health essay quiz question please answer it in 50 mins

health essay quiz question please answer it in 50 mins ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON health essay quiz question please answer it in 50 mins I’m working on a Health & Medical exercise and need support. its gonna be 500 words . Explain the concept of market justice and social justice as it applies to MCOs; discuss at least 3 MCO types. health essay quiz question please answer it in 50 mins Financing #1.docx Laying the groundwork #2.docx Historical Overview #3.docx maybe these can help you financing__1.docx laying_the_groundwork__2.docx historical_overview__3.docx ? Financing ? financing ? Any mechanism that enables people to pay for health care services ? It is generally a necessary condition to access health care ? Funding of health insurance (private or public) is the most common form of financing ? Financing also includes the various methods of paying providers (reimbursement) ? Financing of health care ultimately aggregates into national health expenditures ? Who Finances Health Care? ? Employers ? Government ? Individuals ? FIGURE 7-1 National Health Expenditures per Capita and Their Share of the Gross Domestic Product, 1960–2008 ? Effects of Financing ? Desirable Effects ? Undesirable Effects ? Insurance ? A mechanism to protect against substantial financial loss (risk) ? It protects both the patient and the provider against financial loss ? Risk is unpredictable for an individual ? Risk can be predicted with reasonable accuracy for a large group ? Insurance shifts risk from the individual to the group ? Resources are pooled and losses are shared on some equitable basis by all members of the insured group ? Cost Sharing ? Sharing of costs between the insured and the employer or between the insured and the insurance plan ? Three types: – premium cost sharing between the insured and the employer – deductible – copayments ? It reduces misuse of insurance benefits, mainly moral hazard, by controlling overutilization ? A stop-loss provision limits total out-of-pocket costs for the insured ? Private Insurance 1. Group insurance 2. Self-insurance: 3. Individual private insurance: 4. Managed care plans: 5. High-deductible health plans (HDHPs) ? Public insurance ? Two major programs: Medicare and Medicaid ? CHIP ? Main characteristics of public insurance: 1. Public insurance but private delivery 2. Categorical programs: they insure certain categories of people ? FIGURE 7-7 Number of Children Ever Enrolled in the Children’s Health Insurance Program ? Managed Care Since around 1990, ? managed care has been the single most dominant force in U.S. health care delivery ? managed care has experienced unprecedented success ? the main driver: managed care’s ability to control costs ? Introduction ? Managed care organizations (MCOs) garnered great buying power by: enrolling a large segment of the insured population and taking responsibility to procure cost-effective health care for enrollees ? organizational integration and formation of alliances by providers was in response to managed care ? What is Managed care? ? Managed care is a mechanism of providing health care services where a single organization takes on the management of: financing insurance delivery payment ? Utilization control methods Gatekeeping Utilization Review Prospective Utilization Review Concurrent Utilization Review Retrospective Utilization Review ? Gatekeeping Gatekeeping ? 3 Types of utilization review Prospective Utilization Review Concurrent Utilization Review Retrospective Utilization Review ? Types of managed Care Organizations ? HMOs Staff Model Group Model Network Model Independent Practice Association (IPA) Model ? PPOs ? Point-of-Service Plans ? Types of HMos ? PPO ? Out of Network Options ? Discounted fees with providers ? pos POS plans combine features of HMOs with patient choice found in PPOs. POS plans overcome restricted provider choice but retain the benefits of tight utilization Free choice of providers is a major selling point for POS POS peaked in 1998-1999, but has declined due to high out-of-pocket costs ? Reimbursement ? Payment by third parties to the providers of medical services ? Numerous methods of reimbursement exist health essay quiz question please answer it in 50 mins ? FFS Reimbursement ? Itemized billing and payment ? Itemized fees are generally set by providers, but actual reimbursement may be limited to a usual, customary and reasonable (UCR) amount ? Fee for service induced providers to deliver extra nonessential services which increased the cost of health care ? It has been largely replaced by other methods of reimbursement ? Package Pricing ? Charges for services are bundled under one fee ? Again, the fee is established by the provider ? Resource-Based Relative Value Scale (RBRVS) ? Reimbursement Methods Used in Managed Care ? PPOs negotiate discounted fees with the providers ? HMOs mostly use capitation. Under capitation, the provider is paid a set fee per member per