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2016-2017 PHS Unit 2
Healthcare Systems & Insurance
| Question | Answer |
|---|---|
| Hospital | Provides INPATIENT care. |
| Hospitals are classified by funding; list the four funding types. | 1) Proprietary/for profit; non profit; government & religious |
| Hospitals are classified by services; list the two service types. | 1) General & 2) Specialty |
| Long-term healthcare facility | Provides care for elderly, people with physical or mental disabilities and people with chronic or long-term illness. |
| Nursing home | For live-in patients who no longer can care for themselves |
| Assisted Living | self-sufficient person pays a fee to live in a unit with BASIC services |
| Independent living | patients live in a "Senior Living Community" and use ONLY the services they need |
| Emergency Care | Provide special care for accidents or sudden illness (risk of losing life, limb or eye sight) |
| Medical Offices | Provide diagnosis, treatment, examination, basic laboratory testing & minor surgery; usually operated by a group of group of physicans |
| Dental Offices | Provide dental exams, cleaning and treatments for a variety of disorders |
| Clinics | Provide a variety of OUTPATIENT services |
| Optical Centers | Provide vision exams; prescribe eye glasses or contact lenses |
| Medical Labs | where diagnostic test are processed (usually blood or urine specimens) |
| Dental Labs | where implants, dentures and other corrective devices for the mouth are made |
| Home Health Care | Provide healthcare to patients in their own home |
| Palliative Care | Comfort care for the terminally ill |
| Mental Health | Provide care of patients who have mental illness and disorders |
| List 4 types of Mental Health Services | 1) Counseling; 2) Psychiatric; 3) Chemical abuse; 4) Phsycial abuse |
| Genetic Counseling Centers | Provide testing & counseling to individuals or couples who are pregnant or considering pregnancy |
| Rehabilitation | Provide services to help patients with physical or mental disabilities develop maximum ability for self-care |
| List 3 examples of rehabilitative therapy | 1) Physical therapy 2) Occupational therapy 3) Speech therapy |
| Industrial Health Centers | Onsite clinic within a large industry or employer that provides basic exams, accident/illness prevention and wellness programs |
| School Health Services | Provide health screenings, health education, and emergency care to students and staff, along with recommendations for a safe/sanitary school environment |
| Local Health Departments | provide immunizations, inspections for health and sanitation, statistics and records, health education or clinics |
| Voluntary/nonprofit agencies | organizations focus on specific disease; educate public |
| List two examples of a voluntary/nonprofit agency | 1) American Red Cross & 2) American Cancer Society |
| How do voluntary/nonprofit agencies receive funding? | Supported by donations, membership feeds, fundraisers and grants |
| World Health Organization (WHO) | compiles statistics on disease; investigates serious health problems across the world |
| Food & Drug Administration (FDA) | regulates food and drug products sold to the public |
| Occupational Safety and Health administration (OSHA) | A federal agency that establishes and enforces standard that protect workers from job-related injuries and illness |
| National Institute of Health (NIH) | National organization that is involved in the research of disease |
| Centers for Disease Control (CDC) | National organization that researches causes, spread and control of disease |
| Managed Care | offer services through a system of providers at reduced rates |
| 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 |
| Preferred Provider Organization (PPO) | Focuses on clients' preferences; a Primary Care Physician (PCP) referral IS NOT required |
| Medicaid | State-administered medical assistance program for low-income individuals/families |
| Medicare | Nationally administered medical assistance program for citizens age 65 or older |
| Medigap | Health insurance policy that helps pay for expenses not covered by Medicare |
| State Children's Health Insurance Program (SCHIP) | Low cost health insurance to uninsured children of families who do not qualify for Medicaid |
| TRICARE | Insurance for active duty and retired military and their families/survivors |
| 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 |
| Network or In-Network | Contracted healthcare providers, facilities and suppliers by your insurance company. |
| 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. |
| Deductible | The amount you pay for healthcare services BEFORE your health insurance plan starts to pay for the healthcare services. |
| 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). |
| Co-payment (Or Co-pay) | Usually a set amount. The amount you have agreed with your insurance company to pay for healthcare services. |
| Premium | Amount you pay to purchase your health insurance |
| 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%. |
| 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. |
| Excluded Services | Healthcare services that your insurance will not pay for, such as chiropractic care. |
| Preauthorization | Except in an emergency, your health insurance must approve healthcare services PRIOR to them being provided. |
| Preventative Services | Screenings, counseling and routine check-ups that help prevent disease or provide early detection and treatment for disease. |
| 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. |
| Specialist | A physician with advanced training in a focus area, such as cardiology, neurology, nephrology etc. |
| Referral | A consult request from your PCP to a specialist. |
| 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. |
Created by:
vorachekt
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