Download MHA5008 Health Care Economics Latest 2025-2026 Exam Questions with Correct Answers 100% and more Exams Nursing in PDF only on Docsity!
MHA5008 Health Care Economics Latest 2025-
2026 Exam Questions with Correct and Verified
Answers Guaranteed Pass Already A+ Graded
Capella University
The goal of primary prevention preserve and maximize human capital by providing health promotion and social practices that result in less disease. An emphasis on primary prevention may reduce dollars spent and increase quality of life. Primary Prevention Work with legislators and insurance companies to provide coverage for health promotion to reduce the risk of diseases. Secondary Prevention Encourage clients who are pregnant to participate in prenatal care and WIC to increase the number of healthy babies and reduce the costs related to preterm baby care. Tertiary Prevention Participate in home visits to mothers who are at risk for neglecting babies to reduce the costs related to abuse.
The first developmental stage (1800-1900) characterized by epidemics of infectious diseases, such as cholera, typhoid, smallpox, influenza, malaria, and yellow fever. Health concerns. The first county health departments were established in 1908. The second developmental stage (1900-1945) U.S. health care delivery was focused on the control of acute infectious diseases. Environmental conditions influencing health began to improve, with major advances in water purity, sanitary sewage disposal, milk and water quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes (Lee and Estes, 2003). The third developmental stage (1945-1984) shift away from acute infectious health problems of previous stages toward chronic health problems such as heart disease, cancer, and stroke. These illnesses resulted from increasing wealth and lifestyle changes in the United States. To meet society's needs, the number and types of facilities expanded to include, for example, hospital clinics and long-term care facilities. The Joint Commission on Accreditation of Hospitals, established in 1951 and later renamed The Joint Commission on Accreditation of Healthcare Organizations (and now called The Joint Commission [TJC]), focused on the safety and protection of the public and the delivery of quality care. the number of persons employed in the health care industry grew by 90%. The fourth developmental stage (1984 to present)
Factors Influencing Health Care Costs inflation, changes in population demographics, and technology and intensity of services The aging population is expected to affect health services more than any other demographic factor. Part A coverage available to all persons who are eligible to receive Medicare, with older adults comprising the majority of these individuals. requires a deductible from recipients for the first 60 days of services with a reduced deductible for 61 to 90 days of service. The deductible has increased as daily hospital costs have increased. For skilled nursing facility (SNF) care, persons pay nothing for the first 20 days and a cost per day for days 21 through 100. After 100 days, persons must pay the total cost for care (CMS, 2009). The person pays zero for hospice care and home health. part B coverage supplemental (voluntary) program that is available to all Medicare-eligible persons for a monthly premium ($134 in 2010). The vast majority of Medicare-covered persons elect this coverage. Part B provides coverage for services other than hospital (physician care, outpatient hospital care, outpatient physical therapy, mental health, and home health care) that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, equipment, and some supplies. After a deductible, up to 80% of reasonable charges are paid for medical and other services. For mental health services, 55% of the costs are paid. Part B resembles the major medical insurance coverage of private insurance carriers. Figure 5-5 shows the total expenses of the Medicare program from 1970 to 2007.
Hospital care major factor contributing to Medicare costs Medicaid, full payment has been provided for five types of services Inpatient and outpatient hospital care •Laboratory and radiology services •Physician services •Skilled nursing care at home or in a nursing home for people more than 21 years of age •Early periodic screening, diagnosis, and treatment (EPSDT) for those less than 21 years of age Health Maintenance Organization (HMO) An HMO is a provider arrangement whereby comprehensive care is provided to plan members for a fixed, "per member per month" fee. Common features include the following: a.Capitation b.Use of designated providers c.Point-of-service care, or receiving care from nondesignated plan providers d.One of the following models: (1)Staff model, whereby physicians are HMO employees
reimbursement is based on either organization costs or charges. The cost method reimburses organizations on the basis of cost per unit of service (e.g., home health visit, patient-day) for treatment and care. Costs include all or a percentage of added, allowable costs. Allowable costs are negotiated between the payer and provider and include items such as depreciation of building, equipment, and administrative costs (e.g., administrative salaries, utilities, and office supplies) (Hunt and Knickman, 2005). For example, the unit of service in home health is the visit, and the agreed-on price is a set amount of money that the home health agency will be paid for a home visit in the region of the United States in which the home care agency is located. Prospective reimbursement, more recent method of paying an organization, whereby the third-party payer establishes the amount of money that will be paid for the 120121 delivery of a particular service before offering the services to the client (Hunt and Knickman, 2005). Since the establishment of prospective payment in Medicare in 1983, private insurance has followed by requiring pre-approvals before clients can receive certain services, such as hospital admission or mammograms more than once a year (Hunt and Knickman, 2005). Under this payment scheme, the third-party payer reimburses an organization on the basis of the payer's prediction of the cost to deliver a particular service; Capitation physicians and nurse practitioners are aware in advance of the payment they will receive to perform a routine, uncomplicated physical examination or a more complex, detailed physical examination, diagnosis, and treatment (Hunt and Knickman, 2005). Cost-effectiveness analysis.
