Topic Review Midterm_1555996626.pptx

Topic Review Midterm Harriette Szaniszlo MSNEd, RN  With Health Insurance the healthy people carry the costs for the sick people. 08/13/2024 2  A Pay for Performance (P4P)., is a model for payments that provides money incentives to doct...

Topic Review Midterm Harriette Szaniszlo MSNEd, RN  With Health Insurance the healthy people carry the costs for the sick people. 08/13/2024 2  A Pay for Performance (P4P)., is a model for payments that provides money incentives to doctors who meet the quality care standards. 08/13/2024 3  Nursing care services are paid through the type of room /unit the patient stays. 08/13/2024 4 Most privately insured Americans health insurance is provided by the employer. 08/13/2024 5 The role of the federal government in the US healthcare system is to Finance, regulate and re imburse. 08/13/2024 6  A truly free healthcare market would require an accurate and transparent information for patients. 08/13/2024 7 A DRG ( Diagnosis Related Group) - Is paid per Admission Diagnosis. 8  In 1955 – Medicare was created to: Provide Healthcare for those over 65. 08/13/2024 9  Social Determinants of personal health includes: 1. Genetics 2. Access to care. 08/13/2024 10 Flexner Report: Did not assist the Profession of Nursing. 08/13/2024 11  Essential Health benefit s 1. Mental 3. required by 2. Pediatric Health Emergency ACA Services Services Services. (Accountabili ty Care Act) – includes: 08/13/2024 12  Individuals with a high deductible insurance plan need to consider how much healthcare they might need. 08/13/2024 13  PROFESSIONALS IN A 1. DOCTORS 2. NURSES PATIENT CENTERED MEDICAL HOMES COULD INCLUDE: 08/13/2024 14  An example of reimbursements for patient outcomes would be: 1. Patient safety measures. 2. Re admission with heart failure. 08/13/2024 15  The affordable Care Act of 2010- did not passed strategies to destabilize the health insurance market. 08/13/2024 16  Hospitals and healthcare organizations are regularly monitored and evaluated that they are providing a safe and quality patient care. 08/13/2024 17  Deductible is an amount of money established by the insurance company to be paid by the PATIENT. 08/13/2024 18  Cost sharing includes: Deductible, Co payment and Coinsurance payments. 08/13/2024 19  3 Main Goals of ACA (Affordable Care Act) Program: 1. Expand Medicaid to cover more people. 2. Find healthcare methods that contain the high healthcare costs. 3. promote health prevention and 08/13/2024 20 wellness.  Patient do not make Co payment - through their employer, but through health care providers. 08/13/2024 21  The DRG(Diagnosis Related Group) provides prolonged treatments and extra days for patients in the hospital. 08/13/2024 22  Patient centered medical homes are characterized by coordination of care to control costs. 08/13/2024 23  ACA is financed in several ways. Public funding through the single payer is one way. 08/13/2024 24  Out of pocket cost sharing helps consumers be more aware and cost conscious of healthcare. 08/13/2024 25  Coordinated care for the patient hospitalized with Congested Heart Failure includes the following: 1. Cardiologist 2. Dietician 3. A Home health Nurse 08/13/2024 26  Coinsurance is the percentage of covered health cost the patient is responsible for paying after they met their deductible. Ex.- 20% percent , and the plan covers the rest. 08/13/2024 27  An example of Controlled Market is one usually regulated by the government and involves determining who can enter the market and the prices they may charge. 08/13/2024 28  The ACA financing model includes: 1. Individual Mandate 2. Employer Mandate 08/13/2024 29  Catastrophic Plan- is an option when the patient is healthy, under age 30, and can’t find any affordable insurance coverage. 08/13/2024 30  Healthcare in the US has a high technology care. 08/13/2024 31  Fee for Service (FFS) – pays for some items and service used during hospitalization. 08/13/2024 32  Affordable Care Act (ACT) – does not allow lifetime cap on health costs and benefits. 08/13/2024 33  Autonomy -means the patient has the right to make their healthcare decision. 08/13/2024 34  Beneficence- an act of charity, doing good to others. 08/13/2024 35  Disparity in Healthcare means- it is not fairly given to all people. 08/13/2024 36  One way to determine a good health outcome for the US is to address compliance to healthy behavior. 08/13/2024 37  American Health Insurance M O S T P R I V AT E LY I N S U R E D A M E R I C A N S H E A LT H I N S U R A N C E I S U S U A L LY P U R C H A S E D W I T H E M P LOY E R.  Social determinants are conditions in which people are born, grow live work and age. And are influenced by the following: 1. Power Social Determi- 2. Global Resources nants of 3. Money Health: 4. local resources 5. National Resources  Patient may pay increased prices for healthcare coverage if they continue to smoke tobacco. 08/13/2024 40 Affordable Care Act Financing Model As originally enacted, ACA financing model includes the following: 1. Employer insurance mandates 2. Single Payer 3. Public Funding through taxes 4. Individual Insurance Mandates Healthcare in the US : Healthcare in the US are mostly financed by: 1. Medicare 2. Medicaid 3. Federal Taxes 4. Commercial Insurance Patient Protection and Affordable Care Act PATIENT PROTECTION AND AS PASSED, INCLUDES AFFORDABLE CARE ACT : STRATEGIES TO STABILIZED THE HEALTH CARE MARKET. Reimbursement REIMBURSEMENT I N C LU D E S P AY M E N T T O A L L C A R E PROVIDERS. Negative Aspects of Healthcare System- 1. Inconsistent quality 2. Expensive Prices 3. Over treatment and under treatment of some patients.  n Thank You , and GOODLUCK EVERYONE! Professor Szaniszlo 08/13/2024 46