NR222- Chapter 3
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Created by:
amberfoster4672 on May 17, 2012
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16 terms
Terms | Definitions |
|---|---|
 Vulnerable Populations | Older adults, chidlren, racial and ethinc minorties, poor, uninsured, chronically ill, disabled, terminally ill, mentally ill, aids victims, alchol and substance abuse people, homeless, rural areas, non english speakers, communicaiton difficulties, low levels of education |
| Life expectancy | US 75 for males, 80 for females |
| World Health Organization (WHO) | objective is to influence health opportunities and outcomes for all people so that they can attan the highest possible level of helth. Six goals: 1. promoting development 2. fostering health security 3. strenghitng health systems 4. harnessing reasrch, infomration,a nd evidence, 5. enhacing partnerships, 6. improve performacne |
| Institute of medicine | Non profit organizaton that conducts reaearch from a systems approach to imprve health care of the nation. |
| IPA | group of providers come together and develop IPA. Contract with insruance comapny on behalf of providers they represent. Insurance company works with IPA to get contracts. Insurance company pays IPA, IPA pays doctors, etc. |
| HMO | HMO- least expensive plan, least amount of providers in network, more for younger healthier persons who dont go to the doctor frequently. PCP is gatekeeper, has to approve specialists |
| PPO | Pay more than HMO, has larger number of providers in network. Do not have to approve specialist. |
| POS | Largest network. Most expensive. Unlimited access to large variety of specialists. |
| Primary care provider | Doctor who serves at the gatekeeper and foundation of a managed care organization. |
| Capitation | A system such as an HMO in which each provider reacieves a flat annual fee for each participant regardless of how often the services are used. |
| Hospitalist | formed to control hospital costs. Physicians whose professional focus is caring for the hospitalized patient. |
| Medicare | Federallu funded health insurance program for persons over 65, disabled persons who are entitled to social securty benefits, and people with end stage renal disease requiring dialysis or kidney transplant. Also known as Title XVIII of the SSA. Part A Inpatient care in hospitals, skilled nursing facilities, home health care, hospice Part B Supplementary voluntary coverage Pays doctor's visits Part D Pharmaceutical costs—multiple plans available Challenges Growth in elderly population Depletion of Medicare resources (trust fund) Uncovered services (glasses, hearing aids) |
| Medicaid | Federally funded insruance progam available to certain low income families who fit into an eligibility program that is recognized by federal and state law. Commonly known as welfare. Also called Title XIX of the ammednments to the SSA. Assistance program managed jointly by federal and state funds State-determined eligibility Costs up to 50% of state budgets—open-ended program Benefits vary by state Available to: Certain low-income individuals No age requirements Families with children: 5-year lifetime limit |
| Private health insurnace | Traditional insurance companies (BC/BS) PPOs—"brokers" between insurers/providers HMOs—prepayment plans POS—combination of HMOs and PPOs Self-insurance/self-funded |
| Public insurance/assistance | Medicare and Medicaid |
| HIPAA | Health insurance portability and accountability act. Individuals with health insutance who lose or leave a job can maintain coverage even when they are sick. No cost provisions so it can be costly. |
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