Chapter 3 - Health Policy and the Delivery System

The Patient Self-Determination Act requires health care facilities to have which of the following A. Policies and procedures for advance directives B. Documentation of individual decisions about life-sustaining treatment C.Documentation of health care coverage D. Available education about advance directives E. Written prohibition of employment discrimination F. Guidelines for provision of services to persons with disabilities

A, B , and D

The Institute of Medicine has made recommendations for promoting safety within the health care system. Which of the following are accurate reflections of the recommended practices? (select all that apply) A.Promote health literacy. B. Improve transparency in the reporting of health information technology. C.Implement a disaster preparedness plan. D.Improve communication about medication errors. E. Nurses demonstrate an understanding of the environment they work in.

A,B, and E

A health care organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

Accountable care organizations (ACOs)

Nurses with advanced education beyond the baccalaureate degree who are prepared to manage and deliver health care services to individuals, families, groups, communities, and populations; includes clinical nurse specialists, nurse practitioners, nurse midwives, nurse anesthetists, and others.

Advanced practice nurses (APNs)

The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name "Affordable Care Act" is used to refer to the final, amended version of the law.

Affordable Care Act (ACA)

Rate paid to a physician or group of physicians that is a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.

Capitation rate

A type of primary care medical practice in which physicians charge individual clients a membership fee (on average of $1500 to $1900 per year; range reported as $60 to $15,000 per year) in return for enhanced health care services or amenities.

Concierge care

What is the role of the gatekeeper in a managed care health plan

Coordinate and oversee an individual's care.

What is the four step model for dealing with violence?

Define the problem Identify risk/protective factors Devise/test means for dealing with violence Apply successful means at large scale

Individual health care payment arrangement in which the person pays for each visit.

Fee-for-service

A physician or APN who provides primary care and who makes referrals for emergency services or specialty care.

Gatekeeper

In the private sector, which organization provides health care insurance that includes independent prepayment plans?

Health Maintenance Organizations (HMO)

A set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

Health insurance exchanges

The prototypical managed care structure that encompasses two possibilities: (1) a health plan in which providers assume some of the financial risk and (2) a health plan that uses primary care providers as gatekeepers.

Health maintenance organizations (HMOs)

Health care reimbursement accounts established for the employee.

Health savings accounts (HSAs)

A health insurance plan with lower premiums and higher deductibles than a traditional health plan.

High-deductible health insurance plans (HDHPs)

A physician whose professional focus is caring for the hospitalized individual.

Hospitalist

A type of medical plan that reimburses the patient and/or provider as expenses are incurred.

Indemnity insurance plan

Organizations composed of independent physicians in solo or group practices who provide health care services to members of an HMO in their private offices, eliminating the expense of the staff model HMO, which furnished and owned the facility in which care was provided.

Independent practice associations (IPAs)

What indicator is one of the most important determinants of the health of a nation?

Infant mortality rates

Individual payment to a fund to provide protection for each contributor against financial losses resulting from an unlikely, but possible, occurrence.

Insurance

A system that seeks to manage the cost of health care, the quality of that health care, and access to care. It is based on the belief that health care costs can be controlled by "managing" the way in which health care is delivered.

Managed care

Title XIX Social Security Amendment (1965), a combined federal and state program. The program provides access to care for the poor and medically needy of all ages.

Medicaid

A federal health insurance program that finances medical care for people over 65, disabled individuals who are entitled to Social Security benefits, and people with end-stage renal disease requiring dialysis or a kidney transplant.

Medicare

Organizations that give an individual access to professional nursing services. The key components of a community nursing center include a nurse as chief manager, nursing staff who are accountable and responsible for care and professional practice, and nurses as the primary providers of care.

Nursing centers

A health care plan in which members decide how to receive services at the time of service; it combines HMO and indemnity features. As with HMOs, providers are paid through a capitation or risk-based system and, as with preferred provider organizations, individuals can choose a non-plan provider by paying extra.

Point-of-service (POS)

_______ act as "brokers" between insurers and health care providers.

Preferred Provider Organizations (PPOs)

A network of providers who agree to deliver services for a discounted fee. The provider generally incurs no financial risk; the financial burden is on the client rather than the provider.

Preferred provider organizations (PPOs)

Health care providers who provide care in the managed care arena. They can be physicians or midlevel practitioners (physicians' assistants, nurse practitioners, or nurse midwives) who provide basic health care services.

Primary care provider (PCP)

The primary federal agency charged with providing health services to the public is the

United States Department of Health and Human Services (USDHHS).