health pollicy 100 week 3

Shortage of physicians 

Too many specialists 

Creates problems 

People cannot seek out preventive care

Increases the cost 

 

Yes

Nurses 

Largest group of health care

professionals

• Caregivers of sick and injured

patients

• Address physical, mental, and

emotional needs

• Many practice locations

(home, hospital, clinic, etc.)

• Setting specialties (long-term

care, public health, etc.)

Yes

• Nurses wide range of practices

• Physicians spend less time with patients 

• Nurses help in hospital settings and at homes

• Nurses travel to take care of patients

• 
  

Nursing levels 

Certified nursing assistant 

Licensed practical nurse 

Registered nurses - Bachelor of Nursing or 

Advanced practice registered nurses -master of science in nursing 

Nurse practitioners, nurse midwives, clinical nurse specialists, certified nurse anesthetists 

Doctor of nursing or philosophy 

Nurse practitioners serve as physicians in the documentary in New Mexico

Yes

Levels of Nursing

Nurse Assistants 

• Individuals who are trained to

function in an assistive role to the

registered professional nurse in the

provision of patient/client care

activities as delegated by and

under the supervision of the registered professional nurse

• Help with feeding and hygiene 

• Changing a bed, helping someone eat

Licensed Vocational Nurse 

LVN/LPN care for patients under

supervision of RNs or physicians

• Basic bedside care (taking

temperatures, measure vitals,

cleaning wounds, collecting

samples)

• Skills acquired by means of a

course in an accredited school of

vocational nursing, or similar

• LVN/LPNs must pass the NCLEX-PN

licensing exam

Levels of Nursing

Registered Nurse 

• Provide care in hospitals, clinics,

outpatient surgical centers,

hospices, military, mental health

agencies, etc.

• RNs must pass the NCLEX-RN

licensing exam

⚬ BSN (four year program at college or

university)

⚬ AND (two- to three-year program at

community college or nursing school

⚬ Diploma (three-year program at

Hospita

• The most common type of nurses 

• Work in different environments

Advanced Practice Nurse

 

RNs who pursue graduate study

⚬ Nurse practitioners (NP)

￭ Can prescribe medications and, in

23 states, can practice

independently w/o a physician

⚬ Certified Nurse Midwives (CNM)

⚬ Certified Registered

Anesthetists (CRNA)

⚬ Clinical Nurse Specialists (CNS)

￭ Experts in specialized areas of

clinical practice, such as pediatrics,

emergency room care, diabetes,

oncology, mental health, etc

Thye are able to step in when thre is a lack of primary care physicians 

Six nursing degrees and certificates video 

• Cna - 4-12 weeks 

• Care for patients' daily needs, vital signs, bathing, walking, feeding 

• LPN - 12 months - oral medications, vital sisn, assist patient care, basic procedures, 

• ADN nurse - assisting patients, administering medicine, assisting medicine and consult with doctors 

• BSN-  team leading, research, thinking, 

• MSN - nurse education - teach, APRN, prepare for NP, CNM, CNS, CRNAS, 

• DNP- 

Yes

Nursing Shortage 

Higher demands for health

care

⚬ Aging population

⚬ Growing population

• Decreasing supply of nurses

⚬ Retirement

⚬ High burnout rates

⚬ High turnover rates

• Not enough nurses entering

the field

⚬ Limited nursing school

capacity

⚬ Lack of nursing faculty

￭ Salary

￭ Other nursing careers are

more lucrativ

• Shortage of nurses 

• She was lot cause of the burnout of benign a foct 

• There is a lot of violence towards nurses 

• During COVID, demands for care and shortage of nurses - pateitns became more demanding, patients more aggressive 

• The blonde nurse she rushes in theri and punches the patient get off new nurs,e soemthing ot sedante him to calm him down 

• She had been in similar situations; she had that on hand 

• Conversation about administration finds out 

• Not that easy too 

• Being a professor does not pay very well; better to work in a clinical setting 

• 
  

Addressing the storage 

Train More Nurses Act”

• Increase funding specifically for

nursing faculty salaries

• Safe Staffing Ratios

• Minimum nurse-to-patient ratios

• “Ladder” Programs

• Creating pathways for lower-level

nurses to become RNs through

employer-funded bridge programs

• Technology & Virtual Nursing

• Virtual nurses to handle admissions,

discharges, documentation, etc. so

bedside nurses have more time for

patient care

• AI tools that listen to patient

interactions and draft notes to reduce

paperwork for nurse

• Virtual -nurse paperwork to alleviate the burnout 

• Note taking apps and tools

• There is an example for the notetaking app 

• Improve the storage  

• Virtual -nurse paperwork to alleviate the burnout 

• Notetaking apps and tools

• There is an example for the notetaking app 

• Improve the sotaheg 

Yes

Understanding Health Insurance 

What is health

insurance?

