100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
Previously searched by you
Previously searched by you
logo
605 Latest Exam Questions And 100% Verified Correct Answers. $10.29
Add to cart
Quickly navigate to
Preview
  2.  
  3. NR 605
  4.  
  5. NR 605

Exam (elaborations)

605 Latest Exam Questions And 100% Verified Correct Answers.
 0 purchase
  • Course
  • NR 605
  • Institution
  • NR 605

Managed Care - Answer 1) acts as the insurance company and the providers of care. 2) Employs mechanisms to control (manage) utilization of medical services. 3) Determines the price at which the services are purchased and how much the providers get paid. 4) Is the most dominant health care del...

[Show more]

Preview 4 out of 58  pages

Document information

  • September 12, 2024
  • 58
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

Written for

  • NR 605
  • NR 605

Seller

avatar-seller
COCOSOLUTIONS

Reviews received

Content preview

605 Latest Exam Questions And 100%
Verified Correct Answers.
Managed Care - Answer 1) acts as the insurance company and the providers of care.

2) Employs mechanisms to control (manage) utilization of medical services.

3) Determines the price at which the services are purchased and how much the providers get paid.

4) Is the most dominant health care delivery system in the United States and available to most
Americans. This is includes both Health Maintenance Organizations (HMO) and Preferred Provider
Organizations (PPO).

5) Employers and government are the primary financiers of managed care.

6) An MCO functions like an insurance company.

- It promises to provide health care services contracted under the health plan to the enrollees of the
plan.



Enrollee - Answer a member; an individual covered under the plan



gatekeepers - Answer a healthcare professional (primary care, general practitioner) who regulates
access especially to hospitals and specialists

- managed care plans rely on gatekeepers to orchestrate and control the health care of enrollees



Health plan - Answer -a contractual arrangement between the MCO and the enrollee

-includes a list of covered health services to which enrollees are entitled

-uses selected providers, usually primary care, general practitioners (the "gatekeepers")



Tricare - Answer Financed by the military, and covers families, dependents or retired military



VA health care system - Answer -Is available to retired veterans

-Focuses on hospital, mental health and long-term care

,-Is one of the largest and oldest (1946) organized health systems in the world

*provide medial care, education and training, research, contingency support and emergency
management for the Department of Defense medical care system.



"safety net" providers - Answer provide care and services to the poor, uninsured, minorities and
immigrants living in disadvantaged communities



cost shifting - Answer -Medicaid, the primary financial source for the safety net, does not allow much
cost shifting

-charges an insured patient more than it does an uninsured patient for the same procedure. Those with
health insurance pay for financial loss hospitals incur when providing services to those without insurance



Market justice - Answer -"assume free market", market based demands, peoples ability to pay,
economic reward

-individual responsibility(pull up by boot straps)

-"freedom of individuals to be left alone"

-private solutions to social problems



Social Justice - Answer -social resource, active government involvement, ability to pay inconsequential,
equal access is viewed as basic right

-everyone entitled to basic package of benefits

-public solutions to social problems

-public health practitioners should work towards these social goals



National Health Insurance - Answer -Canada

-insures national population against the cost of health care

-private providers, coordinated by government



National Health Systems - Answer -Great Britain

-financed by tax supported national health insurance programs

-government owns/runs everything

,Socialized Health Insurance Systems - Answer -Germany

-healthcare is financed through government mandated contributions by employers, employees, and
general taxed.

-private providers, government controll



Systems Framework - Answer -Organized approach to understanding the components of the US health
care delivery system.

- components designed to achieve common goals, organize approach



What Is Health? - Answer -It presupposes(precondition) the existence of illness or disease.

-It emphasizes clinical diagnosis and medical interventions to:

-Treat disease or its symptoms.

-Have a clinical diagnosis and medical interventions.



Health - Answer Health is not merely the absence of disease (or injury), but complete physical, mental,
and social wellbeing.



bio-psycho-social model of health



health care system - Answer all the activities whose primary purpose is to promote, restore, or
maintain health.



Holistic Health - Answer -Treats the whole person.

-Incorporates alternative therapies.

-Has physical, mental, social, and spiritual aspects.



Holistic concepts of health care, along with preventive and health promotional efforts, need to be
adopted to significantly improve the health of Americans.

, Illness - Answer -Identified by a person's perception and evaluation of how he/she is feeling. The
hypochondriac is born.

-People are ill when they infer a diminished capacity to perform tasks and roles expected by society.



Disease - Answer -Based on a professional evaluation.

-Requires therapeutic intervention.



Overall satisfaction - Answer -Overall satisfaction with life during and following a person's encounter
with the health care delivery system.

-An indicator of how satisfied a person was with the experiences while receiving health care.



Goal: To have a positive effect on an individual's ability to function, meet obligations, feel self-worth.



Interventions - Answer 1) Social or medical care policy. - welfare of nation

2) Community-based interventions. -inequalities in a community

3) Health care interventions. - improve quality of services and reduce disparities across groups

4) Individual interventions. - minimize negative social determinants in health status



four distinct time periods: - Answer -Preindustrial era

-Postindustrial era

-Corporate era

-Era of health care reform (still in its infancy)



Preindustrial Medical Institutions - Answer -Almshouses (poorhouses) were run by the local
government.

-Hospitals were few, and had deplorable sanitary conditions and poor ventilation.

-State governments operated asylums for patients with untreatable, chronic mental illness.

-Pesthouses were operated to isolate people.

-Dispensaries were staffed by medical students or apprentices.

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller COCOSOLUTIONS. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $10.29. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

69252 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 15 years now

Start selling
$10.29
  • (0)
Add to cart
Added