312 Exam 2 / Most Resent Versions with
Well-Detailed Question and Comprehensive
Answers from Reliable Resources / Already
Graded A+
Affordable Care Act
law passed in 2010 to expand access to insurance, address cost
reduction and affordability, improve the quality of healthcare, and
introduce the Patient's Bill of Rights
why are we having provider (general practice/internist) shortages?
A decrease in insurance reimbursement compared to the specialist,
especially in rural areas
What specialties are we seeing shortages in?
OBGYN, radiology - due to high malpractice insurance
why is it important for nurses to understand HC economics?
- providing nursing care in the most cost-effective manner
- protect the scope of nursing practice
- develop opportunities to expand settings for practice
- understand what consumers want/satisfy needs
- promote HC system change to expand access, improve quality and
equitable distribution of HC resources
What has the advancement of HC tech led to?
- rising insurance rates and costs of care
- high employer benefit costs, consumer costs
- HC decision-making by insurance (not providers) to decrease costs
- Overall, it's a burden on the economy
economics
,study of how scarce resources are allocated among alternative uses
to meet/satisfy human wants
The economic model assumes
- rational consumer behavior driving decisions; motivated by self-
interest, response to incentives
- finite (limited) resources
health care resources
capital (faculties, beds, equipment, medical supplies,
pharmaceuticals, labor/personnel)
uncertainty in health care economics
- The need/demand for health care is irregular and usually can not be
predicted
- HC providers can not often anticipate the cost of care
- When patients present w illness and how they respond is variable
- Availability of insurance coverage contributes to spending
supply and demand (price elasticity) in health care
- As price increases, usually demand decreases, but in healthcare,
demand can stay high
- consumer choice/preference/price is less of a factor (HC is a need)
insurance/3rd party payment
- Insurance guards against the uncertainty of illness
- consumers do NOT pay full price/unaware of costs
- Insurance provides incentives for providers; it can deny care
non-profits HC facility
- many hospitals/community facilities and/nursing homes
- tax exempt: "charity" for the community, but many requirements
investor-owned/private HC facility
- forprofit
- multi-hospital chains
- pay taxes, publicly traded, answer to shareholders
- better economies of scale, but charge more because of the profit
motive
, gov health care facilities
state (ex: psychiatric) and federal facilities (ex: VA)
premium
periodic payment paid by policyholder (self-insured or employee
group plan) to an insurer
co-pay
A partial amount is to be paid by the consumer when the HC service
is rendered
deductible
A fixed amount that the consumer must pay before insurance
payments are made
moral hazard
- occurs when a person's behavior changes based on insurance
coverage
- Insurance companies offset this with 2 sharing relationships
total consumer cost
monetary and non-monetary
monetary cost
copayments, deductibles, also monthly insurance premiums, out-of-
pocket expenses, lost wages/time off work
nonmonetary cost
pain, risk, inconvenience
concept of capitation
payment system where providers received a fixed, per-patient fee for
a set period, regardless of services provided, which encourages
focus on prevention/efficiency
private insurance
reimbursement for expenses by direct payment to those in need of
care (minus premiums, copayments, deductibles, etc)
social (public) insurance
does not factor higher risk (risk pooling) into premiums; higher
incomes pay more
Well-Detailed Question and Comprehensive
Answers from Reliable Resources / Already
Graded A+
Affordable Care Act
law passed in 2010 to expand access to insurance, address cost
reduction and affordability, improve the quality of healthcare, and
introduce the Patient's Bill of Rights
why are we having provider (general practice/internist) shortages?
A decrease in insurance reimbursement compared to the specialist,
especially in rural areas
What specialties are we seeing shortages in?
OBGYN, radiology - due to high malpractice insurance
why is it important for nurses to understand HC economics?
- providing nursing care in the most cost-effective manner
- protect the scope of nursing practice
- develop opportunities to expand settings for practice
- understand what consumers want/satisfy needs
- promote HC system change to expand access, improve quality and
equitable distribution of HC resources
What has the advancement of HC tech led to?
- rising insurance rates and costs of care
- high employer benefit costs, consumer costs
- HC decision-making by insurance (not providers) to decrease costs
- Overall, it's a burden on the economy
economics
,study of how scarce resources are allocated among alternative uses
to meet/satisfy human wants
The economic model assumes
- rational consumer behavior driving decisions; motivated by self-
interest, response to incentives
- finite (limited) resources
health care resources
capital (faculties, beds, equipment, medical supplies,
pharmaceuticals, labor/personnel)
uncertainty in health care economics
- The need/demand for health care is irregular and usually can not be
predicted
- HC providers can not often anticipate the cost of care
- When patients present w illness and how they respond is variable
- Availability of insurance coverage contributes to spending
supply and demand (price elasticity) in health care
- As price increases, usually demand decreases, but in healthcare,
demand can stay high
- consumer choice/preference/price is less of a factor (HC is a need)
insurance/3rd party payment
- Insurance guards against the uncertainty of illness
- consumers do NOT pay full price/unaware of costs
- Insurance provides incentives for providers; it can deny care
non-profits HC facility
- many hospitals/community facilities and/nursing homes
- tax exempt: "charity" for the community, but many requirements
investor-owned/private HC facility
- forprofit
- multi-hospital chains
- pay taxes, publicly traded, answer to shareholders
- better economies of scale, but charge more because of the profit
motive
, gov health care facilities
state (ex: psychiatric) and federal facilities (ex: VA)
premium
periodic payment paid by policyholder (self-insured or employee
group plan) to an insurer
co-pay
A partial amount is to be paid by the consumer when the HC service
is rendered
deductible
A fixed amount that the consumer must pay before insurance
payments are made
moral hazard
- occurs when a person's behavior changes based on insurance
coverage
- Insurance companies offset this with 2 sharing relationships
total consumer cost
monetary and non-monetary
monetary cost
copayments, deductibles, also monthly insurance premiums, out-of-
pocket expenses, lost wages/time off work
nonmonetary cost
pain, risk, inconvenience
concept of capitation
payment system where providers received a fixed, per-patient fee for
a set period, regardless of services provided, which encourages
focus on prevention/efficiency
private insurance
reimbursement for expenses by direct payment to those in need of
care (minus premiums, copayments, deductibles, etc)
social (public) insurance
does not factor higher risk (risk pooling) into premiums; higher
incomes pay more
