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127 Cards in this Set

  • Front
  • Back
ability to obtain health care services in a timely manner, at a reasonable cost, by a qualified practitioner, at an accessible location.
actuarial classification
individuals enrolled in specific programs are classified using the statistical mathematics of insurance, including probabilities to ensure the premium payments will adequately provide future payouts.
adverse selection
when a larger proportion of people with poorer health status enroll in specific plans or options. Plans that enroll a subpopulation with lower-than-average costs are favorably selected.
ambulatory care
medical services provided on an outpatient basis in a hospital or clinic setting.
capitated reimbursement
a method of payment for health services in which the provider is paid a fixed amount for each patient without regard to the actual number or nature of services provided.
(1) a person or animal who harbors and spreads an organism that causes disease in others but does not become ill (Chapter 25); (2) an organization that contracts with the Health Care Financing Administration (HCFA) to administer claims processing and make Medicare payments to health care providers.
carve-out services
services provided within a standard benefit package but delivered exclusively by a designated provider or group, such as mental health care.
cost sharing required by a health plan whereby the individual is responsible for a set percentage of the charge for each service.
cost sharing required by the health plan whereby the individual must pay a fixed dollar amount for each service.
cost containment
reduction of inefficiencies in the consumption, allocation, or production of health care services.
cost shifting
cost of uncompensated care is passed on to the insured, resulting in higher costs for those with insurance coverage.
current procedural terminology (CPT) codes
a list of codes for medical services and procedures performed by physicians and other health care providers which has become the health care industry's standard for reporting physician procedures and services.
cost sharing whereby the individual pays a specified amount before the health plan pays for covered services.
diagnosis-related group (DRG)
a system of payment classification for inpatient hospital services based on the principal diagnosis, procedure, age, gender of the patient, and any complications.
net health benefit provided by a medical service or technology for a typical patient in community practice.
flexible spending account
a mechanism by which an employee may pay for uncovered health care expenses through payroll deductions.
person in a managed care organization who decides whether or not a person will be referred for specialty care. (Doctors, nurses, nurse practitioners, and physician assistants function as gatekeepers.)
health care providers
individuals or institutions that provide medical services.
health insurance plan
pays a predetermined amount for covered services.
health maintenance organization (HMO)
managed care plan that acts as an insurer and sometimes a provider for a fixed prepaid premium. HMOs usually employ the physicians.
indemnity plan
health plan that pays covered services on a fee-for-service basis.
managed care groups
groups that negotiate with health care providers to render care for a specified amount of reimbursement based on community ratings modified by group-specific demographics.
managed care plan
health plan that uses financial incentives to encourage enrollees to utilize selected providers who have contracted with the plan.
a state or federal statute or regulation that requires coverage for certain health services.
Title XIX Social Security Amendment (1965), a combined federal and state program. The program provides access to care for the poor and medically needy of all ages.
Title XVIII Social Security Amendment (1965), a federal program administered by the Health Care Financing Administration, which pays specified health care services for all persons older than 65 years who are eligible to receive Social Security benefits.
Medigap insurance
privately purchased individual or group health insurance plans designed to supplement Medicare coverage.
the consequences of a medical intervention on a patient.
out-of-pocket expenses
payment made by the individual for medical services.
amounts paid periodically to purchase health insurance benefits.
primary care provider
a generalist physician, typically a family physician, internist, gynecologist, or pediatrician, who provides comprehensive medical services.
prospective payment system
reimbursement based on a classification system that indentified costs according to diagnosis and client characteristics
administrative agencies
departments of the executive branch with the authority to implement or administer particular legislation.
Clara Barton
responsible for organizing relief efforts during the American Civil War.
two or more groups join to maximize resources, thus increasing their impact and improving their chances of success in achieving a common goal.
Florence Nightingale
considered the founder of nursing. She was the first nurse to exert political pressure on a government. (Chapters 2) She also transformed military health and knew the value of data in influencing policy.
the structure of principles and rules determining how a state, country, or organization is regulated.
health policy
public policies that pertain to or influence the pursuit of health, or a course of action to obtain a desired health outcome for an individual, family, group, community or society.
institutional policies
policies that govern worksites and identify the institution's goals, operation, and treatment of employees.
