Discuss the utilization control methods of gatekeeping and the three types of utilization review in terms...

Discuss the utilization control methods of gatekeeping and the three types of utilization review in terms of how they try to contain costs.

Describe the different types of long-term care services that are available.

Expert Solution

Gate keeping is an arrangement that requires a primary care physician to coordinate all services
-Emphasizes preventive care
-Secondary care provided only when referred

Process of evaluating the appropriateness of services provided is called utilization review ,

There are 3 types
1. Prospective
2. Concurrent
3. Retrospective

prospective utilization -medical necessity is determined before care is delivered.

concurrent utilization - decisions are made during the course of health care, most commonly used in discharge planning .

retrospective utilization - utilization after services have already been delivered, patient has already had health care, services have already been provided.

Long Term care - Is variety of services which is made to meet a patients health or personal care needs for a long period of time. These services help people live independently and safely when they cannot perform day to day activities on their own. It can be provided in different places by different caregivers, depending on a person's needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home. Home health care is the most regularilized long time service it includes nursing care to help a person recover from surgery, an accident, or illness. Home health care may also include physical, occupational, or speech therapy and temporary home health services. These services are provided at the homes of the patients.

Nightingale answered 1 year ago

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