PUBHLTH 129: Study Guide
22 Cards in this Set
| Front | Back |
|---|---|
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class III medical devices
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-support life
-requires premarket approval from the FDA
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cost sharing
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-spreads risk from individual to group
-helps avoid moral hazard
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how do managed care plans differ from traditional insurance
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-contract with certain providers
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medicare part A
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-hospital insurance
-covers inpatient services, hospice skiled nurse
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medicare B
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-financed by annual deductables
-physician services, outpatient, diagnostics
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medicare C
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-private health care insurance
-HMOs, PPOs
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medicare D
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-prescription drugs
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capitation
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-fixed monthly fee
-removes incentive for provider induced demand
|
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retrospective
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-actual price when provider delivers service
-need to do more to get more
|
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prospective
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-set price before
-no incentives to keep patients longer
|
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what incentives do providers have to do discounted fee arrangements
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-higher volume of patients
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when was the HMO act passed and how did it work
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-1973
-trend increased but slowed down in 80s
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why did managed care grow in 1980s
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-private businesses couldnt afford rising premiums, wanted control over cost to help profits
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main characteristics of HMO
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-use of gate keeping
-focus on prevention and primary care
-soem fee for service
|
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differences between HMO and PPO
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-PPO's you can go out of network
-PPOs use more specialty care before preventative
-no risk sharing with PPOs
|
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three meanings of cost
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-consumers + financers: physician bills
-national perspective
-providers perspective
|
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major factors contributing high costs
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-growth of tech
-increase in elderly
-abuse of medicare/caid
|
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PROs
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peer review organization
-assesses care
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2 competition based cost containment stradegies
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-demand side incentives: wants customers to be more conscious
-supply: wants health care organizations to be cost efficient
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implications of definition of quality
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-doesn't include cost or access
-quality occurs on a continuum
-emphasis on desired health outcomes
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dimensions of quality micro macro
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-micro-services at point of delivery, quality of life, patient satisfaction
-macro- quality from population stand point, cost, access, population health
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new developments and improvements
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-clinical practice guidelines: a plan for managing clinical problem based on evidence
-cost efficient when benefits recieved are greater than cost incurred
-timeline that identifies planned medical interventions along with expected patient outcomes
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PUBHLTH 129: Study Guide