Lavinia Dock
a prolific writer and political activist. She waged a campaign for legislation to allow nurses instead of physicians to control the nursing profession.
Lillian Wald
early twentieth-century community health nurse and political activist who recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912.
the act of trying to influence legislators; an art of persuasion.
a person who voluntarily, or for a fee, represents himself or herself, an individual, organization, or entity before the legislature.
Mary Wakefield
named by President Barack Obama as administrator of the HRSA on February 20, 2009.
nursing policy
specifies nursing leadership that influences and shapes health policy and nursing practice.
an association that sets and enforces standards in a particular area; a group of individuals who voluntarily enter into an agreement to accomplish a purpose.
organizational policies
rules that govern organizations and the positions they taken on issues with which the organization is concerned.
a course of action to be followed by a government or institution to obtain a desired end.
policy analysis
an objective process that identifies both the sources and consequences of policy decisions in the context of the factors that influence them.
political action committee
important source of collective political influence since the 1970s. These nonpartisan entities promote the election of candidates believed to be sympathetic to their interests.
the art of influencing others to accept a specific course of action.
public health law
legislation, regulations, and court decisions enacted by governments at the federal, state, and local levels to protect the public's health.
public policy
authoritative decision made in the legislative, executive, or judicial branches of government intended to direct or influence the actions, behaviors, or decisions of others.
Ruth Watson Lubic
a nurse midwife who crusaded for freestanding birth centers in the United States.
social policy
policy associated with individuals and communities. In very general terms, social policy can be defined as the branch of public policy that advances social welfare and enhances participation in society.
Sojourner Truth
a former slave who became an ardent and eloquent advocate for abolishing slavery and supporting women's rights.
population subgroups in a community made up of people who share one or more common characteristics.
atmospheric quality
the protectiveness of the atmospheric layers, the risks of severe weather, and the purity of the air available for breathing purposes.
critical theory
an approach that raises questions about oppressive situations, involves community members in the definition and solution of problems, and facilitates interventions that reduce health-damaging effects of environments.
environmental health
the state of health that exists as a result of the forces and conditions that surround and influence human beings.
environmental justice
the concept of the disproportionately high exposures of low–income and minority populations to environmental health risks such as air pollution, hazardous waste incinerators, toxic landfills, pesticides, lead exposure, and unsafe drinking water.
environmental racism
a type of prejudice that forces impoverished and marginalized groups, especially people of color, to live in close proximity to industrial contamination.
food quality
the availability and relative costs of foods, their variety and safety, and the health of animal and plant food sources.
an environmental health concern that refers to the availability, safety, cleanliness, and location of shelter, including public facilities and individual or family dwellings.
living patterns
the relationships among persons, communities, and their surrounding environments that depend on habits, interpersonal ties, cultural values, and customs.
participatory action research
intervention that calls for nurses, community members, and other resource people to work together in identifying environmental health problems that should be investigated, designing the studies, collecting and analyzing the data, disseminating results, and posing solutions to the problems.
Precautionary Principle
“when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause-and-effect relationships are not fully established scientifically” (Wingspread Conference, Global Development Research Center, 1998).
radiation risks
health dangers posed by various forms of ionizing radiation relative to barriers that prevent human exposure and other life form exposure.
sick building syndrome
a phenomenon in which public structures and homes cause toxic syndromes in their occupants because of building materials, poor ventilation, substances in furniture and carpeting, building operations, or cleaning agents.
waste control
the management of waste materials resulting from industrial and municipal processes and human consumption as well as efforts to minimize waste production.
work risks
health dangers employees face, including poor employment environments and potential injury or illness due to working conditions.
Bill and Melinda Gates Foundation
founded in 2000, this foundation has local, national, and global objectives. Globally, the foundation focuses on reducing extreme poverty, improving health, and increasing public library access.
Carter Center
founded in 1982, the Carter Center is a nonprofit NGO founded by former President and First Lady, Jimmy and Rosalynn Carter that has three objectives: (1) to prevent and resolve conflicts, (2) to enhance freedom and democracy, and (3) to improve health.
Centers for Disease Control and Prevention (CDC)
responsible for the prevention and control of disease, injury and disability.
