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JMU - HEALTH SCI 354 - Study Guide - Midterm

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JMU - HEALTH SCI 354 - Study Guide - Midterm

School: James Madison University
Department: Nursing and Health Science
Course: U.S. And Global Health Care Systems
Professor: April Temple
Term: Spring 2019
Tags: Healthcare
Name: HTH 354 Exam 1
Description: Overview of Healthcare Systems
Uploaded: 01/29/2019
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background image 1. The Quad­Function Model 1. Basic components of health services delivery system 2. Financing (employers, government, independent) 1. About half have health insurance through employer 1. Premium cost sharing 2. Medicare (government) pays for 65+ 3. Medicaid (government) pays for lower income/disabled
4. Other people pay independently
5. About 10% are uninsured 2. Insurance (protection) 1. paying upfront to utilize later
2. Business of risk; pay a little bit (premiums) it will protect you from
higher costs down the line 3. Is a business 1. Take money monthly and not have to pay out ideally  (affordable care act remedied insurance companies not  wanting to insure the sick) 2. Delivery (healthcare providers, hospitals, etc.) 1. Where go and seek care 2. Payment (pay for service­­­ insurance or out of pocket) b. Health Care Reform: expansion of health insurance to cover uninsured 1. Patient Protection Act 2. Affordable Care Act (ACA) 1. Passed march 23, 2010 1. January 2009 obama was inaugurated, took 15 months to  get passed 1. When everything was democratic 2. One of main objectives: decrease the number of uninsured and  increase access 1. At the time 18% were uninsured 3. All US citizens and legal residents must be covered by private and  public 1. Relaxed standards to qualify for Medicaid but many states  chose not to implement this 1. By 2017 31 states expanded Medicaid 2. Most provisions were implemented January 1, 2014 1. Mandate for employers to provide health insurance was  postponed until 2015 2. Dependents stay on parents health insurance until 26  (before this were only kept if full­time students) 3. Not universal coverage
4. Uninsured rates of the nonelderly population from 1995­2015 ent 
form 16.3%­10.5% b. Managed Care
background image a. Quantity of health care consumed= utilization of health services
b. Managed care: system of healthcare delivery that seeks to achieve 
efficiency by integrating the four functions of healthcare delivery, 
employs mechanisms to control utilization of medical services, determines
the price of services and how much providers are paid c. Major Characteristics of the US Healthcare System a. No central agency 1. No one agency in charge b. Partial access
c. Imperfect market
1. No real shopping around when you go to the doctors, billed after  so do not generally know the price b. Third party insurers and payers  1. Don’t have to pay as much b. Multiple payers
c. Power balancing
1. While no central agency the government does play a role b. Litigation risks c. High technology
d. Continuum of services
1. Excellent specialty care but need to work on primary b. Quest for quality 1. Do have some of best healthcare but access is not to everyone b. Trends and Directions a. Illness wellness, acute primary care, inpatient outpatient,  individual community health, fragmented managed care,  independent integrated systems, service duplication continuum of  services c. Health Care Systems of Other Countries a. National Health Insurance (NHI)­­­ Canada 1. Just like medicare in US; everyone has it; go through the  government 2. Paid through taxes
3. Give “medicare” when born (paid through government)
4. Hospitals and healthcare workers are independent b. National Health System (NHS)­­­ Great Britain 1. Government owns hospitals, physicians, and healthcare workers;  they are government employees paid through taxes b. Socialized Health Insurance (SHI)­­­ Germany 1. Similar to the ACA 2. Different insurance companies but no gap in coverage; insurance  companies do not profit because the government restricts prices b. Health Care Around the World

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School: James Madison University
Department: Nursing and Health Science
Course: U.S. And Global Health Care Systems
Professor: April Temple
Term: Spring 2019
Tags: Healthcare
Name: HTH 354 Exam 1
Description: Overview of Healthcare Systems
Uploaded: 01/29/2019
3 Pages 95 Views 76 Unlocks
  • Better Grades Guarantee
  • 24/7 Homework help
  • Notes, Study Guides, Flashcards + More!
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