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PVAMU CHN Chapter-8
| Question | Answer |
|---|---|
| Third- party payer | Reimbursement made to health care providers by agency other than the client for the care of the client. ( e.g., insurance companies, governments, employers). |
| Safety net providers | those community providers who offer services to the uninsured and underinsured. |
| Retrospective reimbursement | - method of payment to an agency based on units of service delivered ( pay for what you receive) |
| Prospective payment system (PPS)- | diagnosis-related group payment mechanism for reimbursing hospitals for inpatient health care services through Medicare. (1983 mandated for inpatient stay. Incentive away from more care but toward more efficient services) |
| Medicare | a federally funded health insurance program for the elderly and disabled and persons with end-stage renal disease. |
| Medical-technology | the set of techniques, drugs, equipment and procedures used by health care professions in delivery of medical care to individuals. |
| Medicaid | a jointly sponsored state and federal program that pays for medical services for the aged, poor, blind, disabled, and families with dependent children. (welfare, funded by federal and state) |
| Means testing- | a method used to assess whether a clients income level qualifies him/her for Medicaid or medicare |
| Managed care- | a method of organizing a number of different health care services together along a continuum of care, for example, from physicians office to hospital , to home health, to nursing home. The client pays for services through an insurance plan. |
| Intensity | the use of technology supplies and health care services by or for the client |
| Inflation- | a sustained upward trend in the prices of goods and servicesa sustained upward trend in the prices of goods and services |
| Health economics | branch of economics concerned with the problems of producing and distributing the health care resources of the nation in a way that provides maximum benefit to the most people. ( how scarce resources affect the health care industry) |
| Health care rationing | - a method to reduce health care costs by controlling the use of health care services and technologies. (EX: provider refusing to accept Medicare clients) Public Health Issue |
| Gross domestic product (GDP)- | a statistical measure used to compare health care spending among countries. |
| Fee-for-service | – list of health care services with monetary or unit values attached that specifies the amounts third parties must pay for specific services. (Determines cost for service- delivers service- submits bill to third party- payer pays the bill) |
| Enabling | the act of shielding or enabling the addict from experiencing the consequences of the addiction. Also applies to shielding individuals from the consequences of their actions more generally |
| Efficiency | the process of meeting goals in a way that minimizes costs and maximizes benefits |
| Effectiveness | a measure of an organization ‘s performance as compared with its philosophy, goals and objectives |
| Economics | social science concerned with the problems of using or administering scare resources in the most efficient way to attain maximum fulfillment of society’s unlimited wants. (the science concerned with the use of resources) |
| Diagnosis-related groups (DRGs) | a patient classification scheme that defines 468 illness categories and the corresponding health care services that are reimbursable under Medicare. ( the basis for prospective reimbursement.) |
| Covered lives | persons enrolled in health care plan who are eligible for services under that plan (covered enrollees) |
| Capitation | a payment system whereby one fee is charged the client to pay for all services received or needed. |
Created by:
ebrozgal
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