Declaration of Alma-Ata
encouraged governments all over the world to protect and promote the health of all people.
the process of increasing social and economic dependence and integration as capital, goods, persons, concepts, images, ideas, and values cross state boundaries.
health for all by the year 2000
“the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life” (WHO, 1999, p. 65).
International Council of Nurses (ICN)
the oldest international health organization. It is a federation of nurses associations from 112 countries and was one of the first health organizations to develop strict policies of nondiscrimination based on nationality, race, creed, color, politics, sex, or social status. The objectives of the ICN include promotion of national associations of nurses, improvement of standards of nursing and competence of nurses, improvement of the status of nurses within their countries, and provision of an authoritative international voice for nurses.
Millennium Development Goals
developed in 2000 to coordinate and strengthen global efforts to meet the needs of the poorest of the poor.
nongovernmental organizations (NGOs)
organizations with no participation or representation of any government.
Pan American Health Care Organization (PAHO)
an international public health agency with nearly a century of experience in working to improve the health and living standards of the Americas. It serves as the regional office of WHO and is recognized as part of the United Nations system.
primary care
basic health care that emphasizes general health needs rather than specialized care. It involves continual and comprehensive care that includes efforts to keep people as healthy as possible and to prevent disease. Ideally it is delivered in settings close to where people live and work.
primary health care
essential services that support a healthy life; involves access, availability, service delivery, community participation, and the citizen's right to health care.
United Nations
comprises 192 nations committed to world peace and security through international cooperation.
United Nations International Children's Emergency Fund (UNICEF)
an agency of the United Nations concerned with the health and welfare of mothers and children.
World Bank
an intergovernmental financial agency that helps to improve the economic status of poor countries by providing loans, expertise, and cooperative projects. The major goal of the World Bank is to improve the health status of individuals living in areas that lack economic development. Since 1970, the World Bank has become more focused on health-related initiatives to promote sustainable economic growth (Ruger, 2005).
World Health Organization (WHO)
an international agency founded after World War II to direct and coordinate international health efforts, produce and disseminate global health standards and guidelines, help countries to address public health issues, and to support health research.
“a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage,”(McLanahan and Percheski, 2008, p. 259).
establishing the division of labor between nurse and family that will meet the objectives.
an inability to connect with family and friends.
ecological framework
a blend of systems theory and developmental theory, with the addition of an understanding of one's own environment.
tool that is used to depict a family's linkages to their suprasystems. It portrays an overview of the family in their situation.
expressive functioning
family functional assessment that includes nine categories: emotional communication, verbal communication, nonverbal communication, circular communication, problem solving, roles, influence, beliefs, and alliances and coalitions.
external structure
structure that includes the following two categories: (1) extended family, including family of origin and family of procreation; and (2) larger systems, including work, health, and welfare.
any person(s) who plays a significant role in an individual's life. This may include a person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both different-sex and same-sex significant others. “Family” includes a minor patient's parents, regardless of the gender of either parent…without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and other persons operating in caretaker roles (Human Rights Campaign, 2009, Inclusive Definitions of Family)
family health assessment
used as a guide to assist the nurse in data collection and organization of the data collected from families over time.
family health tree
a tool based on a genogram that provides a mechanism for recording the family's medical and health histories.
family interviewing
model that uses general systems and communication concepts to conceptualize health needs of families and a family assessment model to assess families' responses to “normative” events such as birth or retirement or to “paranormative” events such as chronic illness or divorce.
gay or lesbian family
made up of a cohabiting couple of the same sex who have a sexual relationship. The homosexual family may or may not have children.
general systems theory
a way to explain how the family as a unit interacts with larger units outside the family and with smaller units inside the family.
a way to diagram the family for three generations of family members with the generally agreed-on symbols to denote genealogy.
instrumental functioning
routine activities of daily living.
internal structure
structure of the family that includes five categories: family composition, gender, rank order, subsystem or labeling the subgroups or dyads, and boundaries.
network therapy
therapy that involves changing the network of families, either extended family or friends, who tend to maintain a dysfunctional status quo in the nuclear family.
nuclear family
a small group consisting of parents and their nonadult children living in a single household.
transactional model
a system that focuses on process as opposed to a linear approach.
