Intro To Health Care

Front 1

standards of participation

Back 1

Providers must comply with the standards established by the government to be certified to provide services to Medicaid, CHIP, and Medicare beneficiaries.

Front 2

global budgets

Back 2

A plan of total expenditures in a health care system established in advance.

Front 3

Medicaid

Back 3

A joint federal-state program of health insurance for the poor.

Front 4

Medicare

Back 4

A federal program of health insurance for elderly, certain disabled individuals, and people with end-stage renal disease.

Front 5

premium cost sharing

Back 5

The portion of insurance costs an employee must pay.

Front 6

uninsured

Back 6

Those without private or public health insurance.

Front 7

reimbursement

Back 7

The amount insurers pay to a provider.

Front 8

provider

Back 8

Any entity that delivers health care services and can either independently bill for those services or is tax supported.

Front 9

primary care

Back 9

Continual basic and routine care.

Front 10

universal coverage

Back 10

Health insurance that is available to all citizens.

Front 11

Quad-function model

Back 11

The four key functions necessary for health care delivery: 1) financing
2) insurance
3) delivery
4) payment

Front 12

utilization

Back 12

Extent to which health care services are actually used.

Front 13

managed care

Back 13

A system that integrates the functions of financing, insurance, delivery, and payment and uses mechanisms to control costs and utilization of services.

Front 14

enrolee

Back 14

The individual covered under a health plan.

Front 15

health plan

Back 15

The contractual arrangment between the MCO and the enrollee (including covered health services the enrollee is entitled to).

Front 16

access

Back 16

The ability of an individual to obtain health care services when needed.

Front 17

universal access

Back 17

The ability of all citizens to obtain health care when needed.

Front 18

free market

Back 18

An economic market in which prices are based on competition not controlled by a government.

Front 19

demand

Back 19

The quantity of health care purchased.

Front 20

phantom providers

Back 20

Providers who function in an adjunct capacity and bill for their services separately. (anesthesiologists, pathologists that assist surgeons during surgery)

Front 21

package pricing

Back 21

Bundling of fees for an entire package of related services.

Front 22

capitation

Back 22

Having all health care services included under one set fee per covered individual.

Front 23

moral hazard

Back 23

Consumer behavior that leads to a higher utilization of health care services because people are covered by insurance.

Front 24

need

Back 24

The amount of medical care that medical experts believe a person should have to remain or become healthy. (can also be based on self-evaluation of one's own health)

Front 25

provider-induced demand

Back 25

Artificial creation of demand by providers that enables them to deliver unneeded services to boost their income.

Front 26

third party

Back 26

The insurer, who pays for and handles the administrative functions associated with the plan.

Front 27

single-payer system

Back 27

National health care system with one primary payer - the government.

Front 28

balance bill

Back 28

Billing the patient for the amount that a health plan did not cover.

Front 29

administrative costs

Back 29

The costs associated with billing, collections, bad debts, and maintaining medical records.

Front 30

defensive medicine

Back 30

Excessive medical tests and procedures performed as a protection against malpractice lawsuits otherwise regarded as unnecessary.

Front 31

system

Back 31

A set of interrelated and interdependent logically coordinated components designed to achieve common goals.

Front 32

outpatient care

Back 32

Any health care services that are not provided based on an overnight stay where room and board costs are incurred.

Front 33

inpatient services

Back 33

Services delivered on the basis of an overnight stay in a health care institution.

Front 34

national health insurance

Back 34

A system (such as Canada) where government finances health care through taxes but is delivered by private providers.

Front 35

national health system

Back 35

A system (such as Great Britain) where tax-supported NHI operates as well as government management of delivery. (Providers are government employees)

Front 36

socialized health insurance

Back 36

A system (such as Germany) where government mandated contributions come from employers and employees. Private providers deliver care and sickness funds collect payments.