PBH Q4

• stay at least 24hrs 
• short term 
• long term: nursing home

• less than 24hours
• like clinics, ED, tx facilities 

organization with med school and affiliated hospital 

• no just dr. office
• all ranges

healthcare delivery system AND financial system, to fund care

• healthcare AND PUBLIC HEALTH system 
• connect in/out patient

delivery of services to defined population 

• joint commission on the accreditation of healthcare organizations
• for accrediting hospitals

• medically undeserved area
• deficiency of health care resources like beds, equipment, personnel 

• medically underserved population
• areas/population that have limited access thru all kinds of barriers

• -aka neighborhood health centers-empowerment/funds to nonprofit thru bypassing state govt
• -'65 as Johnson's war on poverty 
• -must be in MUA or serve MUP
• -tax exempt status
• -other healthcare services needed to facilitate access like case mgmt, translation, transp
• -governing board (most have to be pts of CHC)
• -regardless of pay, they need to help and give sliding fee

• -"ultimate guarantor of quality" 
• -civil law NOT CRIMINAL LAW soo based on PREPONDERENCE OF the evidence 
• -on negligence law: protect the individual from harm 

• duty was owed-need to care
• duty was breached-fail to meet standard of care
• breach caused injury-causation
• damages-direct like expenses/indirect like pain distress/punitive-negligent 

limit of total amount that insurance will pay 

amount that the injured still has to pay even if they are covered

family has to pay before eligible for insurance 

• income-Mediaid
• age in SS system of Medicare
• employment 
• health status-not for group but for individual 

price paid by purchaser on monthly or yearly 

• '60s for 65+ and now disabled and end stage renal disease
• prescribed drugs are partially covered
• preventative services 
• paid thru payroll tax

• hospital care and hospice 
• by payroll tax and no need premium

• -voluntary supplementary insurance cover diagnostic/therapeutic by outpatient 
• -75%tax revenues/25%monthly premium
• -copay of 20%

special program to encourage Medicare beneficiares to enroll in prepaid plans

• -new/for P.A and P.B
• -new premium, deductible
• -based on private plans 
• -75% of drugs
• -Donut hole above 2500
• -5000 then Medicare takes over>>>>>CATASTROPHIC 

• -fed plus state program for poor through preventive services
• -pays 50-83% based on per capita income state
• -helps disabled, children, pregnant with income less 133% of level aka $20,000
• -most dont qualify like men 
• -NURSING HOMES

cost of insurance was the same regardless of the health status of group of employees>>>now experience rating

employees insurance coverage based on use of services in previous years

fixed number of dollars/month to provide services to an member regardless number of services

charges paid for specific services provided>>encourages services/accused before/'90s

• -health maintenance organization>>>POS
• -charged patients a monthly fee designed to cover a package of services
• -clinicians were paid based on number individuals who enrolled 
• -staff model 
• -compensation based on capitation>>underuse to reduce cost

• preferred provider plans
• fee for service>>>PPO
• only with limited number of clinicals aka preferred providers

• point of service plans
• ORIGIN: HMO
• choose to get care outside system
• mixed models
• MOST COMMON 

• state child health insuranc program '90s
• Medicaid for children/help eligibility
• increase tax on cigarettes

least basic for entire pop

• legistaltion of 111th US congress
• increase insurance of pre existing condition and expands access
• incrases project national med spending

cost free preventive, teens on parent til 26, choose dr, go to ER without penalty

Joint Commssion on the Accrediation of Healthcare Organizations

• nonprofit vs profit
• 90% are non
• 50% are private nonprofit

• skill: short term, specific like strong
• nursing: long term, custodial

16,000

• avaiblitiy of operation rooms
• technicals
• perosnal
• prevents
• structure
• procession
• outcome measures

• access and service
• provides
• staying healthy
• getting better
• living with illness

combined community health centers with healthcare services for migrants, homeless, and public housing

• Medicare: '60s, 65+ old, disabled, renal disease
• Mediaid: federal plus state help poor and other groups

• above 2500 on drugs for P.A
• 2500-5000 is uncovered
• above 5000, then gov pays

• Reimbursement
• incentives
• Cost
• sharing
• Regulation
•  Restrictions
• on malpractice

employer give their employees with insurance

• find own health insurance
• govt can help/tax exempt for rich

govt takes costs of individual

• improve safety
• support deliver effectively 
• facilitate 
• efficiency 

military health care

• nursing home care
• custodial care

healthy, young, poor who don't qualify, self employed