Imagine you are sharing Sunday dinner with your extended family. Over dinner, the discussion turns to health care....
Managed Care and Integrated Organizations
1. Grandpa has heard about this new-fangled expression, managed care. Explain managed care to him in terms that he can understand.
2. Grandpa also wants to know if the military is a managed care system. Give him two reasons why it could be, and two reasons it may not be.
3. Grandma, overhearing the conversation, says that managed care is too complicated for her. She simply wants to know two key differences between her traditional health insurance and managed care.
4. Grandma is intrigued. Now, she wants to know why she should opt for managed care over her current insurance. Give her two reasons why this may be so.
5. During your conversation, the concepts of utilization monitoring and control come up. Explain two methods used to monitor and control the utilization of services under managed care.
6. Aunt Jeanne has been listening quietly and recognizes you're an expert in health care administration. She wants to know the difference between Medicare and Medicaid. Define each.
7. Aunt Jeanne wants to know how many of her older seemingly (financially) comfortable friends ended up using Medicaid for nursing home care. Give her two potential explanations of circumstances under which they may have decided to use Medicaid.
8. Aunt Jeanne then says, "There's no way in heck I'm going to a nursing home!" Rather, she'd prefer some alternatives to staying in a nursing home. List two alternatives for her (from the text) and describe briefly.
Health Services for Special Populations
9. Aunt Jeanne says that she's a long way from needing long-term care. She's more interested in the new Women's Center at Central Hospital, but can't understand why they need a special clinic just for women. She thinks it has something to do with interior decorating. Identify four health concerns women face, which could be why the hospital has an interest in providing specialized services for women.
10. Uncle Rodger pipes up, "We live out there in the boonies. We have our own health challenges, and they're different for us than for the city slickers." Identify two challenges of rural health that he may be referencing.
11. Uncle Rodger doesn't think they need a Women's Center; rather, they need to deal with real health problems. He's inferring that the challenges of rural health constitute more immediate problems associated with health care. You know that there are many differences between the two populations. Provide two examples of measures that have been taken to improve access to care in rural areas.
Cost, Access, and Quality
12. Aunt Marjorie then says that she's fed up with the whole business and is moving to Canada. Identify two reasons why she might want to move to Canada for healthcare, but then you tell her that there are reasons why she may want to reconsider (list two as well).
13. Aunt Marjorie listens intently to the ongoing discussion. She's convinced that managed care is about making money. You know it's a matter of perspective. Identify four key stakeholders that may benefit from providing healthcare in a managed care environment.
14. Describe briefly how each stakeholder listed above (Question 13) would view the issue of cost.
15. Aunt Marjorie has a new job in real estate and will be enrolling in her company's managed care plan. Explain to her four ways in which she might assess her plan using measures of cost, access, or quality.
16. Aunt Marjorie doesn't understand the terms premium or co-pay. Define each term using an explanation she can understand.
17. Cousin Greg, a student at the local community college, is more interested in how these issues relate to the next Presidential election. He wants to know how social issues become government policy. Just having finished an outstanding health systems class at Wayland Baptist, you provide a short outline of the policy cycle, to include the general steps.
18. Cousin Greg wants to know how the government has gotten involved in healthcare over the years. You provide him with four (4) examples from your U.S. Health Care Systems class (list only).
19. You learn that Cousin Greg is writing a paper for his introductory health class. He's confused about the term "political will". Explain the meaning of political will.
20. Cousin Greg's last question has to do with national health insurance and socialized health insurance. He wants to know what the difference is and who is using these models. Provide one explanation and one example for each.
Below are the questions with suggestions on how to address them. Some of them have comments in parenthesis that need to be addressed.
1)Grandpa has heard about this new-fangled expression, managed care. Explain managed care to him in terms that he can understand.
Managed care just means that the insurance has a contract with doctors, laboratories and other places that provide health services that allows you to receive the best possible care controlling what those services costs. That doesn't mean you will receive the attention you need. Part of being managed care is that they make sure you receive the care you need for high blood pressure including care that prevents complications.
2)Grandpa also wants to know if the military is a managed care system. Give him two reasons why it could be, and two reasons it may not be.
The military run their own managed care system with services in house and a health insurance that allows them to seek health care outside the system. **(You may be able to find the specific reasons under the managed care materials describing VA health care system.)**
3)Grandma, overhearing the conversation, says that managed care is too complicated for her. She simply wants to know two key differences between her traditional health insurance and managed care.
Well, Grandma, your traditional health insurance is what is called a fee for services. You only pay when you see your doctors and you can see any doctor you choose. With the managed care you may have to pay a monthly fee, see the doctors that have contracts with the insurance and pay a small fee every time you see them.
4)Grandma is intrigued. Now, she wants to know why she should opt for managed care over her current insurance. Give her two reasons why this may be so.
You know grandma, manage care is really good for you because they make sure you keep up with your regular check-up, screening test on time and are doing everything you need to keep your sugar under control. They do this because they have a system in place that monitors and controls what services you use.
5)During your conversation, the concepts of utilization monitoring and control come up. Explain two methods used to monitor and control the utilization of services under managed care.
Manage care can monitor and control the services you use and you need through your primary care physician or PCP. S/he is responsible to coordinate all the services you need like preventive care, routine physicals including your referrals to specialist. They can also do it through a utilization review process, in which the insurance has a system in place that makes sure you are using the services you need according to the information to your age, gender or illness.
6)Aunt Jeanne has been listening quietly and recognizes you're an expert in health care administration. She wants to know the difference between Medicare and Medicaid. Define each.
That is very easy Aunt Jeanne. Medicare is health insurance for people ...
During a family dinner, a student is caught in the middle of a discussion. Questions on managed care and integrated organizations, long term care, health services for special populations, cost, access and quality and health policy are address in a family-friendly format.