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Advanced Role Ch 10
Terms in this set (43)
What are the 3 way the US healthcare system is unique in the world?
1. we spend far more $ on services than any other country
2. segments of the health system serve as corporate, for profit centers
3. no universal coverage for all citizens
The healthcare system is composed of what 5 basic operating elements or components?
1. health providers
2. health payers
3. health regulators
4. health manufacturers
5. health clients
health providers =
health payers =
public or private insurers
health regulators =
public or private
health manufacturers =
Our current healthcare delivery system is fragmented and emphasizes _1_ rather than _2_.
US healthcare provides the best and most comprehensive care in the world, but only to the _1_ or at _2_.
2. extraordinary cost for others
What ranking did the US get in the 2003 WHO report on quality and function of healthcare systems?
What were some of the noted disparities in US healthcare in the 2003 WHO report?
patient outcomes such as infant mortality, life expectancy, obesity, diabetes, CV disease, cancer
How many US citizens are uninsured or underinsured?
Beginning in 1873, what event made physicians gatekeepers to the healthcare and ensured that persons seeking care would initially have to be seen by a physician?
passage of medical practice acts that mandated licensure of physicians in each state
What Act in 1906 gave the American Medical Association control over pharmaceuticals and prescriptions from the nostrum makers?
Federal Pure Food and Drug Act
Early nursing legislation adopted the practice of registration but NOT _1_.
the practice of nursing
What was the first state to enact nursing legislation?
How did early legislation of physicians and nurses differ?
-physicians adopted a licensure model of legislation outlining their practices
-nurses adopted a registered model of legislation focusing on registration and neglected to outline nursing practice
When did the National League for Nursing Education (national league for nursing) begin a private sector accreditation program for nursing education?
What is the significance of the Sheppard Towner Act of 1921?
it helped finance public health nurses and state laws were passed to register births and midwives resulting in lower cost and improved infant and maternal mortality rates.
Why was the Shepard-Towner Act discontinued?
it was opposed by the medical community as it was not under physician control
When did the national interest of adopting a model of health insurance begin in the US?
When did voluntary health insurance first begin?
in 1929 in Dallas when teachers agreed to pay a monthly cost for health insurance
***this concept was the forerunner of BlueCross and BlueShield
What was the major force behind the acceptance and spread of private health insurance?
labor movement shortly after WWII when he supreme court ruled that labor unions could appropriately negotiate and strike over healthcare benefits
What are the 5 health services program sectors that compose US healthcare?
1. principal government health authorities
2. other government agencies
3. private healthcare sectors
4. non health commercial sectors
5. voluntary sectors
The relative power of each of the 5 operating components is in constant _1_.
Ex: MD's power can be strengthened by refusing to accept medicare patients when reimbursements are inadequate. OR
MD's may lose out when insurance companies refuse to authorize services
What are the 3 health management divisions of the federal government in descending order of size?
1. Dept. of health and human services (largest)
2. Dept of Veterans Affairs
3. Dept of Defense
What are some of the subdivisions of the Dept of Health and human services?
medicare and medicaid services
agency for healthcare research and quality
the public health service
health rescues and services administration
What federal health management division effects CRNAs the most?
dept of health and human services
Medicaid affords health services for the indigent. Who funds this?
federal and state govt
Medicaid eligibility is determined by...
each state as well as many restrictions on health services and reimbursement rates for providers
When was Medicare and Medicaid legislation enacted?
Earned entitlement health insurance program for elderly paid by SS taxes =
What are the 4 means through medicare payment is administered?
Part A, B, C, D
Medicare Part A pays for...
hospital stay, hospice, home healthcare
Medicare Part B pays for...
providers (including CRNAs)
Medicare Part C pays for...
medicare beneficiary enrollment in managed care organizations
Medicare Part D pays for....
APN's receive only __% of the annual federal govt payout used to expand healthcare workforce ie. training, education.
Voluntary Healthcare sector includes:
American Heart association
Visiting Nurses Association
AANA and other professional organizations are considered what sector of the healthcare system?
private healthcare sector
Healthcare services payment from public is via what 3 primary mechanisms?
1. federal or state govt
2. insurance or managed care companies
3. private pay "out of pocket"
What is the single most expensive component of the US healthcare system?
hospital care, 1/3 of the dollar spent
What influence dominates the hospital environment, especially in policy making, often the detriment of other healthcare providers?
What's the problem with most of the money going to hospital care?
hospitals focus on acute care and high revenue services and NOT outpatient care and preventative services
***there is a slow shift in this now with with some wellness initiatives
THIS SET IS OFTEN IN FOLDERS WITH...
Advanced Role Quiz-Chapters 6 & 7
Advanced Role Ch 11
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