NUR 228 Lecture Notes - Lecture 1: Psychiatric And Mental Health Nursing, Health Insurance Marketplace, Baby Boomers
Document Summary
In 1983, the prospective payment system (pps) was developed: hospitals could no longer charge the actual cost, but grouped the medicare patients into diagnosis-related groups (drgs). They get a set amount for the patient based on the. Drg: other networks or organizations thought it was such a great idea they developed capitated payments, capitation: providers receive a fixed amount per patient based on the diagnosis or surgical procedure. This is for insurance companies or other providers. Not medicare: they get the best standard of care at the lowest cost, managed care, a provider receives a certain amount of money for each patient enrolled in the program. The provider goal is to have enough money to pay for everyone"s healthcare. Everyone must have health care coverage or pay a penalty: 2. Adult children may stay on their parents" plan until age 26: 3. The states create a healthcare exchange for enrollees: 4.
