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12 Cards in this Set
- Front
- Back
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Explain Managed Care
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- A health care delivery system
- Idea grew from the private market - Concern over cost of health care - came from the private marketto decrease utliization which should result in improved quality - "cool book" medicine; these symptoms require this treatment - Where we get the notion of dicounted fees - Capitation - grew out of managed care - per member per month . contractedprovideris responsible for all the care to said employees |
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Primary characteristics of the US health care system
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- advanced technology
- high levels of education should have high quality of care - has the best health care system in the world if you can ccess it - not a system fragmented |
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Iron triangle
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Access
Cost Quality |
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US health care system has little or no ...
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- networking
- interrelated components - standardization - coordination - cost containment - planning and direction |
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Major players in health care system
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- physicians (provider side)
- administrators (very important role) - insurance executives - part of administrators (want higher premiums) - large employers - provide insurance for most (want lower premiums) - government - public insurance (Medicare, Medicaid, CHIP) |
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Ten basic characteristics which set us apart
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1. no central agency governing system
2. access is selctivly based on insurance coverage 3. third-party insurers act as intermediaries between the financing and delivery functions 4. imperfect market 5. existence of multiple payers complicates system 6. balance of power prevents one entity from dominating 7. legal risk influence physician's behavior 8. new technology = demand for imediate use 9. new service settings have evolved along a continuum 10. quality is no longer accepted as an unacievable goal |
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Explain Managed Care
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- A health care delivery system
- Idea grew from the private market - Concern over cost of health care - came from the private marketto decrease utliization which should result in improved quality - "cool book" medicine; these symptoms require this treatment - Where we get the notion of dicounted fees - Capitation - grew out of managed care - per member per month . contractedprovideris responsible for all the care to said employees |
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Significance to health care management
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Postitioning of organization
Handling threats and opportunities Evaluating implications Planning Capturing new markets Complying with regulations Following the organizational mission |
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National Health Insurance (NHI) - Canada
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- Government funded via taxes
- Private providers - Financing, insurance and payment closely linked - Delivery through private sector |
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National Health System (NHS) - Great Britain
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- Government financed and delivered
- Government system - Most medical field govt. employees but some in tightly regulated government sector - Tight consolidation of all four functions |
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Socialized Health Insurance (SHI) - Germany
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- Government mandates contributions by employers and employees
- Private providers - Private not-for-profit (sickness funds) collect monies and pay for services - Insurance and payment functions tightly intergrated - Delivery private - Government exercises overall control |
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The systems framework
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System: a set of interrelated and interdependent, logically coordinated components designed to achieve common goals
Main Elements: Inputs Structure Process Outputs Outlook Access, cost, and quality are the main outcome criteria to evaluate the success of a health care delivery system |
