Healthcare Systems & Insurance
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| Hospital | Provides INPATIENT care.
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| Hospitals are classified by funding; list the four funding types. | 1) Proprietary/for profit; non profit; government & religious
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| Hospitals are classified by services; list the two service types. | 1) General & 2) Specialty
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| Long-term healthcare facility | Provides care for elderly, people with physical or mental disabilities and people with chronic or long-term illness.
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| Nursing home | For live-in patients who no longer can care for themselves
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| Assisted Living | self-sufficient person pays a fee to live in a unit with BASIC services
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| Independent living | patients live in a "Senior Living Community" and use ONLY the services they need
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| Emergency Care | Provide special care for accidents or sudden illness (risk of losing life, limb or eye sight)
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| Medical Offices | Provide diagnosis, treatment, examination, basic laboratory testing & minor surgery; usually operated by a group of group of physicans
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| Dental Offices | Provide dental exams, cleaning and treatments for a variety of disorders
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| Clinics | Provide a variety of OUTPATIENT services
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| Optical Centers | Provide vision exams; prescribe eye glasses or contact lenses
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| Medical Labs | where diagnostic test are processed (usually blood or urine specimens)
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| Dental Labs | where implants, dentures and other corrective devices for the mouth are made
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| Home Health Care | Provide healthcare to patients in their own home
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| Palliative Care | Comfort care for the terminally ill
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| Mental Health | Provide care of patients who have mental illness and disorders
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| List 4 types of Mental Health Services | 1) Counseling; 2) Psychiatric; 3) Chemical abuse; 4) Phsycial abuse
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| Genetic Counseling Centers | Provide testing & counseling to individuals or couples who are pregnant or considering pregnancy
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| Rehabilitation | Provide services to help patients with physical or mental disabilities develop maximum ability for self-care
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| List 3 examples of rehabilitative therapy | 1) Physical therapy 2) Occupational therapy 3) Speech therapy
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| Industrial Health Centers | Onsite clinic within a large industry or employer that provides basic exams, accident/illness prevention and wellness programs
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| School Health Services | Provide health screenings, health education, and emergency care to students and staff, along with recommendations for a safe/sanitary school environment
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| Local Health Departments | provide immunizations, inspections for health and sanitation, statistics and records, health education or clinics
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| Voluntary/nonprofit agencies | organizations focus on specific disease; educate public
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| List two examples of a voluntary/nonprofit agency | 1) American Red Cross & 2) American Cancer Society
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| How do voluntary/nonprofit agencies receive funding? | Supported by donations, membership feeds, fundraisers and grants
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| World Health Organization (WHO) | compiles statistics on disease; investigates serious health problems across the world
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| Food & Drug Administration (FDA) | regulates food and drug products sold to the public
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| Occupational Safety and Health administration (OSHA) | A federal agency that establishes and enforces standard that protect workers from job-related injuries and illness
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| National Institute of Health (NIH) | National organization that is involved in the research of disease
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| Centers for Disease Control (CDC) | National organization that researches causes, spread and control of disease
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| Managed Care | offer services through a system of providers at reduced rates
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| Health Maintenance Organization (HMO) | focuses on prevention; patient MUST have Primary Care Physician (PCP) referral to see a specialist and all non-emergent care MUST be pre-approved
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| Preferred Provider Organization (PPO) | Focuses on clients' preferences; a Primary Care Physician (PCP) referral IS NOT required
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| Medicaid | State-administered medical assistance program for low-income individuals/families
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| Medicare | Nationally administered medical assistance program for citizens age 65 or older
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| Medigap | Health insurance policy that helps pay for expenses not covered by Medicare
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| State Children's Health Insurance Program (SCHIP) | Low cost health insurance to uninsured children of families who do not qualify for Medicaid
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| TRICARE | Insurance for active duty and retired military and their families/survivors
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| Worker's Compensation | Provides treatment for workers injured on the job with payments made by employers and the state for healthcare costs and lost wages
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| Network or In-Network | Contracted healthcare providers, facilities and suppliers by your insurance company.
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| Out-of-Network | A healthcare provider, facility or supplier that is NOT on the contract with your insurance company. It will cost more to use out-of-network healthcare services.
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| Deductible | The amount you pay for healthcare services BEFORE your health insurance plan starts to pay for the healthcare services.
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| Co-insurance | A percentage your insurance and you agree to pay for healthcare services (80/20 - 80% paid by health insurance and 20% by you).
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| Co-payment (Or Co-pay) | Usually a set amount. The amount you have agreed with your insurance company to pay for healthcare services.
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| Premium | Amount you pay to purchase your health insurance
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| Out-of-pocket maximum | The maximum amount of money you will pay during a policy period for healthcare services. After this is reached, your health insurance will pay 100%.
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| Explanation of Benefits (EOB) | A summary of the healthcare services received by someone on your health insurance plan and the amount of money the insurance company is paying for those services.
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| Excluded Services | Healthcare services that your insurance will not pay for, such as chiropractic care.
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| Preauthorization | Except in an emergency, your health insurance must approve healthcare services PRIOR to them being provided.
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| Preventative Services | Screenings, counseling and routine check-ups that help prevent disease or provide early detection and treatment for disease.
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| Primary Care Physician (PCP) | The doctor you see first for your healthcare. In an HMO type insurance plan, they must see you first before referring you to a specialist for care.
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| Specialist | A physician with advanced training in a focus area, such as cardiology, neurology, nephrology etc.
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| Referral | A consult request from your PCP to a specialist.
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| Affordable Care Act | Law implemented in Mar 2010 that increased access to affordable healthcare/insurance, increase patient Bill of Rights and increased coverage for preventative services.
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