NUR 4837 Healthcare Policy and Finance FINAL Exam Solution Guide

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NUR 4837 Healthcare Policy and Finance FINAL Exam Solution Guide-Including general internists and general pediatricians, what does the total supply of generalist amount to in the United States? How do... es this number compare with the UK? the total supply of generalists (including internists and pediatricians) amounts to 1/3 (33%) of all physicians in the US. In the UK it is about 50%. What is one action taken to fill the primary care gap in the United States? - Some physicians at the secondary and tertiary care levels have also acted as PCPs for their patients. Who is more likely to work in primary care settings than physicians? - Nurse practitioners and physicians assistants Who is the Care Coordinator and "Gatekeeper"? - 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 medication/prescription 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. What are the forces driving healthcare in the U.S.? Biomedical model among medical educators - Financial incentive for physician specialization and hospital expansion - Professionalism- acting in patient's best interest Who benefits from Medicare? Medicare is for the elderly Part A of Medicare Hospital insurance plan for the elderly financed largely through social security taxes from employers and employees Part B of Medicare Insures the elderly for physician services and is paid for by federal taxes and monthly premiums from the beneficiaries Part D of Medicare Offers prescription drug coverage and is paid for by federal taxes and monthly premiums from beneficiaries. Enacted in 2003 Medicaid A program run by the states and is funded by federal and state taxes, which pays for the care of millions of LOW-INCOME PEOPLE Medicare Modernization Act of 2003 - provided: - the expansion of the role of private health plans (the Medicare Advantage program, Part C) -establishment of a prescription drug benefit (Part D) What are the first generation health maintenance organizations? Kaiser -HMOs (health maintenance organizations) Both are prepaid group practices What are the second generation health maintenance organizations? -Independent Practice Association or IPAs (or network HMOs, integrated medical groups, Physician- Hospital Organizations (PHO)) -Health Maintenance Organization Act of 1973 based on second generation of network HMOs that evolved from Kaiser- Permanente Medical Care program What is a Preferred Provider Organizations (PPO)? allow patients to choose their own providers outside of a traditional HMO model there may be increased costs to the patient in this type of model compared with HMO models What did the Affordable Care Act of 2010 do? expansion of health insurance -reform in how health care is organized and delivered through the concept of the Accountable Care Organization What is an Accountable Care Organization (ACO)? 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 Many ACOs contract with both Medicare and private plans. (private health insurers changing PPO into ACO models emulating the Medicare Shared Savings Program [Show More]

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