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Chapter Two Exam

Health Care Delivery and Economics

DefinitionTerm
a program in which the federal government helps states pay for the health care of those with income below the poverty line, as well as certain other individuals medicaid
What can you think of to help you differentiate medicaid from medicare? MedicAID - to those who need it MediCARE - Elders or disabled individuals
the federal governments health insurance program to help people older than sixty-five years of age or those with certain disabilities or conditions medicare
a physician paid a set amount per member per month to manage the health care of those members primary care physician
any method of financing and organizing the delivery of health care in which costs are contained by controlling the provision of benefits and services managed care
stay overnight or longer in a health care facility Inpatients
care provided in many settings and is designed to meet the needs of the patient in one day and then allow him or her to return home outpatient care ex. tonsillectomy, same day procedures
level of care in which the patient can receive intense physical, occupational, and speech therapy services rehabilitation or rehab
uses a team consisting of nurses and certified nursing assistants or unlicensed assistive personnel to provide care for a group of patients Team nursing
medical services provided to patients in their homes because they are confined to their homes by an illness or disability home health care
medically-directed nurse-coordinated program providing a continuum of home and inpatient care for the terminally ill patient and family hospice care
empowers the patient to take control of and manage his or her care client-centered care
one nurse is responsible of all aspects of nursing care for his or her assigned patients, often used in intensive care units primary care nursing
passed to address several problems in the existing health care system of the united states Affordable Care Act of 2010
Affordable Care Act of 2010 was created to solve: lack of health insurance for many, denial of coverage based on pre-existing conditions, limitations with coverage, people who needed insurance the most were the least likely to have, costly employee condition could cause rate increases for businesses
A cost containment program featuring a primary care physician (PCP) as the gatekeeper to eliminate unnecessary testing and procedure health maintenance organization (HMO)
Plan similar to HMO in that a primary care physician still serves as a gatekeeper, but it is not capitated. Insured people can seek care from physicians who are both in and out of the network. Point of service (POS)
In this type of plan, a group of health-care providers contract with a health insurance company to provide services to a specific group of patients on a discounted basis. Preferred Provider Organization (PPO)
Capitation refers to payment plans used by Health Maintenance Organizations (HMOs)
Overall, the Affordable Care Act of 2010 was created to: contain costs in health care
services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, must seem reasonable and necessary to the entity paying for them medical necessity
any method of financing and organizing the delivery of health care in which costs are contained by controlling the provision of benefits and services managed care
If an elderly person needed help with meals, medications, and personal care but did not need continuous nursing care, which inpatient setting would be the most appropriate level of care? Assisted Living Facility
Which member of the therapy staff would be consulted if the patient had difficulty swallowing? speech therapist
A cost-efficient way to provide care to people who are confined to their homes because of illness or disability is the use of: home health care
A patient who is terminally ill with cancer is no longer being treated with radiation or chemotherapy (cancer-attacking medication). The most appropriate level of care for this patient would be: hospice
Created by: loweunde