Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download motacki 6 - TeacherWeb
Document related concepts
no text concepts found
Transcript
Chapter 6 Health Care Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 1 The Progression of Payment for Health Care Up until the late 19th Century – Care was provided in the home Early 20th century - People paid for services in hospitals Mid 20th century – Medicare and private insurance companies entered the health care arena By the late 20th century – costs had risen exponentially and insurance companies began to look for more cost effective ways to pay for health care Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Factors That Influence the Financial Burden of Health Care in the United States Demographic influences Uninsured individuals Medical technology Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Health Insurance Plans Private health care payment sources Private insurance Point of service plans Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Health Insurance Plans U.S. Government Insurance Plans Medicaid State Children’s Health Insurance Program (SCHIP) Medicare Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Medicare The U.S. government’s largest health care financing program Administered by the Social Security Administration Covers elderly and disabled people Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Medicare (Cont’d) Part A – Hospital Insurance Pays for hospital stays Pays for skilled nursing facility for up to 100 days (not for custodial or long-term care) Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Medicare (Cont’d) Part B – Medical Insurance Physician Nursing services (home care for specific skilled need) X-rays, lab work, diagnostic tests Ambulance transport (limited) Flu and pneumonia vaccines Dialysis Medications for organ transplant recipients Chemotherapy Durable medical equipment (DME) Prosthesis Oxygen Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Medicare (Cont’d) Part C – Medicare Advantage Plans In order to reduce costs, Medicare participants were given the opportunity to select a Medicare plan through a private insurance company. These are also known as Medicare+Choice plans. These plans are similar to private insurance plans where referrals are required to see specialists and pre-authorizations are required for procedures. Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Medicare (Cont’d) Part D – Prescription Drug Plans Began January 1, 2006 Anyone using Part A and Part B coverage is eligible for Part D, but they must enroll in a stand-alone prescription drug plan. Anyone enrolled in a Medicare Advantage Plan will enroll in a Medicare Advantage+Prescription Drug Plan. Each Prescription Drug Plan chooses which drugs they choose to cover and at what payment tier they wish to cover. It is up to the insured to look over all of the plans to see which plan covers the biggest portion of the drugs they use. Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Medicare (Cont’d) Hospice Additional coverage for Medicare recipients during the last 6 months of life Provides home care (on a 24-hour basis if needed) Palliative management of pain 24-hour interdisciplinary team Volunteers Bereavement care to survivors after the death Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Health Care Is Rapidly Changing Many changes in past 10 years Nurse works with the case manager to advocate for the care the patient needs Sadly, the reimbursement method often dictates much of the care available to the patient Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 15
