Us Health Care System/health Policy: Dr. Helgeland

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What is Title 18?

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Social Security Amendment of 1965 referring to Medicare Program

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What is Title 19?

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Social Security Amendment of 1965 referring to Medicaid Program

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Cost Shifting

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refers to the ability of providers to make up for the lost cost in one area by increasing prices in other areas that are free of controls

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E-health

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health care information and services over the Internet

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Means Tested

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a government program is referred to as means-tested if a person's income level determines its benefits

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Medicaid

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is the program for providing health care to the poor through federal matching funds provided to the states based on each state's financial needs

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Medicare

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is the publicly financed health insurance program for the elderly and certain disabled persons

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Medicare Part A

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provides coverage for hospital and limited nursing home care

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Medicare Part B

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government-subsidized voluntary insurance for physician services and outpatient services

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Telemedicine

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distant delivery of health care

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Private Health Insurance

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voluntary health insurance because it is not mandatory(ex. Blue Cross/Blue Shield, MCO's)

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Access

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Ability of an individual to get healthcare when needed. The need is primarily determined by the patient and secondarily determined by a referring physician. Health insurance is the primary means for ensuring access.

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Gatekeepers

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are managed care general practitioners or primary care providers who typically manage routine services and determine appropriate referral for higher-level services

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Capitation

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payment mechanism in which all healthcare services are included under one set fee per covered individual. The fee is generall paid per month and referred to as per-member-per-month(PMPM). The fee covers all serivices during that year.

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Managed Care

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manages the utilization of medical services, the price of services are purchased and how much the providers get paid. Most dominant health care delivery system in the US and integrates the basic functions of health care delivery

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Market Justice

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places the fair distribution of health care on the market forces in a free economy, medical care and its benefits are distributed on the basis of people's willingness and ability to pay

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Moral Hazard

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term used to explain the increased utilization of health care services when people have health insurance coverage

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Package Pricing

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Bundled charges, a number of related services included in one price

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Primary Care

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Is a basic and routine care delivered by a general practitioner. In a managed care system, the primary care physician also makes the determination for the need for higher-level services

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Socialized Justice

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Emphasizes the well-being of the community over that of the individual: thus the inability to obtain medical services because of a lack of financial resources would be considered unjust

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Supplier-induced Demand

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Refers to the demand for health care created by providers for their own financial benefit

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Activities of Daily Living (ADLs)

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Measures a person's ability to function independently based on 6 basic activities: bathing, eating, dressing, toileting, maintaining continence and getting into or out of bed or chair.

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Acute Condition

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Relatively severe, short duration and often treatable

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Chronic Condition

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Less severe than an acute condition but of long and continuous duration. The patient may not ever fully recover

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Demand Side Rationing

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Refers to barriers to obtaining health care faced by people who do not have sufficient income to pay for these services or purchase insurance

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Disease

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Based on a professional evaluation as opposed to self-evaluation

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Health Care

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Refers to the treatment of illness and the maintenance of health

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Holistic Health

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Emphasizes the well-being of every aspect of what makes a person whole and complete

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Holistic Medicine

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Seeks to treat the individual as a whole person

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Iatrogenic Illnesses (or injuries)

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Are caused by the process of Health Care

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Illness

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Is recognized by a person's own perceptions and evaluation of how he or she feels. For example, an individual may feel something, but a disease may or may not be present.

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Instrumental activities of Daily Living (IADLs)

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Are used in reference to a person's ability to perform activities that are necessary for living independently in the community, such as preparing meals, shopping for routine items, managing money and housekeeping

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Market Justice

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Ascribes the fair distribution of health care to the market forces in a free economy. Medical care and its benefits are distributed on the basis of people's willingness and ability to pay

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The Medical Model

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The Medical Model of health care delivery presupposes the existence of sickness. In other words, health care is delivered only when a person is sick. The model emphasizes diagnosis and treatment of disease as opposed to health promotion and disease prevention.

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Morbidity

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means disease or disability

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Mortality

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Is the term used in measurement of death rates

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Planned rationing

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Supply-Side rationing

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Public Health

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Deals with broad societal concerns about ensuring conditions that promote optimum health for society as a whole by influencing the social, economic, political, and medical care factors that affect health and illness. The objective of public health is to prevent disease, prolong life, and promote health through organized community effort

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Quality of Life

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Refers to the overall satisfaction with life during and following a person's encounter with the health delivery system. Some of the life domains germane to quality of life are comfort factors, security, degree of independence, decision-making autonomy, and attention to personal preferences

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Social Justice

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regards health care as a social good that should be collectively financed through general taxes and made available to all citizens regardless of the individual's ability to pay.

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Subacute Condition

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Is between an acute and chronic condition

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Supply-Side Rationing

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Also called planned Rationing because the government faced with limited resources, makes deliberate attempts, often referred to as health planning, to limit the availability of heath care services, particularly those beyond the basic level of care

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The Wellness Model

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The Wellness Model views health as a positive concept. The model emphasizes effort and programs geared toward prevention of disease and maintenance of an optimum state of well-being.

