Health Care Management - Key Terms Ch 1, 2, 3
Terms
undefined, object
copy deck
- Managed Care
- Managed Care is a mechanism of providing health care services in which a single organization takes on the management of financing, insurance, delivery, and payment.
- HMO
- Health Maintenance Organization
- PPO
- Preferred Provider Organization
- Enrollee
- (Member) Refers to the individual covered under the plan
- TRICARE
- Military health plan that offers 3 options: TRICARE Prime, Extra, and Standard
- Quasi-market
- ?
- Item-based pricing
- ?
- market justice
- The principle of market justice places the responsibility for the fair distribution of health care on the market forces in a free economy.
- social justice
- Social justice 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.
- system
- Consists of a set of interrelated and interdependent components designed to achieve some common goals.
- system structure
- Helps one understand that the structure of health care services in the US is based on foundations, provide logical arrangement, and demonstrate a progression from inputs to outputs.
- system processes
- Hospitals, clinics, and nursing homes associated with distinct health conditions.
- system outcomes
- Refer to the critical issues and concerns surrounding what the health services system has been able to accomplish, or not accomplish, in relation to its primary objective.
- system outlooks
- Projections in the future of accomplishment of desired system outcomes
- medical model
- The medical model presupposes the existence of illness or disease. It therefore emphasizes clinical diagnosis and medical intervention in the treatment of disease or its symptoms.
- health care delivery
- The delivery of medical care or illness care
- WHO
- World Health Organization
- health
- The optimum capacity of an individual to perform his or her expected social roles and tasks, such as work, school, and doing household chores.
- holistic medicine
- Seeks to treat the individual as a whole person
- holistic health
- Incorporates the spiritual dimension as a fourth element in addition to the physical, mental, and social aspects necessary for optimal health.
- acute conditions
- Relatively severe, episodic (of short duration), and often treatable. ex: heart attack
- subacute conditions
- postacute, requiring further treatment after a brief stay in the hospital. ex: head trauma care
- chronic conditions
- Less severe but of long and continuous duration. ex: asthma, diabetes, and hypertension
- quality of life
- the overall satisfaction with life during and following a person's encounter with the health care delivery system.
- planned rationing
- ?
- almshouse
- Existed in almost all cities of moderate size and run by the local government. It was a place where the destitute and disruptive elements of society were confined.
- John Hopkins
- University that took the lead in further reforming medical education when it opened its school.
- Flexner Report
- Based on an inspection of medical schools.
- AMA
- American Medical Association
- Blue Cross plans
- A hospital insurance plan designed for teachers at Baylor Univ.
- Medicare Part A
- Designed to use Social Security funds to finance hospital insurance and short-term nursing home coverage after discharge from a hospital
- Medicare Part B
- Designed to cover physicians' bills through government-subsidized insurance in which the elderly would pay part of the premiums
- Medicaid
- Intended to cover the eligible poor, would be financed through federal matching funds to the states based on financial needs determined by each state's per capita income.
- Blue Shield plans
- Plan designed to pay physician fees.