Chapter 4 Flashcards
Under this system, insurance companies reimburse patients for the costs of their health care within the limits of the policy, and the patient is responsible for any costs not covered.
Free-for-service
These organizations provide complete and comprehensive health care for the cost of the premium and a small fee called a copayment for each visit. You will see your pcp then they will refer you to a specialist if needed
Health maintenance organizations (HMO)
These systems allow private hospitals and physicians to provide services while also providing care through insurance plans that operate as HMO’s or PPO. They save money by limiting access to expensive services when they are not needed.
Managed Care Systems
A system that offers care at reduced rates with an established network of providers.
Preferred provider organization
To ensure all Americans were covered by health insurance. Under this law, employers are required to provide health insurance for their full time employees when they have 50 or more workers.
Affordable Care Act (“Obamacare”
A federal health insurance program. Covers a portion of the medical care costs for those 65 years and older.
Medicare
Persons must fall within a designated group, recognized by the federal and state governments, to be eligible for partial or full funding. Include age, income and resources, disability and US citizenship
Medicaid
Healthcare Facilities
Hospitals
Private
Public
Not for profit
Proprietary
One or two paragraphs declaration of the institutions basic philosophy and primary goals. This statement provides guidance for the decisions that govern the activities of the facility.
Mission Statement
Outpatient centers
Urgent care and surgery centers
Specializes in trauma and emergency situations ; a triage expert in disaster situations
Emergency department
Treats individuals and families in the context of daily life
Family practice physician
Recent medical school graduate gaining practical experience
Interns
Licensed physicians receiving advanced training
Fellows
Licensed physicians in an educational program to become certified in a specialty area.
Residents
Speciality has become an option for physicians who choose to treat hospitalized patients only.
Hospitalist
Diagnoses and treats diseases of the gastrointestinal tract
Gastroenterologist
Specializes in problems and diseases of elderly persons
Geriatrician
Treats problems and diseases of the female reproductive system
Gynecologist
Specializes who treats patients in the intensive care unit
Intensivist
Specializes in pregnancy , labor, delivery, and immediate postpartum care
Obstetrician
Specializes in tumor identification and treatment
Oncologist
Diagnoses and treats problems and diseases of the eye
Ophthalmologist
Specializes in conditions or the ear, nose and throat
Otorhinolaryngologist
Specializes in the scientific study of the alterations in the body caused by disease and death
Pathologist
Specializes in the care, diagnosis, and treatment of diseases affecting children
Pediatrician