NUR 4837 Healthcare Policy and Finance
FINAL Exam Solution Guide
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
-reform in how health care is organized and delivered through the concept of the Accountable Care
Organization
What is an Accountable Care Organization (ACO)?
A provider-led organization whose mission is to manage the full continuum of care and can be
accountable for the overall costs and quality of care for a defined population
Many ACOs contract with both Medicare and private plans. (private health insurers changing PPO
into ACO models emulating the Medicare Shared Savings Program
FINAL Exam Solution Guide
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
-reform in how health care is organized and delivered through the concept of the Accountable Care
Organization
What is an Accountable Care Organization (ACO)?
A provider-led organization whose mission is to manage the full continuum of care and can be
accountable for the overall costs and quality of care for a defined population
Many ACOs contract with both Medicare and private plans. (private health insurers changing PPO
into ACO models emulating the Medicare Shared Savings Program
