NUR 4837 Healthcare Policy and Finance FINAL
Including general internists and general pediatricians, what does the
total supply of generalist amount to in the United States? How does this
number compare with the UK? - correct answersthe total supply of
generalists (including internists and pediatricians) amounts to 1/3 (33%)
of all physicians in the US. In the UK it is about 50%.
What is one action taken to fill the primary care gap in the United
States? - correct answersSome physicians at the secondary and tertiary
care levels have also acted as PCPs for their patients.
Who is more likely to work in primary care settings than physicians? -
correct answersNurse practitioners and physicians assistants
Who is the Care Coordinator and "Gatekeeper"? - correct answers- The
primary care provider is the gatekeeper
Example: Polly sees a nurse practitioner who discovers that the reason
she is vomiting is due to the medication she is taking. The NP consults
with the oncologist to change her medication/prescription
Stories such as Polly's demonstrate the importance of having a
generalist care coordinator who can advocate on behalf of his or her
patients and work in partnership with patients to integrate an array of
services involving multiple providers to avoid duplication of services,
enhance patient safety, and care for the whole person.
,NUR 4837 Healthcare Policy and Finance FINAL
What are the forces driving healthcare in the U.S.? - correct answers-
Biomedical model among medical educators
- Financial incentive for physician specialization and hospital expansion
- Professionalism- acting in patient's best interest
Who benefits from Medicare? - correct answersMedicare is for the
elderly
Part A of Medicare - correct answersHospital insurance plan for the
elderly financed largely through social security taxes from employers
and employees
Part B of Medicare - correct answersInsures the elderly for physician
services and is paid for by federal taxes and monthly premiums from the
beneficiaries
Part D of Medicare - correct answersOffers prescription drug coverage
and is paid for by federal taxes and monthly premiums from
beneficiaries.
Enacted in 2003
Medicaid - correct answersA program run by the states and is funded
by federal and state taxes, which pays for the care of millions of LOW-
INCOME PEOPLE
, NUR 4837 Healthcare Policy and Finance FINAL
Medicare Modernization Act of 2003 - correct answersprovided:
- the expansion of the role of private health plans (the Medicare
Advantage program, Part C)
-establishment of a prescription drug benefit (Part D)
What are the first generation health maintenance organizations? -
correct answers-Kaiser
-HMOs (health maintenance organizations)
Both are prepaid group practices
What are the second generation health maintenance organizations? -
correct answers-Independent Practice Association or IPAs (or network
HMOs, integrated medical groups, Physician- Hospital Organizations
(PHO))
-Health Maintenance Organization Act of 1973 based on second
generation of network HMOs that evolved from Kaiser- Permanente
Medical Care program
What is a Preferred Provider Organizations (PPO)? - correct
answersallow patients to choose their own providers outside of a
traditional HMO model
there may be increased costs to the patient in this type of model
compared with HMO models
Including general internists and general pediatricians, what does the
total supply of generalist amount to in the United States? How does this
number compare with the UK? - correct answersthe total supply of
generalists (including internists and pediatricians) amounts to 1/3 (33%)
of all physicians in the US. In the UK it is about 50%.
What is one action taken to fill the primary care gap in the United
States? - correct answersSome physicians at the secondary and tertiary
care levels have also acted as PCPs for their patients.
Who is more likely to work in primary care settings than physicians? -
correct answersNurse practitioners and physicians assistants
Who is the Care Coordinator and "Gatekeeper"? - correct answers- The
primary care provider is the gatekeeper
Example: Polly sees a nurse practitioner who discovers that the reason
she is vomiting is due to the medication she is taking. The NP consults
with the oncologist to change her medication/prescription
Stories such as Polly's demonstrate the importance of having a
generalist care coordinator who can advocate on behalf of his or her
patients and work in partnership with patients to integrate an array of
services involving multiple providers to avoid duplication of services,
enhance patient safety, and care for the whole person.
,NUR 4837 Healthcare Policy and Finance FINAL
What are the forces driving healthcare in the U.S.? - correct answers-
Biomedical model among medical educators
- Financial incentive for physician specialization and hospital expansion
- Professionalism- acting in patient's best interest
Who benefits from Medicare? - correct answersMedicare is for the
elderly
Part A of Medicare - correct answersHospital insurance plan for the
elderly financed largely through social security taxes from employers
and employees
Part B of Medicare - correct answersInsures the elderly for physician
services and is paid for by federal taxes and monthly premiums from the
beneficiaries
Part D of Medicare - correct answersOffers prescription drug coverage
and is paid for by federal taxes and monthly premiums from
beneficiaries.
Enacted in 2003
Medicaid - correct answersA program run by the states and is funded
by federal and state taxes, which pays for the care of millions of LOW-
INCOME PEOPLE
, NUR 4837 Healthcare Policy and Finance FINAL
Medicare Modernization Act of 2003 - correct answersprovided:
- the expansion of the role of private health plans (the Medicare
Advantage program, Part C)
-establishment of a prescription drug benefit (Part D)
What are the first generation health maintenance organizations? -
correct answers-Kaiser
-HMOs (health maintenance organizations)
Both are prepaid group practices
What are the second generation health maintenance organizations? -
correct answers-Independent Practice Association or IPAs (or network
HMOs, integrated medical groups, Physician- Hospital Organizations
(PHO))
-Health Maintenance Organization Act of 1973 based on second
generation of network HMOs that evolved from Kaiser- Permanente
Medical Care program
What is a Preferred Provider Organizations (PPO)? - correct
answersallow patients to choose their own providers outside of a
traditional HMO model
there may be increased costs to the patient in this type of model
compared with HMO models
