3 categories of healthcare facilities
Is a proprietary institution for profit or nonprofit?
For- Profit
When will an HMO (Health Maintenance Organization) provide coverage?
If the care is delivered by a place or professional contracted with the insurance company
A public health care facility that receives most of its funding from local, state, or federal sources is what kind of institution?
Government Institution.
What is direct payment?
A direct payment is when a patient pays for their health care with their own money.
Who should understand the basic economic aspects of health care and how these impact patients?
All health care professionals
Who do voluntary nonprofit-institutions provide services to?
People who are unable to pay, medicaid
Where does Private Insurance come from?
Employment
True or False; Government hospitals are not accountable to government regulations or the community.
False
What is the monthly amount paid to a private insurance company for health insurance coverage?
premium
The goals of the health care reform include
improve the efficiency, equity, and effectiveness of a healthcare system
Are government institutions public healthcare facilities?
yes
How were people paying for their Doctor’s services in most situations in the past?
Fee-for-service/Direct Payment
How do voluntary nonprofit hospitals primarily fulfill their mission to serve the community?
By providing charity care and community health programs.
In many plans the primary care provider serves as a _________
gatekeeper
How are patients assigned to a DRG?
Assignment is based on their diagnosis, surgical procedures, age, and other information.
In what ways are healthcare corporations in control?
They control a chain of facilities, including hospitals, nursing homes, outpatient facilities, etc.
What were Managed Care plans designed for?
To reduce costs while maintaining and improving care
How can voluntary nonprofit hospitals measure the effectiveness of their community benefit programs?
By tracking health outcomes, patient satisfaction, preventive care utilization, and community health indicators, then adjusting programs if needed by the outcome of the results.
This is a health insurance system that allows individuals to obtain group health benefits through an organization such as an employer or a union.
private insurance
How can technology be used regarding resource utilization to more effectively benefit patients? (Give at least two examples)
Electronic documentation of patients speeds up information search and relay, electronic prescription refills prevents health care workers from having to make multiple calls, and test results can be analyzed more accurately and quicker by a computer
What is not permitted in a voluntary nonprofit institution?
The institution's net earnings are not allowed to benefit shareholders or other individuals.
What year were PPS (Prospective Payment Systems) established? (double points)
1983
Who owns proprietary hospitals?
They are owned by individuals, partnerships, or corporations.
A type of health insurance plan that establishes predetermined rates for services with healthcare providers such as doctors and hospitals.
Managed Care.
Two ways professionals can better use resources to practice resource utilization are (state both answers) double points
Conscientious time management and information technology