47 terms

Chapter 2 Health Care Systems

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Agency for Health Care Policy & Research (AHCPR)
federal agency established to research quality of health care delivery & identify standards of treatment that should be provided by health care facilities.
mental health
facilities that treat patients with mental disorders and diseases. examples are psychiatric hospitals, drug/alcohol abuse and physical abuse treatment centers
health insurance plans
insurance that pays for medical care and involves a premium, co-payment and deductible
Worker's Compensation
a health insurance plan providing treatment for workers injured on the job; also reimburses workers for wages lost due to on-the-job injury
tricare (formerly called CHAMPUS)
us government health insurance plan for all military personnel and family, survivor family, retired members of armed forces
voluntary agencies and non-profit agencies
supported by donations, membership fee, fundraisers and federal or state grants. they provide health services at national, state, and local levels. They focus on one specific disease or group of diseases.
assisted living and independent living
allow individuals who can care for themselves to rent or purchase an apartment in the facility; provides meals, housekeeping, laundry, social events, transportation, and basic medical care
Centers for Disease Control and Prevention (CDC)
another division of the USDHHS; concerned with causes, spread, and control of diseases in populations
clinics
institution that provides care for outpatients; a group of specialists working in cooperation: Type of clinics are Surgical or surgicenters, urgent or emergency care, rehabilitation, specialty, outpatient, health department, medical centers.
dental offices
vary in size from offices that are privately owned by one or more dentists to dental clinics that employ a group of dentists.
emergency care services
provide special care for victims of accidents or sudden illness. Facilities include ambulance, rescue squads, helicopter or airplane, fire dept, ER
Food and Drug Adminstration (FDA)
a federal agency responsible for regulating food and drug products sold to the public
genetic counseling centers
can be an independent facility or located in another facility such as a hospital, clinic or physician's office
health departments
provide health services directed by the US Department of Health and Human Services; also provide specific services needed by the state or local community; examples are immunization, inspections, health education, clinics and other services needed in a community
Health Insurance Portability and Accountability Act (HIPAA)
set of federal regulations adopted to protect the confidentiality of patient information and the ability to retain health insurance coverage
health maintenance organization (HMOs)
both health care delivery systems and types of health insurance. Provide preventive health care for a fee that is usually fixed and prepaid. The disadvantage is that you must use only HMO-affiliated providers or pay it yourself if out of network
home health care
any type of health care provided in a patient's home environment; frequently used by elderly or disabled people, examples are nursing, personal, therapy, homemaking.
hospice
program designed to provide care for the terminally ill while allowing them to die with dignity
hospitals
institution that provides medical or surgical care and treatment for the sick or injured: General hospitals, specialty hospitals, government hospitals, university or college medical centers.
industrial health care centers
(occupational health clinics) are found in large companies or industries; provide health care for employees by performing basic examinations, teaching accident prevention and safety and providing emergency care.
laboratories
room or buildings where scientific tests, research, experiments, or learning takes place
long-term care facilities (LTC or LTCFs)
provide assistance and care for elderly patients, usually called residents. They also provide for individuals with disabilities or handicaps and individuals with chronic or long-term illness. They are residential care, extended or skilled care, independent and assisted living facilities.
managed care
a health care delivery system designed to reduce the cost of health care while providing access to care through designated providers
Medicaid
Government program that provides medical care for people whose incomes are below a certain level and for individuals who are physically disabled or blind
Medicare
Government program that provides medical care for elderly and/or disabled individuals who received 2 years SS benefits; or persons with end-stage renal disease. Type A covers hospital insurance; Type B for Medical insurance (must pay premium and deductible, share 80/20); Type D for medication expenses.
Medigap
are insurance plan that serves as supplemental insurance to Medicare; usually pays deductible for Medicare and co-payments of care
National Institute of Health (NIH)
a division of USDHHS; involved in research on disease
Occupational Safety and Health Administration (OSHA)
establishes and enforces standards that protect workers from job-related injuries and illnesses
optical centers
can be individually owned by an ophthalmologist or optometrist or they can be part of a large chain of stores.
organizational structure
encompasses a line of authority or chain of command.
preferred provider organizations (PPOs)
a type of managed care health insurance plan usually provided by large industries or companies to the employees; has in-network providers; you may share 40/60 for out of network providers
rehabilitation
helping restore patients with physical or mental disabilities obtain maximum self-care and function through therapy and education
school health services
found in schools and colleges providing emergency care for victims of accidents and sudden illness; perform tests to check for health conditions such as speech, vision and hearing; promote health education.
U.S. Department of Health and Human Services (USAHHS)
a national agency that deals with the health problems in the United States
World Health Organization (WHO)
an international agency sponsored by the United Nations; compiles statistics and information on disease, publishes health information and investigates and addresses serious health problems throughout the world
medical offices
vary from offices that are privately owned by one doctor to large complexes that operate as corporations and employ many doctors and other health care professionals.
premium
fee the individual pays for insurance coverage, paid to the insurance company.
deductible
amounts that must be paid by the patient for medical service before policy begins to pay
co-insurance
requires that specific percentages of expenses are shared by patient and insurance company such as 80/20
co-payment
specific amount of money a patient pays for a particular service regardless of the total cost of visit
SCHIP- State Children's Health Insurance Program
established in 1997 to provide health care to uninsured children of working families who earn too little to afford private insurance but too much to be eligible for medicaid.
Five main components of HIPAA
Health care access, portability, and renewability; Preventing health care fraud and abuse, administrative simplification and medical liability reform, Tax-related health provisions; application and enforcement of group health plan requirements; and revenue offsets.
Health care access, portability, and renewability:
limits exclusion on preexisting conditions to allow insurance to continue even if job changes, no discrimination based on health status, special enrollment rights to those who lose coverage in certain situations as divorce and termination.
Preventing health care fraud and abuse, administrative simplification and medical liability reform
has methods for preventing fraud and has penalties if it occurs; reduces administrative cost by adopting single set of electronic standards; strict guidelines for maintaining confidentiality of health care information and security of records
Tax-related health provisions
promotes use of health savings accounts; establish standards for long term care insurance; provides tax benefits from some health expenses.
application and enforcement of group health plan requirements
establishes stands requiring group plans to offer portability, access and renewability
revenue offsets.
provides changes to Internal Revenue Code for HIPAA expenses
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