Podcast
Questions and Answers
In the healthcare system, healthy people carry the costs for sick people.
In the healthcare system, healthy people carry the costs for sick people.
True (A)
What is Pay for Performance (P4P)?
What is Pay for Performance (P4P)?
A model for payments that provides monetary incentives to doctors who meet quality care standards.
Nursing care services are paid based on the type of room/unit the patient stays in.
Nursing care services are paid based on the type of room/unit the patient stays in.
True (A)
Who provides health insurance to most privately insured Americans?
Who provides health insurance to most privately insured Americans?
What are the roles of the federal government in the US healthcare system?
What are the roles of the federal government in the US healthcare system?
What is required for a truly free healthcare market?
What is required for a truly free healthcare market?
What does DRG stand for?
What does DRG stand for?
What was the purpose of creating Medicare in 1955?
What was the purpose of creating Medicare in 1955?
Match the following social determinants of health with their descriptions:
Match the following social determinants of health with their descriptions:
What did the Flexner Report do for the profession of nursing?
What did the Flexner Report do for the profession of nursing?
Essential Health Benefits under ACA include which of the following?
Essential Health Benefits under ACA include which of the following?
What should individuals with high deductible insurance consider?
What should individuals with high deductible insurance consider?
Who could be professionals in a patient-centered medical home?
Who could be professionals in a patient-centered medical home?
An example of reimbursements for patient outcomes includes:
An example of reimbursements for patient outcomes includes:
The Affordable Care Act of 2010 passed strategies to destabilize the health insurance market.
The Affordable Care Act of 2010 passed strategies to destabilize the health insurance market.
Hospitals and healthcare organizations are monitored to ensure they provide safe and quality patient care.
Hospitals and healthcare organizations are monitored to ensure they provide safe and quality patient care.
What is a deductible?
What is a deductible?
Cost sharing includes which of the following?
Cost sharing includes which of the following?
What are the three main goals of the Affordable Care Act (ACA)?
What are the three main goals of the Affordable Care Act (ACA)?
Patients make co-payments through their employer.
Patients make co-payments through their employer.
The DRG model provides for prolonged treatments and extra days for patients in the hospital.
The DRG model provides for prolonged treatments and extra days for patients in the hospital.
Patient-centered medical homes are characterized by uncoordinated care.
Patient-centered medical homes are characterized by uncoordinated care.
In what ways is the ACA financed?
In what ways is the ACA financed?
Out-of-pocket cost sharing increases consumer awareness and cost-consciousness regarding healthcare.
Out-of-pocket cost sharing increases consumer awareness and cost-consciousness regarding healthcare.
What does coordinated care for patients hospitalized with Congested Heart Failure include?
What does coordinated care for patients hospitalized with Congested Heart Failure include?
What is coinsurance?
What is coinsurance?
What is an example of a controlled market?
What is an example of a controlled market?
Which of the following are included in the ACA financing model?
Which of the following are included in the ACA financing model?
What is a catastrophic plan?
What is a catastrophic plan?
Healthcare in the US is known for low technology care.
Healthcare in the US is known for low technology care.
What is Fee for Service (FFS)?
What is Fee for Service (FFS)?
The Affordable Care Act allows lifetime caps on health costs and benefits.
The Affordable Care Act allows lifetime caps on health costs and benefits.
What does autonomy mean in healthcare?
What does autonomy mean in healthcare?
What does beneficence mean?
What does beneficence mean?
What does disparity in healthcare mean?
What does disparity in healthcare mean?
One way to determine a good health outcome for the US is to address compliance with healthy behavior.
One way to determine a good health outcome for the US is to address compliance with healthy behavior.
Social determinants of health include which of the following?
Social determinants of health include which of the following?
Patients may pay increased prices for healthcare coverage if they smoke tobacco.
Patients may pay increased prices for healthcare coverage if they smoke tobacco.
What were some original ACA financing models?
What were some original ACA financing models?
How is healthcare in the US mostly financed?
How is healthcare in the US mostly financed?
The Patient Protection and Affordable Care Act includes strategies to stabilize the healthcare market.
The Patient Protection and Affordable Care Act includes strategies to stabilize the healthcare market.
What do reimbursements include?
What do reimbursements include?
What are some negative aspects of the healthcare system?
What are some negative aspects of the healthcare system?
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Study Notes
Health Insurance Dynamics
- Healthy individuals bear the costs of care for those who are ill within the health insurance system.
- Most privately insured Americans receive their health insurance through their employers.
Payment Models in Healthcare
- Pay for Performance (P4P) incentivizes doctors financially to meet quality care standards.
- Diagnosis Related Groups (DRG) establish payment per admission based on diagnosis, influencing hospital stays.
Government's Role in Healthcare
- The federal government finances, regulates, and reimburses healthcare services in the US.
- The Affordable Care Act (ACA) aims to expand Medicaid, control healthcare costs, and promote preventive health measures.
Essential Health Benefits
- Essential health benefits under the ACA include mental health services, pediatric services, and emergency services.
Cost Sharing and Insurance Terms
- Patients must pay a deductible set by insurance companies before coverage begins.
- Cost-sharing can involve deductibles, co-payments, and coinsurance payments.
Patient-Centered Medical Homes
- Patient-centered medical homes focus on coordinated care to control healthcare costs.
ACA Financing
- The ACA is financed through public funding, individual mandates, and employer mandates.
- Financing models include employer insurance mandates and public funding via taxes.
Professional Roles in Healthcare
- Patient-centered medical homes may include doctors, nurses, dieticians, and home health nurses as part of coordinated care teams.
Health Disparities and Determinants
- Disparities in healthcare indicate unequal access and quality of care for different populations.
- Social determinants of health are influenced by factors such as power, global resources, money, and local/national resources.
Reimbursement Challenges
- Reimbursement models are critical for ensuring that care providers are paid fairly, but inconsistencies in quality and costs can lead to over-treatment or under-treatment.
Patient Rights and Ethical Considerations
- Autonomy allows patients the right to make their healthcare decisions, while beneficence involves acting in the patient’s best interests.
Additional Healthcare Insights
- A catastrophic insurance plan is an option for healthy individuals under 30 who cannot find affordable insurance.
- Smoking tobacco may lead to higher healthcare costs for individuals due to associated health risks.
Evaluating US Healthcare
- Effective healthcare evaluation includes compliance with healthy behaviors and monitoring for quality and safety in patient care.
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