Health insurance is a system

intended to pay some or all of the

costs of a person’s medical,

surgical, and hospital care\

Pay some or all a person’s hosptial or healthcare 

Anyone is who a memerb is puttign money into aput, someonse needs to us it, they withdraw money with the cost 

Medical emergency that is costy, insurance themselves against risk 

How it works

Individuals contribute money

regularly to a fund from which

contributors can withdraw money

to pay for their medical expenses.

The U.S. medical insurance system

is a combination of private and

public funding.

Yes

Health Insurance Key Terms

Key term	Simple definition	Example
Premium	The amount you pay every month to have health insurance.	You pay $200 each month for insurance.
Deductible	The amount you pay for covered healthcare services before insurance starts paying its share, subject to your plan’s rules.	Your deductible is $1,000, so you pay the first $1,000 of eligible costs.
Co-insurance	The percentage of a medical bill you pay after meeting your deductible.	Your insurance pays 80%, and you pay 20%.
Co-pay	A fixed amount you pay for a healthcare service or prescription.	You pay $25 for a doctor’s visit.
Out-of-pocket	The money you pay yourself for healthcare costs, such as deductibles, co-pays, and co-insurance.	You pay $50 for a prescription.
Annual coverage limit	The maximum amount an insurance plan will pay for certain covered benefits in one year, if the plan has such a limit.	A plan might limit a particular benefit to $2,000 per year.

Yes

Under the Affordable Care Act, most major medical plans cannot impose annual or lifetime dollar limits on essential health benefits. Some other benefits or types of plans may have limits.

yes

• Premium = Pay to keep your insurance.

• Deductible = Pay before insurance shares eligible costs.

• Co-insurance = Pay a percentage.

• Co-pay = Pay a fixed fee.

• Out-of-pocket = Money you pay yourself.

• Annual coverage limit = A yearly cap on certain benefits, when applicable

Yes

PREMIUM

Amount you pay for your health

insurance every month

• Premiums do not count towards

your out-of-pocket ma

• A GYM MEMBERSHIP 

• You pay money every month to access the coverage 

• You have to continue paying every month, for you not to get canceled 

DEDUCTIBLE

 

Amount you pay each year before

your plan starts to pay for

covered medical expense

• Paying v ery month your prenum to have health insurance, set amount  of money you pay out of pocket ($100), you pay that amount of money and then you reach that amount of money, the instance will start paying a part of your cost 

• Up to 2,0000 to meet, 

Co-insurance

Cost-sharing requirement where

you pay a percentage, and the

insurance company pays the

remaining percentage for

covered medical expenses after

the deductible is me

Once you meet your deductible, the co-insuance starts paying 

Then you get billed $300, but you have 3 0%,, then yu only pay 60%

Platinum - is 10% 

Gold - 20% 

Silver - 30% 

Bronze -40% 

For PPO plans 

Co-payment

 

A specific flat fee you pay for

each medical service, usually

office, ER, urgent care visits, etc.

• When you go to doctors offcie 

• An entry ticket, co pay $30 and then copay higher or lower, 

• Fixed amount of money you get to pay inside the door 

• For annual vist, you do not have to co-pay 

• Reason for that, to intende people do not overultized care 

• They insurance companies want you to fgo utgent care instead of emergemcy room 

• They do not want you to access more expensive care,

Out of pocket max 

The maximum you pay for

covered medical expenses each

year

• Once you reach your out-of-

pocket max your health plan

covers 100% of covered costs; you

no longer pay copays or co-

insurance

• Premiums do not count towards

your out-of-pocket max; copays

and co-insurance do 

Max amount of money you will pay out of pocket

• For example, 5,000 dollars ,m ince reach that amount of money, the unsyacn will pay 100% of expenses, 

• Out of network =, you need to pay for out of networks  cost 

• In network - the insurance pays 100%^

After affordable care act was passed 

Before, insurance companies say we cover you, you have a lot of medical issues and insurances drop you 

After the act, the insurances cannot cut you off

Yes

Annual coverage limit 

The ACA banned annual dollar

limits that health plans can put on

most covered benefits

• Prior to the enactment of the ACA

some plans had dollar limits on

the claims they would pay over

the course of a plan year

• Insurance used to say reach an amount of money; we cannot pay any more 

• But banned because of the pass affordable care act 

Yes

Quick comparison for your exam

Plan	Main thing to remember
HMO	Primary doctor and referrals usually required
PPO	More freedom to choose doctors
EPO	Must generally stay in network
HDHP	High deductible
Catastrophic	High deductible; protects against major costs
HSA	Special account for eligible medical expenses

