Ch. 2 Quiz

• Health care facilities:

  • Voluntary nonprofit institutions
  • Proprietary institutions
  • Government institutions
• Voluntary Nonprofit Institutions

  • exempt from federal, state, & local taxes in exchange for providing community benefits
  • for Charitable purposes only
• Proprietary Institutions

  • For-profit health care facilities
  • Owned by a corporation
  • Often consist of a chain of:
  • Hospitals
  • Nursing homes
  • Outpatient facilities
  • Pay local, state, & federal taxes
• Government Institutions

  • Funded primarily by local, state, or federal sources

  Examples:

  • Military treatment facilities
  • Veterans Affairs (VA) hospitals
  • Public or government-funded hospitals
  • State mental hospitals
  • State rehabilitation facilities
• Health care payment plans

  • Private insurance
  • Direct Payment
  • Government Plans
• Private Insurance

  • Employment-based, group plans
  • Offered by insurance companies
  • Employer pays part of premium; employee pays rest
  • Trend: employers shifting costs to employee
• Private Insurance (cont’d)

  • Premium: monthly amount the insured pays for policy
  • Deductible: amount the insured must pay before benefits start
  • Co-insurance: insured shares a portion (10-30%) of costs
  • Co-pay: flat fee paid by the insured per service
• Direct Payment

  • Patients pay for health care with their own money
  • “Shopping around”:
  • Creates competition
  • Drives down prices
• Government Plans: Medicare (Old & Disabled + dependents)

  • Health care program for older Americans
  • Established in 1965 by amendments to Social Security Act
  • Expanded in 1972 to include disabled & their dependents
  • Converted in 1983 to prospective payment system
• Medicare

  • Part A: inpatient care costs (no monthly premium)
  • Part B: outpatient costs (monthly premium)
  • Part C: extra benefits
  • Part D: prescription drug coverage
• Government Plans: Medicaid

  • Health insurance for low-income & disabled people
  • Established in 1965 as part of Social Security Act
• Government Plans for Military Personnel

  • TRICARE
• New Government Programs

  • CHIP
  • Children’s Health Insurance Program
  • 1997

  CHIRPA

  • Children’s Health Insurance Program Reauthorization Act
  • 2009
• Managed Care

  • Health care providers (gatekeepers) manage access to care
  • Goal: contain costs
  • In-network vs. out-of-network providers
  • Utilization review
• Types of Plans

  • Health Maintenance Organization (HMO) plan
  • Preferred Provider Organization (PPO) plan
  • Point of Service (POS) plan
• • Diagnostic related group (DRG) classification system
  • Patients assigned to DRG based on:
  • Diagnosis
  • Other demographic info
  • Health care paid in standard fees, regardless of actual costs
  • Offers incentive to hospitals for operating more efficiently
• Utilizing Resources Efficiently

  • Responsibility of all health care professionals
  • Conscientious time management
  • Electronic documentation