Contemporary Healthcare-ch6: Healthcare Delivery. Systems Flashcards
An insurance plan in which the client pays a percentage of the payment and some other group (employer, government) pays the remaining percentage.
Coinsurance
Multidisciplinary guidelines for client care based on specific medical diagnosis designed to achieve predetermined outcomes.
Critical pathways
A Medicare payments system to hospitals and physicians that establishes fees according to diagnosis.
Diagnosis-related groups (DRGs)
System in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets.
Differentiated practice
The totality of services offered by all health disciplines
Health care system
A group health care agency that provides basic and supplemental health maintenance and treatment services to voluntary enrollees.
Health maintenance organization (HMO)
Provide care in offices; clients pay a fixed prospective payment and IPA pays the provider, earning or losses are assumed by the IPA
Independent practice associations (IPAs)
A system that incorporates acute care services, home health care, extended and skilled care facilities, and outpatient services.
Integrated delivery system (IDS)
A nurse who practices under the supervision of a registered nurse, providing basic direct technical care to clients
Licensed vocational (practical) nurse (LVN/LPN)
A method of organizing care delivery that emphasizes communication and coordination of care among all health care team members
Managed care
A U.S. Federal public assistance program paid out of general taxes and administered through the individual states to provide health care for those who require financial assistance
Medicaid
A national and state health care program for u.s. residents older than 65 years of age
Medicare
Delivery model that brings all services and care providers to the client
Patient-focused care
A group of physicians or a hospital that provides companies with health services at a discounted rate
Preferred provider organizations (PPO)
Similar to PPOs, but PPAs can contract with individual health care providers; the plan can be limited or unlimited
Preferred provider arrangements (PPAs)