A nurse practitioner is seeking support from a community health and hospital system to open a nurse-managed and nurse-staffed clinic. The nurse provides data demonstrating the role of the clinic in reducing nonurgent emergency department visits and in improving access to services for clients with chronic illness, management of caseloads, and service flow, as well as data showing proposed input and output parameters. This best demonstrates application of the techniques of: Combined public sources. Before 1950, the major portion of U.S. health care was funded by out-of-pocket payments by consumers. In the 1950s, a shift was seen to third-party reimbursement, and that trend continues today. Recent trends of third-party reimbursement indicate that the highest portion of third-party health care financing is being carried by: Cost-effectiveness analysis In evaluation of a program to prevent teen pregnancy, analysis of the net direct and indirect costs, the improvements in the community attributable to the program (such as lower high school dropout rates), and the costs that would result if the program were not implemented (such as the cost of care for low-birth-weight infants) is an example of which of the following? Cost-effectiveness analysis compares net direct and indirect costs, and cost savings with respect to a defined health outcome. Cost-effectiveness analysis is best used to compare two or more strategies or interventions that have the same health outcome in the community. This comparison can be between two program models or one intervention model and the absence of that intervention.
Preserving and maximizing human capital. The U.S. Department of Health and Human Services has argued that a higher value should be placed on primary prevention with the goal of C. Reimbursing for treatment by pediatric and family nurse practitioners. The 1989 changes to Medicaid Title XIX required states to provide care for children younger than age 6 years and pregnant women with incomes less than 133% of the federal poverty level. These changes also ensured adequate access to qualified providers by: The 1989 amendments required states to provide care for children younger than 6 years of age and to pregnant women with incomes less than 133% of the poverty level. These changes also provided for reimbursement for treatment by pediatric nurse practitioners and family nurse practitioners and thereby increased access to qualified providers. A shift in general approach from a more reactionary, acute care orientation toward a proactive, primary prevention orientation is necessary to achieve not only a more cost- effective but also a more equitable health care system in the United States. From a public health perspective, this strategy is necessary to avoid the need for other less desirable approaches that may compromise access and quality such as: Rationing of health care. Macroeconomics.