Yes

Health Maintenance

Organization (HMO)

Generalist - A more restricted and managed care, you  have to get approval to go see a specialist

General : Choose PCP who will act as gatekeeper

PCP If you need one, PCP will make a referral

In network: Limited doctors, hospitals, and other

providers

Out of network; Not covered

It may be more difficult to get authorizations for tests and

Procedure

Preferred Provider

Organization (PPO)

General Less managed

PCP: Not required; no gatekeeper

Specialist: No referral required; easier to access

specialists

In network: Larger network of providers

Covered but will cover less of the costs

Out of network: May be ideal for those needing more provider options and

want more control of available healthcare

Less management type of care

Do not have to go through primary care, just go straight to specalist 

More choice to providers

List of in network and out network list 

More doctors to choice from 

You have more options but pay more 

HMOs go through primary care physicians, they have lower premiums than PPO that has higher prenoiums 

Yes

Capitation- when you sign up insurance plans, there is a fix amount of money to spend more thar care, if they over the amount negative consequences 

 if they go under that amount that fine (PPO), higher premiums access physicians as you need 

Yes

Exclusive Provider

Organization (EPO)

General : Less managed

PCP: Not required; no gatekeeper

Specialist: No referral required; easier access to

specialists

In network: Larger network of providers

Out of network: Not covered

May be ideal for those wanting lower premiums and no

primary care physician

EPO - Combines both plans 

EPO - The in network is a bit bigger and no referral needed  but not cover outnetwork 

EPO - Combines both plans 

EPO - The in network is a bit bigger and no referral needed  but not cover outnetwork 

Yes

HMO

 EPO

 PPO

Must stay in network

 Must stay in network 

Not required to stay in

network

Must select a PCP 

Don’t select a PCP 

Don’t select a PCP

Must get referral to see

specialist

 No referral necessary

 No referral necessary

Yes

Fee-for -Service

(FFS)/Indemnity Plan

General : High flexibility, high premiums

PCP: Not required

Specialist: No referral required

In network: No network

Out of network: No network

Prioritizes freedom of choice for major medical events over

the convenience of subsidized routine care. Good for

managing significant medical bills, not everyday care

Fee-for -Service

(FFS)/Indemnity Plan

• 1980-1990s plan 

• Not comon 

• Pay costly prenium, no netwoek go to any doctor 

• Pay for medical bill, they file a complain and then they pay waiting to get reimburse 

Yes

High Deductible

Health Plan (HDHP)

General: Less managed, lower premiums, high

upfront risk

PCP: Not required

Specialist: No referral required

In network: Large network of providers

Out of network: Covered but will cover less of the costs

May be ideal for those needing more provider options and

want more control of their health care spending

• More popualr now 

• HMO, PPO, EPO, you can havenay of these, the givernemnt can determine if jits considered a HDHP 

• 3400 for a person is considered a high dedcucabel 

• Less managed, less premiums, sometimes they have lwoer presihm and higher deductiblem

• High premium and low deductibles, always in balance 

• Paying less infront, but more to use that care

Yes

Example of HDHP

• You are healthy college student, not worth to pay high prenium and low deductibe

• Pay low penium and high deductible, better since you do not visit the doctor as much 

• You know how much care you need 

• Popular because people go bad high premiums and not using the services, less have lower premiums and more if you use the plan –HDNP

Health Saving Account (HSA) 

Account that you can contribute to and withdraw money from tax-

free for health-related spending, such as

• copays

• deductibles

• eyeglasses

• dental work

• Prescriptions

• Health-related products

Amount you can contribute is set by the IRS and can vary from year to

year

Money rolls over from year to year and from one employer to the ne

• Account you put into fix amount of money 

• Pre tax and money used for medical expenses 

• You have money saved into the account 

• You get deal on it 

• The money does not expire 

• Only get this if you have a high deductible plans 

Yes

FSA- where you put fixed amount of money into medical thingsm but money expires after teh year 

Yes

Catastrophic Health Plan 

These plans are for people under 30 or for people who can’t afford

health care or have a “hardship exemption”.

Emphasize coverage for hospitalizations or serious illness; not as

robust as “regular” plans.

Monthly premiums are low but the deductible/out-of-pocket costs are

higher.

Preventive services are covered, as are preventive measures, like flu

shots and screenings for certain conditions

If you don’t have pre-existing conditions, aren’t on regular Rx drugs,

this plan could make sense for you 

• Plans are very low preniuym in case they have emergency room 

• High deductibles -$10,000 

• Only for extreme cares 

• Affordable care act, anyone who had healthcare insuancem, annual cares are covered 

Yes

Employer sponsored insurance 

 you pay premium before tax money is taking out 

They take out money out of the paycheck 

Yes