HCA 600 Midterm Exam Latest Update

HCA 600 Midterm Exam Latest Update Three major concerns in health care - Answer Cost, Quality, and Equity Managed Care - Answer is a system of health care delivery that influnces or controls uilization of services and cost of services. UR (Utilization Review) - Answer is a safeguard against inappropriate and unnecessary medical care. Pre- Certification - Answer Obtaining eligibility, certification or authorization and collecting information from the health plan prior to services Three types of managed care (MC) plans - Answer PPO,POS & HMO What is consumer- driven health care - Answer An approach to insure that focuses on making consumers sense price signals when they purchase health care. Generally involves setting a high deducatable that individulas must pay before thay can recieve insurance benefits. Consumers Like - Answer *Choices of plans & coverage *Access to latest medical technologies/ pharmaceuticals *High-quality clinical care *Access to doctors & medical professionals Health Care ($) - Answer $3 Trillion Drugs (%) - Answer 10% Hospitals (%) - Answer 31% Physician (%) - Answer 21% For profit - Answer Investor owned Non-profit Hospitals - Answer *Staus (501 c3) *Charitable ORganization *Often donate to community causes (education, primary prevention) Majority of the hospitals in the US - Answer Non-profit US life expectancy - Answer 79.8 Babies that survive - Answer 6/1000 Medicare Eligibility - Answer Senior Citizens (65+), individuals with disability and sever Kidney Disease Medicare Financed - Answer Ran by the Federal Government Medicare Spending - Answer 14% of federal Government spending in 2014, $597 billion Medicare Part A - Answer Inpatient Inpatient - Answer * Paid thru 2.9% tax by employers and employees * this accounts for 88% of part A * Also pays for skilled nursing facilities, home health care, and hospice Medicare Part B - Answer Outpatient Outpatient - Answer * Paid by the revenues from premiums (Part B) Medicare Part C - Answer Managed Care + Choice Managed Care + Choice - Answer *This is supplemental to medicare. *Generally offeres bennifts like vision, dental, and hearing. *These are medicare approved private health insurance plans. Medicare Part D - Answer Drug Benefits Drug Benefits - Answer *Paid for by revenues on premiums (Part D) Medicaid Eligibility - Answer Low-income children, pregnant women, elderly, blind, and disabled. Medicaid beneficiaries % - Answer 65% of beneficiaries are mothers and dependent children