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Chapter Two Exam
Health Care Delivery and Economics
| Definition | Term |
|---|---|
| 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
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