605 Latest Exam Questions And 100% Verified Correct Answers.
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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...
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.
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