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Advanced practice nurses (APNs)

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APNs are nurses who have education and clinical training beyond that required for an RN. the 4 areas of specialization in nursing include clinical nurse specialist (CNS), cerfified registered nurse anesthetist (CRNA), nurse practitioner (NP), and certified nurse midwife (CNM). NPs and CNMs are also categorized as nonphysician practitioners

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Allopathic Medicine

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Views medical treatment as active intervention to produce a counteracting reaction in an attempt to neutralize the effects of disease

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Chiropractors

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They provide treatment to patients through chiropractic manipulation, physiotherapy, and dietary counseling. They typically help patients with neurological, muscular, and vascular disturbances. Chiropractic is based on the beief that the body is a self-healing organism

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Comorbidity

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More than one disease or health problem

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Gatekeepers

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Are managed care general practitioners or primary care providers who typically manage routine services and determines appropriate referrals for higher level or specialty services

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Hospitalist

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Physicians whose primary professional focus is hospital medicine are called hospitalists

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Generalists

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They are physicians trained in family medicine or general practice, general internal medicine, and general pediatrics in the US. They are considered primary care providers

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Licensed Practical Nurses (LPNs)

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Nurses call licensed vocational nurses (LVNs) in some states, care for patients under the direction of physicians and registerd nurses. They must complete a state-approved program in practical nursing and a national written examination

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Maldistribution

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Refers to either a surplus or a shortage of the type of health providers needed to maintain the health status of a given population at an optimum level. maldistribution can occur both geographically and by specialty

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Midlevel practitioner

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Managed care A health care provider–eg, nurse practitioner, physician assistant, etc, whose activities are directed and/or dictated by a supervising physician on whom liability for those activities rests

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Nonpysician practitioners (NPPs)

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Are providers who practice in many areas similar to those in which physicians practice, but they do not possess a doctoral degree. NPPs are some times called midlevel providers bc they receive less advanced training than physicians do but more training tan registered nurses. They are also referred to as physician extenders bc in the delivery of primary care they can. in many instances, substitute for physicians. NPPs typically include physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs)

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Nurse Practitioners

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are advanced practice nurses (APNs) who have completed a program of study leading to competence as RNs in an expanded role. NPs are trained to practice independently of physicians and can often substitute for primary care physicians

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Optometrists

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Provide vision care, including examination, diagnosis, and correction of vision problems. They must be licensed

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Ostepathic medicine

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Emphasizes the musculoskeletal system of the body, such as correction of the joints or tissues ad stresses diet and the environment as factors that might influence natural resistance

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Physician assistants (PAs)

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PAs work in a dependent relationship with a supervising physician to povide comprehensive care. PAs assist physicians in the provision of care to patients. The major services provided by PAs include evaluation, monitoring, diagnostics, therapeutics, counseling and referral

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Podiatrists

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Treat patients with diseases or deformities of the feet, including performing surgical operations prescribing medications and corrective devices and administering physiotherapy. They must be licensed to practice

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Primary Care

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Is the first contact care or the portal to the heath care system. PC focuses on the person as a whole. It seeks to balance the multiple requirements a patient's condition may call for and refers patients to appropriate specialty care when needed. PC should incorporate continuity, comprehensiveness and coordination with other levels of care

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Registered Nurses

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Are the major care givers of sick and injured patients, serving their pysical, mental and emotional need. All states require nurses to be licenses in order to practice. An RN must complete an associate's degree (ADN) a diploma program or a baccalaureate degree (BSN)

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Specialists

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Are physicians who also hold certification in a specialty area. Specialty certification requires additional years o advanced residency training fllowed b several years of practice in the specialty. A speciatly board examination is often required as the final step for becoming a board- certified specialist

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Specialty Care

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Specialty care tends to be limited to illness episodes, the organ system or the disease process involved. Specialty care if needed generall follows primary care

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Cost Effectiveness

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Is a step beyond the determination of efficacy. Whereas efficay is concerned only with the benifit to be derived from the use of technology, cost effectiveness weighs benefits against costs. HC is cost effective when benefits exceed the costs

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Efficacy

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Refers to the health benefit to be derived from the use of technology

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E-health

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All forms of electronic HC delivered over the Internet, ranging from informational, educational, and commercial products to direct services offered by professionals and nonprofessionals, businesses or consumers

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Medical informatics

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Information technology applications that are designed to improve clinical efficiency, accuracy, and reliability

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Medical practice guidlelines

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Are systematically developed protocols to assist practitioners in delivering appropriate HC for specific clinical conditions

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Technology diffusion

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Is the proliferation of technology once it is developed

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Telemedicine

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The use of advanced telecommunications, such as videoconferencing and computer technology to provide HC at a distance

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Balance Bill

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The practice of billing the patient for the difference between the provider's actual charges and the amounts paid by third parties

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Beneficiary

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A participant in a health insurance plan, also called the insured or enrollee