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Definition
A system of healthcare delivery that:
-seeks to achieve efficiency by integrating the basic functions of healthcare delivery
-employs mechanisms to control (manage) utilization of medical services
-determines the price at which the services are purchased and how much the providers are paid. |
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Definition
| The individual covered under a health plan |
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| The contractual agreement between the enrollee and the MCO that contains the collective array of covered health services to which the enrollee is entitled. |
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Definition
| Primary care physicians that control patient referrals to higher-level or specialty services. |
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Definition
| When a provider is paid a fixed value for each patient under their care, regardless of the amount of care required, over the course of a fixed period (typically 1 year). |
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| Insurance program for families and dependents of active-duty or retired career military personnel. |
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| The Veterans Affairs (VA) |
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Definition
| The health care system available to retired veterans who have previously served in the military, with priority given to those who are disabled. |
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| Veterans Integrated Service Network (VISNs) |
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Definition
| Geographic distribution of VA health care system. 23 VISNs coordinate all activities of all health care entities within its jurisdiction. |
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| Special populations (Vulnerable populations) |
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Definition
| Those with health needs but inadequate resources to address those needs. Typically receive care through the nation's "safety net." |
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Definition
| One of largest sources of public health insurance in US. Serves the elderly, disabled, and those with ESRD. |
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Definition
| Covers hospital care, post-discharge nursing care, hospice care, outpatient services, and prescription drugs. Does not cover long-term care. |
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Definition
| Third largest source of health insurance in country. Serves low-income adults, children, the elderly, and individuals with disabilities. |
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Term
| Children's Health Insurance Program (CHIP) |
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Definition
| Formed in 1997 to provide insurance to children in uninsured families. Covers physician visits, immunizations, hospitalizations, and emergency room visits. |
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Term
| Integrated Delivery Systems (IDSs) |
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Definition
| A network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population, and that is willing to be held clinically and fiscally accountable for the outcomes and health status of that population. |
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Definition
| Consists of the medical and non-medical care that is provided to individuals who are chronically ill or who have a disability. Not only health care but support services for daily living. |
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Term
| Ten essential public health services a system should deliver as defined by NPHPSP |
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Definition
1) Monitoring health status to identify and solve community health problems.
2) Diagnosing and investigating health problems and hazards.
3) Informing and educating people about health problems and hazards.
4) Mobilizing the community to solve health problems.
5) Developing policies to support individual and community health efforts.
6) Enforcing laws and regulations to support health safety.
7) Providing people with access to necessary care.
8) Assuring competent and professional health workforce.
9) Evaluating the effectiveness, accessibility, and quality of personal and population-based health services.
10) Performing research to discover innovative solutions to health problems |
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Term
| Ten Main Characteristics of the US Healthcare System (Be able to explain each) |
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Definition
-No central governing agency and little integration and coordination.
-Technology-driven delivery system focusing on acute care.
-High in cost, unequal in access, and average in outcome.
-Delivery of healthcare under imperfect market conditions.
-Government as subsidiary to the private sector.
-Fusion of market justice and social justice.
-Multiple players and balance of power.
-Quest for integration and accountability.
-Access to healthcare services selectively based on insurance coverage.
-Legal risks influence practice behaviors. |
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Definition
| Refers to the costs of ancillary services that often accompany major procedures. Example being that patients know the cost of the surgery, but can't anticipate the costs of supplies etc. |
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Definition
| Payment covers services that are bundled together for one episode of care. |
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Definition
| The amount of medical care that medical experts believe a person should have to remain or become healthy. |
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Definition
| The creation of artificial demand commonly due to practitioners with a financial interest in a treatment or organization. |
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Term
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Definition
| Places the responsibility for fair distribution of healthcare on market forces in a free economy. Medical services are distributed based on ability and willingness to pay. |
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Definition
| Emphasizes the well-being of the community over the indivdual, therefore the inability to obtain medical services due to a lack of financial resources is considered unjust. |
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Term
| The Emergency Medical Treatment and Labor Act of 1986 ("EM-Tala") |
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Definition
| Requires the screening and evaluation of eery patient, provision of necessary stabilizing treatment, and hospital admission when necessary, regardless of ability to pay. |
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Term
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Definition
| The patients able to pay for services, privately insured individuals, employers, and the government ultimately cover the costs of medical care provided to the uninsured. |
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Term
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Definition
| When providers prescribe additional diagnostic tests, schedule check-up appointments, and maintain abundant documentation in order to avoid any negative legal issues. |
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Term
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Definition
| Consists of a set of interrelated and interdependent components designed to achieve some common goals. |
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