an anxiety disorder characterized by a fear of being in an open, crowded, or public place, where escape is perceived as difficult or help not available in case of sudden incapacitation.
anorexia nervosa
a disorder of self-starvation characterized by significant weight loss, amenorrhea, compulsive physical activity, preoccupation with food, and a distorted body image.
anxiety disorders
a group of conditions characterized by feelings of anxiety. Anxiety disorders may be attributed to genetic makeup and life experiences of the individual. Some of the more commonly encountered anxiety disorders are generalized anxiety disorder, panic disorder (sometimes accompanied by agoraphobia), phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD) (APA, 2000).
attention deficit hyperactivity disorder/attention deficit disorder (ADHD/ADD)
a behavior disorder characterized by developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
bipolar disorder
a major mental disorder characterized by episodes of mania, depression, or mixed mood. One or the other phase may be predominant at any given time, one phase may appear alternately with the other, or elements of both phases may be present simultaneously.
bulimia nervosa
a disorder characterized by a pattern of binge eating followed by forced purging, which usually involves self-induced vomiting, caused by gagging, using an emetic, or simply mentally willing the action. Laxatives, diuretics, fasting, and excessive exercise may also be employed to control weight.
Community Mental Health Centers Act
of 1964 provided federal support for mental health services. The Act supported measures to implement facilities to care for those who were mentally retarded and to construct community mental health centers. The Act also mandated deinstitutionalization, or a halt to the long-held policy of keeping the severely mentally ill hospitalized. The intention was to reduce long-term care of seriously mentally ill persons, by transferring treatment to the community (Sharfstein, Stoline, and Koran, 2002).
process of releasing patients from care in psychiatric institutions into the community.
a disorder characterized by an all-pervasive sadness that is present much of the time.
generalized anxiety disorder (GAD)
characterized by chronic, unrealistic, and exaggerated worry and tension about one or more life circumstances lasting 6 months or longer (APA, 2000). Symptoms of GAD include trembling, twitching, muscle tension, headaches, irritability, sweating or hot flashes, dyspnea, and nausea. Periods of increasing symptoms are usually associated with life stressors or impending difficulties.
major depression
having five or more symptoms of depression in the previous 2 weeks.
mental health
refers to the absence of mental disorders and to the ability for social and occupational functioning.
mental illness
includes all diagnosable mental disorders (i.e., those health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning).
obsessive-compulsive disorder (OCD)
an anxiety disorder characterized by recurrent and persistent thoughts, ideas, and feelings of obsessions or compulsions sufficiently severe to cause marked distress, consume considerable time, or significantly interfere with the patient's occupational, social, or interpersonal functioning.
panic disorder
a disorder characterized by frequent attacks of intense, sudden, and overwhelming fears or feelings of anxiety that produce terror and immediate physiological changes that result in paralyzed immobility or senseless, hysterical behavior.
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act
enacted in 2008, this law requires health insurance to cover treatment for mental illness on the same terms and conditions as physical illness (Open Congress, 2008).
an obsessive, irrational, and intense fear of a specific object, activity, or physical situation.
posttraumatic stress disorder
an anxiety disorder with set characteristic signs and symptoms that occur after a person is exposed to, or is the victim of, a traumatic event.
Program of Assertive Community Treatment (PACT)
in existence since the late 1960s, it moves the traditional 24-hour treatment model of acute care settings into the community and serves people with mental illness in a highly individualized fashion. The PACT model provides around-the-clock supportive therapy, mobile crisis intervention, psychiatric medications, hospitalization, education, and skill teaching for consumers and their families. PACT brings service to the consumer and is considered the model of effective community mental health treatment of the future.
psychotherapeutic medications
drugs that are prescribed for their effects in relieving symptoms of anxiety, depression, or other mental disorders.
presents with (1) positive symptoms including hallucinations, delusions, disorganized thinking and speech, and bizarre behavior and (2) negative symptoms such as flat affect, poor attention, lack of motivation, apathy, lack of pleasure, and lack of energy. Onset typically occurs during late adolescence and early adulthood in males and somewhat later in females. There is an increased risk for alcohol use, depression, suicide, and diabetes among persons with schizophrenia.