Exam (elaborations)
C425 Healthcare Delivery, Regulation, And Compliance (WGU)
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C425 Healthcare Delivery, Regulation, And Compliance (WGU)
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C425 Healthcare Delivery, Regulation,And Compliance (WGU)
Capitation A ✔️Ans - covers all services an enrollee may need during an
entire year
Market Justice ✔️Ans - most equitably distributed through the market
forces of supply and demand, rather than government interventions.
Distributed on the basis of willingness and ability to pay
Social Justice ✔️Ans - An ideal that embraces all aspects of civilized life
and that is linked to fundamental notions of fairness and to cultural beliefs
about right and wrong.
defensive medicine ✔️Ans - Ordering more tests and procedures than are
necessary in order to protect physicians from a lawsuit.
medical model ✔️Ans - emphasizes clinical diagnosis and medical
intervention in the treatment of diseases or symptoms. Health is defined as
lack of illness
National Health Insurance ✔️Ans - course of care delivered by providers
(Canada)
National Health System ✔️Ans - Great Britain taxes support the system, but
government also manages the infrastructure for healthcare delivery
Socialized Health Insurance ✔️Ans - government mandated contributions
by employers and employees finance health care (Germany)
Acute Care ✔️Ans - relatively severe, short duration, often treatable. Ex.
stroke
Chronic Care ✔️Ans - continuing for a long time
Planned Rationing ✔️Ans - The government making deliberate attempts to
limit the supply of health care services
, Medicare ✔️Ans - Benefit period = 60 days after admitted
Pt B: cover physicians bill, small premiums for elderly
Premiums are income based
Part D: Prescription Drug coverage
Voluntary, w monthly premium
1973- expanded to non elderly disabled, end stage renal disease patients.
Financed by pay roll taxes
American Medical Association ✔️Ans - protect the interests of physicians,
organized medicine. Supported licensing discouraged employment by
hospitals and insurance companies
Globalization ✔️Ans - various forms of cross border economic activities
Medicaid ✔️Ans - Eligible poor, financed through federal matching funds to
the states
Each state has its own criteria for eligibility based on income, bank
account, property and assets
Federal law covers: low income elderly, blind, disabled, children in low
income families. Means tested program
provider-induced demand ✔️Ans - Artificial creation of demand by
providers that enables them to deliver unneeded services to boost their
incomes.
Deductible ✔️Ans - Amount you must pay before you begin receiving any
benefits from your insurance company
Centers for Medicare and Medicaid Services (CMS) ✔️Ans - provide
clarification and interpretation of complex provisions of the law. Promotes
consistency in
interpretation between states
individual private insurance ✔️Ans - price based on how risky your life is
fee-for-service ✔️Ans - get paid per individual service
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