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Betz Study Final

Betz Study Final - 5 Values of Health Care Access-Ability...

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5 Values of Health Care Access-Ability to receive quality care in your geographic area Rights-Moral versus constitional right to health care. The right to “autonomy” in medical ethics where you can tell him whether you do or do not want care. Efficiency-Giving best care for the least cost Equality means that we should treat people who are in the same situation the same way or treat people who are in different situations differently. Freedom-“Choice” How is Medicare organized? Part A-Hos What are the Committees on Health Care? Senate Finance Committee-Medi Origins of health care in US and private insurance How is Medicare financed? How is long-term care and home care finance delivered? What are promising alternatives to increasing access and controlling costs? How is health care is organized? It is hospital-centric. What is a single-payer system? What were the policy objectives of Medicare? What is Medigap? Insurance provided by carriers to supplement monies reimbursed by medicine for medical services. Physician charges on thing, but Medicare only covers so much (for schedule). Why is Medigap from of insurance necessary? What is Medigap’s significance? What is managed care? It is a system that integrates financing and delivery of care to covered individuals by means of four things. 1. Ar What is prospective payment? Government adopted a prospective payment mechanism based on DRGs for Medicare reimbursement to hospitals was a natural outgrowth of the New Jersey experiment (DRG was Jersey’s plan). Rationale behind replacing retrospective payment system was that under that system hospitals had no incentive to economize in their use of health care in treating Medicare patients. If anything such a system encouraged over utilization of health resources because hospitals were assured that they would be reimbursed for all
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reasonable costs incurred. If a hospital spends more money than the preestablished rate for 492 categories of diagnosis the hospital would absorb the additional cost. The changeover to PPS was the first major change in Medicare expected to revolutionize the economics of U.S. health care. Understand historical trends of Medicare and why there is a cost control imperative. Hat is the largest component of cost of delivery of care? Labor. If your cost go over for DRG payment you eat difference. You will look for cost savings in labor starting in 1983. Nurses took care of 12-15 patients instead of 10 to enhance efficiency. What are promising alternatives to increasing access and controlling costs? Single- payer system so that there isn’t the exorbitant cost of a person visiting the hospital and jacking up insurance rates. Churning- Promotion of routinely doing procedures that were profitable and the decline of those less profitable. What is long-term care? We have no long-term care policy! We do acute-care and
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Betz Study Final - 5 Values of Health Care Access-Ability...

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