Macroeconomics focuses on the "big picture" such as the business cycle and economic growth—the total or aggregate of all individual and organizational behaviors such as growth, expansion, or decline of an aggregate. The aggregate is usually a country or nation. Factors such as levels of income, employment, general price levels, and rate of economic growth are important. Human capital is an important element in macroeconomic theory. Improvement of a human condition like health is a focus for raising and spending money on goods and services because health is valued. This approach also enhances the income-earning ability of people and improves the economy. If the population is healthy, premature morbidity and mortality are lowered, chronic disease and disability are decreased, and economic losses to the nation are reduced. Socioeconomic status is inversely related to mortality and morbidity for almost all diseases. The factors that are frequently cited as having caused the increases in total and per capita health care spending in the United States are well exemplified by which of following health care events Development of the drug sildenafil (Viagra). B. Increase in hip and knee replacement surgeries. C. Increased incidence of ischemic heart disease. D. Mandated two-day maternity hospital stays. E. Medicare Part D prescription drug plan. these factors pushed up insurance premium costs and health care costs and enabled insurance plans to cover high-cost segments of the population (the aged, poor, or disabled) because of the number of low-risk enrollees. Premium competition, the offering of health insurance as a fringe benefit, and the use of health insurance as a negotiable collective bargaining item led to an increase in covered benefits, first-dollar coverage for medical care expenses, and increased employer-paid premiums
third-party payers beginning to cover preventive services, recognizing that the growth of the health care system can no longer be supported. Under capitated health plans, health care providers stand to make money by keeping clients healthy and reducing health care use. Through combining client interests with financial interests of the health care industry, primary prevention and public health can be raised to the status and priority of acute care and chronic care Trends in Health Care Spending Increased from approximately $24 million in 1960 to more than $1.4 trillion in 2000 to $2.5 trillion in 2009 Predict total United States spending in 2019 will be $4.5 trillion Health expenditures will grow at an average rate of 7.3% annually Health spending outpacing gross domestic product More than $17 of every $100 spent has been spent for health care Largest portions of health care expenses for hospital care and physician services Only a small fraction spent on home health, public health, research, and construction Factors Influencing Health Care Costs Demographics affecting health care One in five Americans will be 65 years of age by 2030 Technology and intensity Chronic illness
Economic Barriers decrease Health Care Access Rising costs/inability to pay Increased number of people covered by Medicare and Medicaid Decreased number of people covered by private insurance More employers offering insurance and fewer employees are purchasing it Private insurance does not guarantee financial access to care Public programs offer inadequate prenatal and mental health care programs Negative outcomes for the uninsured and underinsured Health Care Financing Federal government pays a major portion of nation's health care Evolved through the 20th century from a system financed primarily by the consumer to a system financed primarily by third party payers In the 21st century the consumer is being asked to pay more Excessive and inefficient use of goods and services in health care delivery has contributed to rising costs of health care: efficient use of resources
Required to provide six basic services: inpatient and outpatient hospital care, lab and radiology services, physician services, skill nursing care at home/or in SNF, family planning Medicaid services include inpatient/outpatient hospital care, lab, radiology services, physician services, skill nursing care at home or SNF, family planning Children's Health Insurance Program (SCHIP) Federally funded Provides health insurance for children whose parents have limited income but are not eligible for Medicaid The program is a federal one, but grants each state the final say in exactly how they will implement the extended health insurance coverage for children. CHAMPUS Civilian Health and Medical Program of the Uniformed Services. Federally funded health program that provides beneficiaries with medical care, supplemental to that available in US military and Public Health Service facilities. CHAMPUS is like Medicare in that the government contracts with private parties to administer the program. CHAMPUS was revamped as a managed care system and renamed TRICARE.
Retrospective reimbursement is the traditional reimbursement method, whereby fees for the delivery of health care services in an organization are set after services are delivered. charge method reimburses organizations on the basis of the price set by the organization for delivering a service. Prospective reimbursement payment, is a more recent method of paying an organization, whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client. Paying Health Care Organizations retrospective reimbursement, charge method, prospective reimbursement Paying Health Care Practitioners fee-for-service, capitation, fee-for-service
Disease prevention/Health promotion Consumer driven health care Assist consumers in understanding price and quality issues Coalition building, research, lobbying, negotiating with insurers, influencing policymaking The goal of public health finance is to support population focused preventive health services Four principles are suggested that explain how public health financing may occur. The source and use of monies are controlled solely by the government.
- The government controls the money, but the private sector controls how the money is used.
- The private sector controls the money, but the government controls how the money is used.
- The private sector controls the money and how it is used (Gillespie et al, 2004; Moulton et al, 2004). When the government provides the funding and controls the use, the monies come from taxes, user fees (e.g., license fees and purchase of alcohol/cigarettes), and charges to consumers of the services.
Services offered at the federal government level include the following: Policy making •Public health protection •Collecting and sharing information about U.S. health care and delivery systems •Building capacity for population health •Direct care services examples of services offered at the state and local levels Maternal and child health •Family planning •Counseling •Preventing communicable and infectious diseases •Direct care services (see Chapter 46 for more examples) When the government provides the money but the private sector decides how it is used, the money comes from business and individual tax savings related to private spending for illness prevention care. When a business provides disease prevention and health promotion services to its employees and sometimes families, such as immunizations, health screenings, and counseling, the business taxes owed to the government are reduced. This is considered a means by which the government provides money through tax savings to businesses to use for population health care.
