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WGU C425 Review Finals Exam Questions and Answers
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WGU C425 Review Finals Exam Questionsand Answers
Universal Access - -Developed countries have national health insurance
programs.
It provides routine and basic health care.
It is ran by the government and financed-through general taxes.
-All Americans are not "entitled" to routine and basic health care services. -
-Access also requires an adequate health delivery infrastructure.
There is a shortage of primary care physicians mostly in the southern and
mountains region.
Obesity, chronic disease and aging population will create a much greater
demand for medical services and the size of physician workforce will decline.
50 % of PCP accept Medicaid and Participation in Medicare by PCP
36% why PCP are reluctant to accept Medicaid insured patients because of
low reimbursement to providers and delays to receive payments after the
services.
-Health Care Reform - -Is the extension of health insurance to the
uninsured.
For system to remain solvent, it must be accompanied by control costs
measures.
To control costs:
· Manage utilization
· Limit reimbursement to providers
· Employ some sort of rationing for supply of health care services
Only the government can control costs in a single payer system because
they finance the healthcare system for all citizens.
-In a single payer system, - -Medicare, Medicaid, CHIP and VA are no longer
needed.
The government will have the right to over the availability of services,
utilization and payments to providers.
,This will be opposed by many Americans and it is not seen as an alternative
for the future.
-ACA proposed interventions to control costs but few provisions on
addressing control of health care expenditures. - -If the US does not cut
expenses in the bloated government, US may be left with no choice except
to take drastic "austerity measure" a term used to describe spending cuts,
including cuts in social program.
To save Medicare from bankruptcy, changes to reduce costs are proposed in
the ACA.
Medicare benefits and allow a government panel to make decisions about
end of life care.
Medicaid, the push to enroll beneficiaries to managed care and paying MCO
capitated monthly fees to cover all health care expenses for Medicaid
beneficiaries. Taxes will increase for Americans to pay for the health care
programs to be expanded.
-If ACA fails:
Patient choice act, Health Care Freedom Plan, Empowering Patients First Act
were proposed by republican legislatures and the main features for these
plans are. - -1. Established state-based health care exchanges to facilitate
individuals to buy private health insurance and create a market where
private health plans compete for enrollees based on price and quality.
2. Create a national market for health insurance to allow individuals to
purchase health insurance plans across state lines which are currently
prohibited.
3. Allow automatic enrollment in employer plans and create tax incentives
for small business for auto enrollment.
4. Give tax credit or vouchers to individuals to purchase health insurance.
High risk pools that enable hard to insure people to purchase subsidized
covered.
• . Replace Medicaid with a program to provide grants to state for:
a) Acute Medical Care Assistance to the blind, foster care children, low
income women with breast cancer or cervical cancer, TB infected individuals;
b) long term care services and support disabled and elderly populations
6). Establish and implement a bidding mechanism to promise competition
among Medicare Advantage plans (Part C).
7) Prevent Medicare fraud and abuse.
8) Supplement the costs of Private health insurance for low income families
by distributing debit cards which may be used for costs and accessing health
care.
,9). Repeal CHIP because options for this program may not be necessary.
10) Reform the Tort System by developing mechanism for the resolution of
disputes concerning injuries allegedly caused by health care providers.
Reduce frivolous lawsuits.
11) Assure consumers have access to price information prior to treatment so
that they can make their own decisions about the care.
-What issues exists in this system which is driven by medical model of
health are unresolved? - -1) inadequate emphasis on wellness, disease
prevention and health promotion
2) a rise of chronic conditions and ensuing disabilities, the current health
care system focuses on acute illnesses.
3) Inadequate access to primary care resulting in patients overutilizing the
ER
4) increases the costs of health care w/o any improvement in health care
5) The delivery of care is fragmented instead of continuous and coordinated.
-3 emerging models of health care delivery - -1) Medical Home Model
2) Community Oriented Primary Care Model
3) Accountable Care Organizations.
-Teamlet Model - -1) refers to two-person team consisting of a PCP, nurse
practitioners or physician assistant and an allied health professional who will
function as a health coach.
The main function of health coach:
· is to assist patient in gaining the knowledge and skills, confidence to self
manage their chronic conditions.
· Assist in coordinating appts
· Help patients adopt a healthy lifestyle
· Help patients understand and adhere to medication regimen
-Connected Health Care Model - -1) uses communication technology
2) patient self management and distant home monitoring
Main objective is to keep chronically ill patients connected to necessary
clinical expertise in between office visits
-Future work force challenges - -· Shortage of health care professionals
· To have a successful model of health care delivery system to be highly
effective must have trained professionals.
· Nurses should practice to their full extent through education and training.
· Licensing requirements rules governing scope of practice should be allowed
across states for nurses who have masters or doctoral degrees
· Residency programs for nurses need to incorporate training in community
health, public health and geriatrics
, -Future workforce challenges - -PCP need to be trained to function as a
comprehensivist to address the needs of growing number of people with
chronic conditions.
PCP must be prepared to manage complex pharmacology to address end of
life issues and medical ethics and lead health care teams
PCP need to be trained to function as a comprehensivist to address the
needs of growing number of people with chronic conditions.
PCP must be prepared to manage complex pharmacology to address end of
life issues and medical ethics and lead health care teams.
There is a shortage of health professionals trained in geriatrics which is a
challenge because of shortage of faculty in colleges and universities who are
trained in geriatrics.
The elderly uses most home health care services and nursing homes,
accounts for hospital inpatient days and ambulatory care visits.
Elderlies suffer from chronic conditions complicated by comorbidities, the
use of many prescriptions and increased in mental conditions and dementia.
These trends demand will have shortage of MD, nurses, therapist, social
workers and pharmacists who are trained in geriatrics.
Integration of a racially and culturally diverse workforce will be a challenge
as the U.S. Healthcare System itself becomes more complex in taxing both
patients and workers.
-Cultural Competence: - -refers to knowledge, skills, attitudes and behavior
required of a practitioner to provide optima health care services to persons
from a wide range of cultural and ethnic backgrounds.
Health care providers need to understand the different belief systems,
cultural biases, ethnic origins, family structures and many other culture-
based factors that influence people who have illnesses in compliance with
medical advice and respond to treatment.refers to knowledge, skills,
attitudes and behavior required of a practitioner to provide optima health
care services to persons from a wide range of cultural and ethnic
backgrounds.
Health care providers need to understand the different belief systems,
cultural biases, ethnic origins, family structures and many other culture-
based factors that influence people who have illnesses in compliance with
medical advice and respond to treatment.
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