WGU C425 - Healthcare Delivery
Systems, Regulation, and Compliance -
OA 2nd Attempt - Difficult Topics Review
What do Regulatory Organizations do? - ANSWER>>Promote public health by
-monitoring healthcare-related organizations
-imposing sanctions for non-compliance
Ultimate Goal of Healthcare Regulations - ANSWER>>Patient Safety
Regulation - ANSWER>>Rules, laws, directives, mandates, etc that encourage
compliance.
Non-compliance can result in large range of consequences based on severity of
violation
-penalties, fines
-civil or criminal penalties
Compliance Monitoring - ANSWER>>Ultimately the healthcare manager's
responsibility
-create culture of compliance
-guarantee all employees' understanding of regulations and the consequences of
non-compliance
Role(s) of Consumer Protection - ANSWER>>-build consumer confidence
-when they feel safe, they are more inclined to seek healthcare
-help foster strong provider-patient relationships
-reminder to providers that all patients have a right to respectful and personalized
care
-holds providers accountable for their patients
, HIPPA - ANSWER>>Health Insurance Portability and Accountability Act
-protect patient info
-knowledge of and compliance with HIPPA is essential for healthcare managers
Patient Protection - ANSWER>>Starts with legal guidelines
-est by The Office for Civil Rights and ERISA
-law is only first step in ensuring patient-centered care
-there are multiple factors that contribute to health and well-being
Purpose of Competition in Healthcare - ANSWER>>-Encourage healthcare orgs to
deliver higher quality care
-Encourages minimizing costs for patients
-Gov has est key Anti-trust Regulations to prevent anti-competitive action
Healthcare pre-1965 - ANSWER>>-only payment source was private insurance
-excluded elderly, unemployed, and poor
2 Most Transformative Events in US Healthcare - ANSWER>>1965- Creation of
Medicare and Medicaid
2010 - Affordable Care Act
Demand-Side Rationing - ANSWER>>Indirect Rationing
- Occurs when NOT everyone has health insurance
- Patient's ability to pay is what rations the health care
- Consumers are the demand side
Supply-Side Rationing - ANSWER>>Restricting the availability of expensive medical
technology and specialty care
-from organization side, not consumer side
Systems, Regulation, and Compliance -
OA 2nd Attempt - Difficult Topics Review
What do Regulatory Organizations do? - ANSWER>>Promote public health by
-monitoring healthcare-related organizations
-imposing sanctions for non-compliance
Ultimate Goal of Healthcare Regulations - ANSWER>>Patient Safety
Regulation - ANSWER>>Rules, laws, directives, mandates, etc that encourage
compliance.
Non-compliance can result in large range of consequences based on severity of
violation
-penalties, fines
-civil or criminal penalties
Compliance Monitoring - ANSWER>>Ultimately the healthcare manager's
responsibility
-create culture of compliance
-guarantee all employees' understanding of regulations and the consequences of
non-compliance
Role(s) of Consumer Protection - ANSWER>>-build consumer confidence
-when they feel safe, they are more inclined to seek healthcare
-help foster strong provider-patient relationships
-reminder to providers that all patients have a right to respectful and personalized
care
-holds providers accountable for their patients
, HIPPA - ANSWER>>Health Insurance Portability and Accountability Act
-protect patient info
-knowledge of and compliance with HIPPA is essential for healthcare managers
Patient Protection - ANSWER>>Starts with legal guidelines
-est by The Office for Civil Rights and ERISA
-law is only first step in ensuring patient-centered care
-there are multiple factors that contribute to health and well-being
Purpose of Competition in Healthcare - ANSWER>>-Encourage healthcare orgs to
deliver higher quality care
-Encourages minimizing costs for patients
-Gov has est key Anti-trust Regulations to prevent anti-competitive action
Healthcare pre-1965 - ANSWER>>-only payment source was private insurance
-excluded elderly, unemployed, and poor
2 Most Transformative Events in US Healthcare - ANSWER>>1965- Creation of
Medicare and Medicaid
2010 - Affordable Care Act
Demand-Side Rationing - ANSWER>>Indirect Rationing
- Occurs when NOT everyone has health insurance
- Patient's ability to pay is what rations the health care
- Consumers are the demand side
Supply-Side Rationing - ANSWER>>Restricting the availability of expensive medical
technology and specialty care
-from organization side, not consumer side
