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2016-2017 PHS Unit 2

Healthcare Systems & Insurance

QuestionAnswer
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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