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?
- the 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?
- Some 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?
- Nurse practitioners and physicians assistants
Who is the Care Coordinator and "Gatekeeper"?
- - 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.
What are the forces driving healthcare in the U.S.? - - Biomedical model among
medical educators
- Financial incentive for physician specialization and hospital expansion
- Professionalism- acting in patient's best interest
Who benefits from Medicare?
- Medicare is for the elderly
Part A of Medicare
, - Hospital insurance plan for the elderly financed largely through social security
taxes from employers and employees
Part B of Medicare
- Insures the elderly for physician services and is paid for by federal taxes and
monthly premiums from the beneficiaries
Part D of Medicare
- Offers prescription drug coverage and is paid for by federal taxes and monthly
premiums from beneficiaries.
Enacted in 2003
Medicaid
- A program run by the states and is funded by federal and state taxes, which pays
for the care of millions of LOW-INCOME PEOPLE
Medicare Modernization Act of 2003
- provided:
- 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?
- -Kaiser
-HMOs (health maintenance organizations)
Both are prepaid group practices
What are the second generation health maintenance organizations?
- -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)?
- allow 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
What did the Affordable Care Act of 2010 do? - -expansion of health insurance
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?
- the 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?
- Some 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?
- Nurse practitioners and physicians assistants
Who is the Care Coordinator and "Gatekeeper"?
- - 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.
What are the forces driving healthcare in the U.S.? - - Biomedical model among
medical educators
- Financial incentive for physician specialization and hospital expansion
- Professionalism- acting in patient's best interest
Who benefits from Medicare?
- Medicare is for the elderly
Part A of Medicare
, - Hospital insurance plan for the elderly financed largely through social security
taxes from employers and employees
Part B of Medicare
- Insures the elderly for physician services and is paid for by federal taxes and
monthly premiums from the beneficiaries
Part D of Medicare
- Offers prescription drug coverage and is paid for by federal taxes and monthly
premiums from beneficiaries.
Enacted in 2003
Medicaid
- A program run by the states and is funded by federal and state taxes, which pays
for the care of millions of LOW-INCOME PEOPLE
Medicare Modernization Act of 2003
- provided:
- 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?
- -Kaiser
-HMOs (health maintenance organizations)
Both are prepaid group practices
What are the second generation health maintenance organizations?
- -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)?
- allow 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
What did the Affordable Care Act of 2010 do? - -expansion of health insurance
