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43 Cards in this Set
- Front
- Back
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capitation
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a payment system whereby one fee is charged the client to pay for all services received or needed.
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covered lives
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persons enrolled in a health care plan who are eligible for services under that plan.
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DRG
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diagnosis-related groups - a pt classification scheme that defines 468 illness categories and the corresponding health care services that are reimbursable under Medicare.
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economics
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social science concerned with the problems of using or administering scarce resources in the most efficient way to attain maximum fulfillment of society's unlimited wants.
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effectiveness
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a measure of an organization's performance as compared with its philosophy, goals, and objectives.
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efficiency
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the process of meeting goals in a way that minimizes costs and maximizes benefits.
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enabling
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the act of shielding or preventing the addict from experiencing the consequences of the addiction. Also applies to shielding individuals from the consequences of their actions more generally.
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fee-for-service
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list of health care services with monetary or unit values attached that specifies the amounts third parties must pay for specific services.
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GDP
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gross domestic product - a statistical measure used to compare health care spending among countries
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health care rationing
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a method to reduce health care costs by controlling the use of health care services and technologies.
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health economics
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branch of economics concerned wih the problems of producing and distributing the health care resources of the nation in a way that provides maximum benefit to the most ppl
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human capital
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a measure of macroeconomic theory that involves improving human qualities, such as health, and is a focus for developing and spending money on gods and services bc health is valued, it increases productivity enhances the income-earning ability of people, and improves the economy
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inflation
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a sustained upward trend in the prices of goods and services
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intensity
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the use of technologies, supplies, and health care services by or for the client
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managed care
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a method of organizing a number of different health care services together along a continuum of care, for example, from physician's office, to hospital, to home health, to nursing home. The client pays for services through an insurance plan.
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means of testing
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a method used to assess whether a client's income level qualifies him or her for Medicare and or Medicaid
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Medicaid
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a jointly sponsored state and federal program that pays for medical services for the aged, poor, blind, disabled, and families with dependent children
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medical technology
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the set of techniques, drugs, equipment, and procedures used by health care professions in the delivery of medical care to individuals.
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Medicare
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a federally funded health insurance program for the elderly and disabled and persons with end-stage renal disease.
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PPS
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prospective payment system - the diagnosis-related group payment mechanism for reimbursing hospitals for inpatient health care services through Medicare
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public health economics
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focuses on the producing, distributing, and consuming of goods and services as related to public health.
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retrospective reimbursement
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method of payment to an agency based on units of service delivered
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return on investment
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improved health outcomes as a result of the resources provided for a program or intervention. Resources include money, providers, time, and equipment.
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safety net providers
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those community providers that offer services to the uninsured and underinsured.
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third-party payers
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reimbursement made to health care providers by an agency other than the client for the care of the client (i.e. insurance companies, govts, employers)
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Work with legislators and insurance companies to provide coverage for health promotion to reduce the risk of diseases.
Which level of prevention? |
primary prevention
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Encourage clients who are pregnant to participate in prenatal care and WIC to increase the number of healthy babies and reduce the costs related to pre-term baby care.
Which level of prevention? |
secondary prevention
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Participate in home visits to mothers who are at risk for neglecting babies to reduce the cost related to abuse.
Which level of prevention? |
tertiary prevention
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first phase of US health care system
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1800-1900
*infectious epidemics *inadequate and unsafe hospital care *Health concerns related to social and public health issues (food, water, sanitation, housing) *minimal technology *experience-based training *health labor force skilled "on the job" *few hospitals, unsanitary and overcrowded *nurses in US with education are largely linked to religious orders *Family and friends provided most health care in home |
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second phase of US health care system
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1900-1945
*acute infections & trauma (less focus on epidemics) *specialty hospitals emerge *therapeutic advances *shift to science-based training *general improvements in sanitation (food, water, sewage system) *nurses formally trained in hospital-based schools |
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third phase of US health care system
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1945-1984
*chronic disease *increasing numbers and types of facilities *"durable" technologies - therapeutics and diagnostics *development of medical specialties, new "types" of employees *increase evidence of link btwn chronic illness and lifestyle changes in US *Nursing edu expanded from hospital based diploma to university BSN and AD programs *Strong link btwn "employement" and the provision of health care benefits bc increasingly "socially entrenched"/"normative" (via general economic growth & prosperity, and organized labor) |
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fourth phase of US health care system
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1984 - present
*Emergence of new and old infectious disease *mergers, "integration" *"super" drug therapies, computerization, "service" technologies *primary care, "turf" issues, multidisciplinary care teams *managed care *health system resource limitations apparent *private sector employers facing rising costs and reduced profits from employee health care *growth of managed care systems and ambulatory care settings *higher acuity pts at the hospital, shorter LOS |
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4 components of health services development...
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service intensity, labor, facilities, technology
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Comparison of where to obtain information for Medicare and Medicaid services.
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Medicare - local social security administration office
Medicaid - state welfare office |
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Comparison of recipients for Medicare and Medicaid.
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Medicare - Clients over 65 years of age and older, is disable, or has permanent kidney failure.
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Comparison of types of program, Medicare and Medicaid.
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Medicare - insurance
Medicaid - insurance |
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Comparison of government affiliation & availability between Medicare and Medicaid.
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Medicare - federal govt, available in all states
Medicaid - All states govt, available in all states |
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Comparison of financing of hospital insurance for Medicare and Medicaid.
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Medicare - medicare trust fund, mandatory payroll deduction, recipient deductibles, trust fund interest.
Medicaid - federal and state govt |
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Comparison of financing of medical insurance for Medicare and Medicaid.
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Medicare - recipient premium payments, general revenue, US treasury.
Medicaid - federal and state govt |
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Comparison of types of coverage for Medicare and Medicaid.
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Medicare - inpatient and outpatient hospital services, skilled nursing facilities, limited home health services.
Medicaid - inpatient and outpatient hospital services, prenatal care, vaccines for children, physician, dental, nurse practitioner, and nurse-midwife services, skilled nursing facilities for persons 21 yrs or older, family services, rural health clinic |
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3 major factors have been associated with the growth of the health care delivery system...
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Price inflation, changes in population demographics, and technology and service intensity.
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Major cause of rising health care cost..
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excessive and inefficient use of goods and services
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GNP vs GDP
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GNP - reflects market value of goods and services produced in the US
GDP - reflects the market value of the output of labor and property located in the US |
