid
    • Medicare: '60s, 65+ old, disabled, renal disease
    • Mediaid: federal plus state help poor and other groups
  43. donute hole
    • above 2500 on drugs for P.A
    • 2500-5000 is uncovered
    • above 5000, then gov pays
  44. costs controleed
    • Reimbursement
    • incentives
    • Cost
    • sharing
    • Regulation
    •  Restrictions
    • on malpractice
  45. employer mandates
    employer give their employees with insurance
  46. individual mandates
    • find own health insurance
    • govt can help/tax exempt for rich
  47. single payer
    govt takes costs of individual
  48. electronic health records
    • improve safety
    • support deliver effectively 
    • facilitate 
    • efficiency 
  49. TRICARE 
    military health care
  50. NOTE not covered by Medicare
    • nursing home care
    • custodial care
  51. uninsured
    healthy, young, poor who don't qualify, self employed

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