NURS382 Lecture Notes - Lecture 2: Managed Care, Welfare Reform, Health Promotion
20 Feb 2019
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Document Summary
Absorption of many non-profit health care organizations by large for-profit companies. Lack of funds for health promotion and protection and illness prevention activities. Potential for further decrease in revenue with movement of medicare and medicaid populations into the private managed care sector. Types - fee-for-service payment, discounted fee-for-service payment, per diem payment everything was covered. Promoted overuse of services and provision of unnecessary services - ie people stayed longer in the hospital (2-3 days for tonsillectomy: prospective reimbursement, means in the current reimbursement. Types - diagnosis related groups (drgs), resource-based relative value scale (rbrvs), capitation dont overtreat, temptation to deny care (preauthorization for procedure) Types of insurance - indemnity plans, managed care plans (health promotion) this isn"t bad if the client can afford it, but if you don"t have that extra money you"re going to have to go to another provider.
