structure of the healthcare system (quiz 1)

american healthcare systems quiz 1

a product (profit driven)

what is healthcare viewed as in the US?

volume

what is payment given for instead of quality in most instances?

EMTALA (emergency medical treatment and active labor act)

requires medicare-participating hospitals that offer emergency services to provide a medical screening exam when a request is made. (does not require that hospitals treat all patients, just that a screening is provided and emergent patients are stabilized)

patient dumping

EMTALA was created with the intention to stop what?

taxpayers

party that favors limits on healthcare spending

providers

party that favors income, autonomy, and comprehensive coverage while opposing limits on provider payments

patients

party that favors comprehensive coverage, quality of care, and low out of pocket costs while opposing limited access to care and higher out of pocket costs

employers and payers

party that favors cost containment, elimination of cost shifting, and administrative simplification

regulators/government

party that favors cost containment and accountability, as well as increased access and quality

access, cost, quality

what three things make up the iron triangle of healthcare

access

point of triangle dealing with wait times, universal coverage, and geographic access

cost

point of triangle dealing with stable healthcare expenses while maintaining the ability to provide new technology

quality

point of the triangle dealing with the rate of medical errors and the improvement of outcomes (morbidity/mortality)

socialized medicine

model of healthcare where the government owns the entire provision of care, as well as employs the clinicians, owns the hospitals, and purchases the equipment

single-payer system

model of healthcare where one institution organizes financing for all care. this institution does not own the hospitals or employ the clinicians, but reimburses them for their services from a single source. clinicians generally remain privatized

privatized medicine

model of healthcare where private organizations and clinicians provide and pay for care. a profit-driven system with availability/access dependent on ability to pay

fee-for-service (FFS)

traditional model for reimbursement and for those without coverage. the provider bills for services delivered and is payed a pre-determined rate. risk is assumed by the third-party payer. (AKA indemnity insurance)

capitation (by the head)

newer reimbursement model used by most private insurance companies. providers are paid a set amount for each enrollee assigned to them. risk is assumed by the provider