NURS 1130 Exam 2 Guide
WithComplete Solution
IOM Quality (1990)
Quality of care is the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge
4 generic roles of government in health care
-Provide for those who cannot provide for themselves
-Supply social and public goods
-Regulate the market
-Instill trust and accountability
Opposing views of role of government in healthcare
-Free market (Adam Smith) ensures provision of public goods and services
-Government (James Madison) provides goods and servides
-Uninsured lower size and power government
-Constraints of managed care lower growth of federal regulation
Very complex problem that has developed tension
Role of government in purchasing health care
-Medicare (elderly and disabled)
,-Federal Employee Health Benefits Plan
-Medicaid (low income)
-State Child Health Insurance Program (CHIP)
-TriCare (military)
-Value based
-Fee for service care
Role of government in providing health care
-Miltary employees and their beneficiaries
-Veterans (Veteran Health Administration)
-American Indians and Alaskan natives (Indian Health Service)
-Federal prison population
Role of government in ensuring access to quality care for vulnerable
populations
Federally qualified health centers (FQHC), includes community health centers,
migrant health centers, health care for the homeless, health centers for
residents of public housing, assuring care and quality, sliding scale
dependent upon income
Role of government in regulating health care markets
-Licensing of professionals (state)
-Medical error reporting (state departments of health)
-Rule for commerce
,-JCAHO
Role of government in developing and evaluating health technologies and
practices
-NIH
-DOD
-VA
-AHR evidence based practice centers
Role of government in monitoring health care quality
-Health care cost and utilization project (HCUP)
-Quality improvement (QI)
-Medical expenditure panels (MEP)
-Patient safety
Role of government in informing health care decision making
-National Guideline Clearinghouse
-Healthfinder
-US Consumer Gateway
-Three of most prominent for professionals and patients, monitored by
government
Role of government in developing the health care workforce
-Funded medical residency programs
, -Medicare pass through costs for medical education
-Traineeship programs for nurses
-Loan programs
-Public health service forgiveness programs
-Programs to increase number of professionals in medical professions
Role of government in convening stakeholders from all aspects of health care
system
-QuIC: quality initiative program (AHRQ, VA, Department of labor, OSHA
institute)
_National Forum on Quality Measurement and Reporting
-Meets at least 4 times per year, gather people together to talk about quality
Medicare
A federal program of health insurance for persons 65 years of age and older
and those that are disabled (Centers for Medicare and Medicaid Services)
Federal Employee Health Benefits Plan
Health benefits plan that all congressman and federal employees have access
to
Medicaid
A federal and state assistance program that pays for health care services for
people who cannot afford them, originally designed for children, now
focusing on adults and elderly too, state financed and required that states
have this program (CMS)
WithComplete Solution
IOM Quality (1990)
Quality of care is the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge
4 generic roles of government in health care
-Provide for those who cannot provide for themselves
-Supply social and public goods
-Regulate the market
-Instill trust and accountability
Opposing views of role of government in healthcare
-Free market (Adam Smith) ensures provision of public goods and services
-Government (James Madison) provides goods and servides
-Uninsured lower size and power government
-Constraints of managed care lower growth of federal regulation
Very complex problem that has developed tension
Role of government in purchasing health care
-Medicare (elderly and disabled)
,-Federal Employee Health Benefits Plan
-Medicaid (low income)
-State Child Health Insurance Program (CHIP)
-TriCare (military)
-Value based
-Fee for service care
Role of government in providing health care
-Miltary employees and their beneficiaries
-Veterans (Veteran Health Administration)
-American Indians and Alaskan natives (Indian Health Service)
-Federal prison population
Role of government in ensuring access to quality care for vulnerable
populations
Federally qualified health centers (FQHC), includes community health centers,
migrant health centers, health care for the homeless, health centers for
residents of public housing, assuring care and quality, sliding scale
dependent upon income
Role of government in regulating health care markets
-Licensing of professionals (state)
-Medical error reporting (state departments of health)
-Rule for commerce
,-JCAHO
Role of government in developing and evaluating health technologies and
practices
-NIH
-DOD
-VA
-AHR evidence based practice centers
Role of government in monitoring health care quality
-Health care cost and utilization project (HCUP)
-Quality improvement (QI)
-Medical expenditure panels (MEP)
-Patient safety
Role of government in informing health care decision making
-National Guideline Clearinghouse
-Healthfinder
-US Consumer Gateway
-Three of most prominent for professionals and patients, monitored by
government
Role of government in developing the health care workforce
-Funded medical residency programs
, -Medicare pass through costs for medical education
-Traineeship programs for nurses
-Loan programs
-Public health service forgiveness programs
-Programs to increase number of professionals in medical professions
Role of government in convening stakeholders from all aspects of health care
system
-QuIC: quality initiative program (AHRQ, VA, Department of labor, OSHA
institute)
_National Forum on Quality Measurement and Reporting
-Meets at least 4 times per year, gather people together to talk about quality
Medicare
A federal program of health insurance for persons 65 years of age and older
and those that are disabled (Centers for Medicare and Medicaid Services)
Federal Employee Health Benefits Plan
Health benefits plan that all congressman and federal employees have access
to
Medicaid
A federal and state assistance program that pays for health care services for
people who cannot afford them, originally designed for children, now
focusing on adults and elderly too, state financed and required that states
have this program (CMS)
