Hco Exam #1

Front 1

Epidemic

Back 1

the occurrence of a disease or condition at higher than normal levels in a population

Front 2

Endemic

Back 2

the habitual presence of a disease within a given geographic area

Front 3

Pandemic

Back 3

a worldwide epidemic

Front 4

Medicare

Back 4

a federal health insurance program for people over 65, those eligible for social security disability-payment, and those who need kidney dialysis or transplants

Front 5

Medicare Part A

Back 5

covers inpatient hospital, home health, hospice, and limited skilled nursing facility services

Front 6

Medicare Part B

Back 6

covers physician services, medical supplies, and other outpatient treatment

Front 7

Medicaid

Back 7

a state/federal health benefit program for those meeting poverty guidelines who are aged, blind, disabled or members of families with dependent children. The program is administered at the same level

Front 8

Managed Care

Back 8

an organized effort by health insurance plans and providers to use financial incentives and organizational arrangement to alter provider and patient behavior so that health care services are delivered and utilized in a more efficient and lower-cost manner

Front 9

Prevention

Back 9

actions taken to reduce susceptibility or exposure to health problems, to detect and treat disease in early stages, and to alleviate the effects of disease and injury

Front 10

Primary Prevention

Back 10

averting the occurrence of disease

Front 11

Secondary Prevention

Back 11

halting the progression of disease from its early, unrecognized stage to a more severe one and preventing the complication of disease

Front 12

Tertiary Prevention

Back 12

involves the prevention of the effects of disease once it has been identified

Front 13

Etiology

Back 13

the causes of disease

Front 14

Ambulatory Care

Back 14

care provided to institutionalized patients

Front 15

Primary Care

Back 15

medical care that is oriented toward the daily, routine needs of patients such as initial diagnosis and continuing treatment of common illness

Front 16

Secondary Care/Services

Back 16

includes routine hospitalization and specialized outpatient care

Front 17

Tertiary Care

Back 17

includes the most complex services, such as open-heart surgery, burn treatment, and transplantation, and is provided in inpatient hospital facilities

Front 18

HIPPA

Back 18

Health Insurance Portability and Accountability Act. State and Federal compliance laws and regulation

Front 19

TRICARE (formerly CHAMPUS)

Back 19

insurance program for veterans and civilian dependents of members of the military

Front 20

HEDIS

Back 20

Health Employer Data and Information Set-a set of performance measures for health plans developed for the NCQA that provides purchasers with information on effectiveness of care, costs, and other quality measures of services.

Front 21

DALYs

Back 21

Disability Adjusted Life Years- a composite measure of the number of years of lost due to premature mortality plus the number of years lived with disability, adjusted for level of disability

Front 22

YLLs

Back 22

Year of Life Lost-measures of the number of years lost when a person dies prematurely

Front 23

YLDs

Back 23

Years Lived with disability-measures the number of years of health life lost due to temporary or permanent disability

Front 24

Life expectancy

Back 24

average expected length of life for a person, most commonly presented at birth and at age 65 and is sex specific

Front 25

Mortality/rates

Back 25

death rate; expresses the number of deaths in a population within a prescribed period

Front 26

Need

Back 26

an interpretation of an individuals evaluated requirements for obtaining professional care through the health services system

Front 27

Demand

Back 27

a function of an individual's actually seeking out, but not necessarily obtaining, health services

Front 28

Utilization

Back 28

a measure of actual use of services

Front 29

Morbidity

Back 29

a measure of disease incidence or prevalence in a given population, location, or other grouping of interest

Front 30

Incidence

Back 30

the number of new cases of a disease over a specified period of time

Front 31

Prevalence

Back 31

the number of existing cases of a disease over a specified time period

Front 32

Gross Domestic Product (GDP)

Back 32

the total current market value of all goods and services produced domestically during a given period

Front 33

Deductible

Back 33

a sum of money that must be paid, typically every year, before the insurance policy becomes active

Front 34

Risk

Back 34

the probability of incurring a loss

Front 35

Voluntary Health Insurance

Back 35

private health insurance usually denoting current industrial employment

Front 36

Social Health Insurance

Back 36

reflects participation in a government entitlement program linked to a previous employment

Front 37

Welfare Medicine Programs

Back 37

denotes lack of employment, low-income employment; those meeting poverty guidelines

Front 38

Coinsurance

Back 38

a type of cost sharing where the insured party and insurer share payment for covered services in a specified ration (percentage) after payment of the deductible by the insured

Front 39

Copayment

Back 39

a fixed dollar amount paid for a covered service by the insured

Front 40

Fee for Service (FFS)

Back 40

a method of paying providers a fee for each service rendered

Front 41

Capitation

Back 41

method of payment for health services in which a provider is paid a fixed amount per enrollee to cover a defined set of services over a specified period, regardless of actual services provided

Front 42

HMO

Back 42

Health Maintenance Organization- a managed care plan that offers pre-paid coverage (capitation) for both hospital and physician services, and integrates financing and delivery of a comprehensive set of health services to an enrolled population and usually requires enrollees to choose only providers affiliated with the plan

Front 43

PPO

Back 43

Preferred Provider Organizations-a fee-for-service type of health plan that allows a beneficiary to use a wide-open range of providers or select from a narrower list of providers who have agreed to give the health plan a discount

Front 44

Premium

Back 44

an amount paid (usually monthly) to purchase health insurance benefits

Front 45

IPA

Back 45

Independent Practice Associations-a HMO that contracts with individual physicians of small physician groups to provide services to HMO enrollees at a negotiated per capita or fee-for-service rate

Front 46

Prospective Payment System (PPS)

Back 46

the medicare system used to pay hospitals for inpatient services based on predetermined rates per DRGs

Front 47

Diagnosis Related Groups (DRGs)

Back 47

a system of classifying patients on the basis of diagnoses for purposes of payment to hospitals

Front 48

Unusual, Customary, and Reasonable (UCR)

Back 48

the fee is usual in that doctor's practice, customary in that community, and reasonable in terms of the distribution of all physician charges for that service in that community

Front 49

Point of Service (POS)

Back 49

a managed care plan that combines features of both prepaid and fee-for-service insurance

Front 50

Risk Sharing

Back 50

the involvement of a pool of money from which certain servics are paid for throughout the year where funds remaining at the end of the year are then divided among providers and the health plan

Front 51

National Health Insurance

Back 51

the government acts as the single payer of medical bills

Front 52

Universal Health Care

Back 52

access to health insurance coverage for everyone

Front 53

Medigap

Back 53

plan purchased by Medicare enrollees to cover copayments, deductibles, and health care goods or services not paid by Medicare

Front 54

Federally Qualified Health Center (FQHC)

Back 54

a health center in a medically undeserved area that is eligible to receive cost-based Medicare and Medicaid reimbursement. (Example: Jordan Valley)

Front 55

State Children's Health Insurance Program (SCHIP)

Back 55

federal program that is joinly funded by the state which provides medical insurance coverage for children not covered by Medicaid

Front 56

Moral Hazard

Back 56

to the extent that the event insured against can be controlled, there exists a temptation to use the insurance

Front 57

Demographic Transition

Back 57

the change from a high-fertility, high-morality environment to a low-fertility, low-mortality environment typical of most developing countries

Front 58

Gatekeeper

Back 58

the idea that one physician/provider is responsible for providing all of the primary care for the patient