month (PMPM). The provider delivers whatever services are needed by the members. ? Capitation shares risk with providers, which makes them prudent in the delivery of services. It removes the incentive for providerinduced demand. ? Reimbursement for Inpatient Services ? Retrospective (cost-based) reimbursement has been largely replaced by prospective reimbursement ? The retrospective method had perverse incentives to increase costs ? In the prospective system, providers are rewarded when their costs are below the predetermined reimbursement amount ? There are various types of prospective payment systems (PPS). Each method uses pre-established criteria to determine in advance the amount of reimbursement. ? PPS Based on DRGs (diagnosis-related groups) ? PPS based on DRGs was implemented in hospitals in the mid1980s ? Upon admission, a patient is classified into a DRG according to the patient’s main diagnosis ? Each DRG carries a fixed amount of reimbursement regardless of how long the patient stays in the hospital ? The hospital loses money if it provides services beyond what the reimbursement covers. It earns a profit when its costs are below the reimbursement amount. ? http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/Downloads /DRGDesc05.pdf ? Other Types of PPS Reimbursement ? APCs – for hospital-based outpatient departments ? RUGs – reimbursement is based on case mix ? HHRGs – per patient bundled rate is paid based on HHRG classification of each patient. HHRGs take into account the patient’s functional status and clinical severity. ? National Health Expenditures ? Total spent in the U.S. on 2.2 trillion in 2007 ? 16% of GDP (gross domestic product) was spent in 2006 ? Medical cost inflation has outstripped the growth rates in GDP ? Laying the groundwork ? Health Care in the US ? Nicole Perry ? Health Care ? refers to the actions by people who work in healthcare and by patients ? a system or systems to offer, provide and deliver health care ? MARKET vs SOCIAL JUSTICE ? a free economy can best achieve a fair distribution of health care vs. ? the equitable distribution of health care is a societal responsibility ? MARKET JUSTICE CHARACTERISTICS 1. Views health care as an economic good 2. Assumes free market conditions for health services delivery 3. Assumes that markets are more efficient in allocating health resources equitably 4. Production and Distribution of health care determined by marketbased demand health essay quiz question please answer it in 50 mins 5. Medical care distribution based on people’s ability to pay 6. Access to medical care viewed as an economic reward of personal effort and achievement ? SOCIAL JUSTICE CHARACTERISTICS 1. Views health care as a social resource 2. Requires active government involvement in health services delivery 3. Assumes that the government is more efficient in allocating health resource equitably 4. Medical resource allocation determined by central planning 5. Ability to pay inconsequential for receiving medical care 6. Equal access to medical services viewed as basic right ? CHARACTERISTICS OF THE US HEALTH CARE SYSTEM 1. No Central Governing Agency; Little Integration and Coordination 2. Technology-Driven and Focuses on Acute Care 3. High on cost, Unequal in Access, and Average in Outcomes 4. Imperfect Market Conditions 5. Government as Subsidiary to the Private Sector 6. Market Justice vs. Social Justice 7. Multiple Players and Balance of Power 8. Quest for Integration and Accountability • Historical Overview, Evolution and Current State of US Health Care • Historical Overview • 1800s: some employer sickness insurance, fraternal orders, unions; fixed sum replaced lost wages. • 1915: drive for compulsory insurance begun on European models • Protect workers from lost income due to accidents • AMA officially opposed compulsory insurance (1919) • Great Depression Shook Physicians and Hospitals • Hospitals experimented with insurance • Baylor University Plan: Blue Cross Model • AMA: continued opposition to government involvement • First Physician Plan and the Birth of Blue Shield • 1929- Justin Ford Kimball-Blue Cross • In 1939, the California Medical Association started the first Blue Shield plan it was designed to pay physician fees • By 1974, Blue Cross and Blue Shield merged • A 50 Year History • The Evolution of Health Care • 1960s: increased access for low-income populations & older Americans 1970s-1980s: controls to slow cost growth 1990s: more cost controls + quality improvements; market influences 2010 and beyond: cost, quality & access; Patient Protection & Affordable Care Act • Evolution of Health Care • Kennedy-Johnson Era: “Creative Federalism” • Federal grants increased from $7 to $24 million • 1963 Health Professions Educational Assistance Act • 1965 Medicare & Medicaid • Many other “access” related policies • Nixon-Ford Era: “New Federalism” • Deleted categorical programs, shifted to state block grants • HMO Act of 1973 • Decentralized, shifted support from public health, social programs • Unintended Effects: • Medicare, Medicaid to improve access BUT… • • • • • • • • • • • • • • • • • • • • • • • • • • • • Hill-Burton Act of 1946 to increase hospital capacity BUT… HMO Act of 1973 to control costs BUT… The Reagan Administration 1981-1989: Reductions in government involvement and funding Block grants to states Reductions in social program support Prospective Medicare hospital reimbursement (DRGs) New resource-based physician payment Medical Services In Preindustrial America The practice of medicine in the Unites States was domestic rather than professional because medical procedures were primitive Medical education was not grounded in science Medical practice was more a trade than profession The nation only had a few hospitals; they existed in very large cities. There was no private or public health insurance Almshouse Pesthouse Medical Services in Postindustrial America America’s system for delivering health care took shape during this period. Medicine became entrenched as Physicians became a cohesive profession, opted for specialization and gained power and prestige The hospital emerged as a repository for high-tech facilities and equipment. health essay quiz question please answer it in 50 mins Private and public health insurance took roots Education Reform Around 1870 medical schools began affiliating with universities and advocating a 4 year education program Harvard revolutionized medical education in 1892 Johns Hopkins University opened in 1893 and required that medical education become a graduate training program The American Medical Association (AMA) Pushed for state laws requiring graduation from a medical school accredited by the AMA as a basis for licensure to practice medicine • American Medical Association • Employment of physicians by hospitals and insurance companies was frowned on. • AMA encouraged independence from corporate control and promoted private entrepreneurship • Supported states in establishing medical licensing laws • AMA and Education Reform • 1904: AMA established • Council on Medical Education: address needed educational improvements and standards • JAMA: publish medical school state licensing failure statistics and group schools by failure rates, demanding poor schools to improve or resign the association • AMA and Educational Reform: Flexner Investigation • 1905: Support for AMA reforms by Carnegie Foundation for the Advancement of Teaching; examine all 155 US & Canadian schools’ entrance requirements, faculty, laboratories & hospital relationships • Schools’ cooperated believing that review would lead to Carnegie Foundation support • The 1910 Flexner Report: Medical Education in the U.S. and Canada • Detailed critique outlining assets, deficits & recommendations • Reduce schools from 155 to 31(85 by 1920) • Promoted state licensing legislation • Supported curriculum enrichment & facility improvements • Stimulated support by foundations and wealthy individuals • Medical Profession • Urbanization led to the concentration of medical practice in cities and towns • Medicine became driven by science and technology, • Advances in: bacteriology, antiseptic surgery, anesthesia, immunology and diagnostic techniques with new drugs helped make medical practice a legitimate profession • Louis Pastuer and Joseph Lister • Current State of US Health Care System • Systems Framework • Systems… • Characterized by… • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • No central governing agency Technology driven and focus on acute care High on Cost; Unequal in Access, and Average in Outcomes Imperfect Market Conditions Government as Subsidiary to the Private Sector Market Justice vs. Social Justice Multiple Players and Balance of Powers Quest for Integration and Accountability Challenges of the Health Care System The US Health Care Situation “The quest for greater efficiency in the delivery of health care services is eternal in a country that spends far more on health care than any other, consistently has growth in spending that outstrips that of income, is unable to provide insurance coverage to at least 15% of its population and ranks poorly…in life expectancy and infant mortality.” L. M. Nichols, 2004 Primary Problems Remain Cost Access Quality New Problems Inexplicable contradictions in objectives Unwarranted variations in performance Ineffectiveness Inefficiency Difficult relationships Many Frustrations Physicians: allege insurers constrain fees without adequate regard for quality Policymakers: Allege providers resist accountability and transparency Insurers: Providers resist evidence-based guidelines Patients: Confront a confusing payment system & disjointed services Struggles with Legislative vs. Market-Driven Reform Future Challenges More challenges!!!! Rural Health Services Technology • • • • • Social Choices Aging Population Access to Care Quality of Care Conflicts of Interest • Ethical Dilemmas … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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