What is a community health organization - Answers organizations involved in providing health
information, education, resources, policy, services, and care
2 main types of health models - Answers 1. medical model: focuses on diagnosis and treatment of
disease
2. wellness model: focuses on the prevention of the disease
Health trends in the U.S. compared to other countries - Answers America has above average spending
and below average life expectancy. Japan has a high life expectancy and they also pay less for
healthcare.
Not-for-profits - Answers * business oriented
* owned by the community, not the investors
* serve community, not maximize profit
* profits are invested back into the organizations or held as cash reserves
* usually tax exempt from federal and property taxes
* provide public benefit
* services may not be profitable - large number of uninsured/underinsured patients
* in addition to patient revenue: fund raising, grants, donations
* can be registered as a corporation
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Not-for-profits exemption - Answers * 501(c)(3) public benefit corporations
* various charitable, non-profit, religious, and educational organizations
* provides donors of 501(c)(3)'s deduction for federal taxes
* gifts must be verified
Not-for-profits exemption criteria - Answers * establish written financial assistance and emergency
medical care policies
* limit amounts charged for emergency or other medically necessary care to individuals eligible for
assistance under the hospital's financial assistance policy
, * make reasonable efforts to determine whether an individual is eligible for assistance under the
hospital's financial assistance policy before engaging in extraordinary collection actions against the
individual
* conduct a community health needs assessment and adopt an implementation strategy at least once
every three years
* not-for-profits tax must be a corporation
* unrelated business income is taxed
* can lose not-for-profit status
* often activities don't break even revenue
* exist primarily to provide programs and services of benefit to others, not provided by the government
For-profit - Answers * investor owned, profits are main objective
* reinvested or redistributed to investor owners
* while providing quality service, managers are expected to maximize shareholder wealth
* company and the shareholders pay taxes
* can turn away non-emergent patients
indemnity - Answers * one party is exempted from incurred liabilities by the other party
* insurer pays for services after they are used either to reimburse patient or pay the provider, defined as
"fee for service"
HMO (Health Maintenance Organizations) - Answers * prepaid health plan
* Capitation: predetermined amount of funds for
* health maintenance act of 1976: strong incentive for growth of HMOs - financial incentive, employers
required to also offer HMO plan as an alternative to indemnity insurance
Managed Care models - Answers * combine paying for and providing services in one business
* must see an in-network provider
* dominant form of coverage: 95% of workers covered by an employer plan were enrolled in managed
care, up 27% since 1988
PPO (Preferred Provider Organizations) - Answers * Delivery network that manages and negotiates
contracts on behalf of the providers, who provide services at lower costs