Health Science Fundamentals

Medicine

Quiz 2 :

Understanding Health Care Systems

Quiz 2 :

Understanding Health Care Systems

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What can you determine by looking at an organizational chart for a facility?
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Health care organizations are the institutions that provide health related facilities to different individuals. Many health care institutions employ use of organizational charts to ease the functioning of the organization and also to maintain error free records of patients.
The different information that an organizational chart can convey in medical practice are listed below:
1. The main purpose of organizational chart is to illustrate skeletal structure of the medical practice.
2. It demonstrates the different types of medical services and things associated with it, like diagnostic services that identify the disease, lab tests etc.
3. It helps to identify the management and supervisory positions assigned to its different functions.
4. It establishes an array of command that helps to ensure communication among relevant parties and facilitates problem-solving.
5. It helps all the workers in an organization to know to whom they have to report, discuss and pose suggestions.
6. Organizational charts provide the means to people to formally organize themselves to carry out a task.
7. The organizational structure is considered as "anatomy of a practice" and the process as the "practice physiology."
8. Every worker within an organization can clearly determine what his or her responsibilities are, just by looking at their organizational chart.
9. It determines the line of authority and gives the organization a decentralized status.

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Managed Care -We hear a lot today about the benefits and difficulties of managed care. What do you think exemplifies the best of managed care? How could we further improve the system? Give examples.
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A managed care plan is a health insurance providing scheme that provides high-quality health care benefits at the lowest cost possible to the enrolled individual or employee. In managed care plans, doctors from different specialties are always present at the service.
The health care providers of the enrolled person are scrutinized before they are recruited for a medical care plan. It provides cost-effective quality care to the person enrolled under the managed care plan.
Disadvantages of managed care plans are as follows:
1. Rules are not flexible regarding the choice of doctors. Sometimes members enrolled under the plan do not feel comfortable with allotted-healthcare provider or doctor available in the network.
2. In order to save money, sometimes the managed health care providers contact/ recruit inexperienced health care. In few other situations health care professional with an aim makes extra money and conduct unnecessary medical tests.
Types of managed care plans are as follows:
1. HMOs (health maintenance organizations) - Here the person receives all kinds of healthcare from the network provider, except in case of emergency. It requires a referral from the primary care physician (present in the network).
2. Preferred provider organizations (PPOs) - A person can choose a physician from a preferred list of physician present in the network, so no referral is required in PPOs.
3. Point-of-service plans (POS) - It requires a primary care physician, but if a person wishes to go outside the network, then referral from primary care physician is not mandatory.
Some tips for the improvement of medical care plans are as follows:
1. A person must be allowed to seek medical aid out-side the network and medical care plans must pay at least more than 50% of the medical bills. Strict scrutiny of the physicians must be conducted at regular intervals by the panel of medical care providers.
2. Approval from the insurance providers must be swift to avoid long waiting periods. Confidentiality must be strictly maintained by the insurance providers regarding the diseased condition of the enrolled person.

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A patient is not sure he understands his new insurance policy. He is going to have a colonoscopy procedure, which will cost $3,350. There is a co-pay of $30 and the co-insurance is 20%.The annual deductible is $1,000, of which the patient has met $325. What amount will the patient have to pay?
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The client of the insurance company has to pay by three ways that include co-pay, co-insurance and deductible. The total amount paid by client is the sum of these amounts.
In the given case, amount of co-pay is $30 and the deductible amount is $325. Amount to be paid as co-insurance can be calculated as follows:
img The total amount paid by the client is calculated as follows:
img Therefore, the total amount paid by the patient is
img .

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What are we trying to do to contain the high costs of health care? (2.2)
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How do volunteer agencies help the medical field?
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How does the Healthcare Effectiveness Data and Information Set help patients/clients? (2.2)
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What does preventive care mean?
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How do the policies of managed care help to provide quality care for patients? (2.1)
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Explain several ways in which we are addressing personal wellness issues. (2.1)
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How does ambulatory care help to meet the needs of patients?
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What are some of the costs that third-party payers might require a patient/client to pay?(2.2)
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Under what three circumstances might ambulatory care be preferable and why? (2.1)
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List two types of facilities that generally house patients for more than a day.
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Name one health care provider and explain how they provide medical care. (2.1)
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An elderly gentleman is leaving the hospital after receiving care for his broken leg. He lives with his family, but he is alone all day while family members are at work. What kind of care will the man need after he leaves the hospital? What type of facilities might you recommend to this patient so he can receive this care?
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Running the Organization -Like any efficient corporation, each health care facility has a chain of command. Why is it important to follow this chain of command? Think of specific examples that show what might happen if you do not follow the chain of command.
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What are the benefits of an organizational chart in a health care facility? (2.1)
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Name three government agencies that provide health services. What does each agency do?(2.1)
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Explain the four major services in health care.(2.1)
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Health Costs -The costs of health care continue to increase. What do you think we can do to help contain these costs? Look at the problem both from the perspective of the patient and the provider.
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