exam 2 Flashcards
Almshouses
a house originally built by an organization or person to take care of the poor.
Poorhouse
a home or residential institution where people were required to live if they could not financially support themselves.
Skilled nursing facility (SNF)
a licensed facility that provides general nursing care to those who are chronically ill or unable to take care of their daily living needs; also called a skilled nursing center.
Assisted living facility
a living arrangement designed to provide basic personal care needs, assistance with activities of daily living (ADLs), limited administration of medications, and services such as laundry and housekeeping; also known as a residential care community.
Activities of daily living (ADLs)
routine activities that people do every day, such as eating, bathing, getting dressed, toileting, transferring, and continence.
Senior center
a community-based center that provides services to the elderly. Programs at these centers address the individual needs of functionally or cognitively impaired adults as well as those who simply want to socialize with others their age
Continuing care retirement community (CCRC)
a retirement complex that offers a range of services and levels of care.
Respite care
care that offers family and other caregivers the opportunity to allow someone else to take care of their loved one or client for a short time, often just for the day; also called adult day services.
Caregiver
any person who helps care for an older individual or person with a disability who lives at home.
Hospice care
short-term supportive and sometimes palliative care for terminally ill patients.
Community health center
a neighborhood health center that generally serves low-income and uninsured populations.
Residential treatment center
a mental health facility where psychiatric treatment is provided in a home-like environment with less medical involvement.
Psychiatric unit
a unit (department) within a community hospital that is dedicated to the inpatient treatment of mental illness
Dual diagnosis
the diagnosis of both a mental illness and substance abuse disorder.
Outpatient psychiatric treatment
psychiatric services offered on a ambulatory basis that do not require a continuous stay of 24 hours or longer at a treatment facility.
Value-based payment
a payment system in which provider payments are linked to the cost and quality of care.
Full capitation
a payment method in which a fixed amount is paid to an organization to provide a comprehensive package of healthcare services for a set period of time.
Partial capitation
a payment method in which an organization is paid a fixed amount to provide a select set of healthcare services for a set period of time
Bundled payments
a payment method in which healthcare providers are paid a set amount for an episode or cycle of care (e.g. hip surgery).
Indian Health Service
the federal government health system that provides services to Native Americans.
Emergency Medical Treatment and Labor Act
a federal law passed in 1986 to prevent “patient dumping”, the practice of emergency rooms refusing to treat people who lack the financial resources to pay for their care.
Health Insurance Portability and Accountability Act (HIPPA)
a federal law passed in 1966 that set standards to protect the privacy and security of patients’ health information.
Balanced Budget Act of 1997
a federal law that authorized Medicare Part C, expanding managed care Medicare programs and the State Children’s Health Insurance Program.
Scare resources
resources that are limited and may not be sufficient to meet demand.
Inputs
resources that are combined to produce outputs; in healthcare, inputs include personnel, equipment, buildings, land, and supplies.
Outputs
goods and services that are produced form a combination of inputs (resources).
Production function
the conversion of inputs into outputs.
Inelastic demand
little change in the consumption of a product or service when prices increase or decrease.
Opportunity cost
the benefits that are given up by choosing an alternative; in other words, the value of a resource when it is employed in its next best use.
Elasticity of demand
the change in the demand for or quality of a product or service in response to an increase or decrease in price.
Diminishing return
a progressively smaller increase in outputs with each incremental increase in inputs.
Adverse selection
a situation in healthcare that occurs when sicker (or potentially sicker) people buy health insurance, while healthier people do not, increasing the overall risk of the pool.
Risk pool
a cluster of people whose medical costs are combined to determine health premiums.
Preexisting condition
an illness or condition that individual has prior to enrollment in health insurance coverage.
Externality
a side effect or an involuntary cost or benefit imposed on a third party.
Asymmetric information
the knowledge gap that exists between two parties.
Third-party payer
an entity (a company or individual) that pays for medical services on behalf of a patient.
Marginal benefit
the gain or benefit that a patient receives from consuming an additional unit of service; also referred to as marginal utility.
Marginal cost
the cost of consuming the next unit of service.
Econometrics
the branch of economics focused on using statistics to describe economic systems.
Morbidity
the rate of disease or injury in a population.
Health disparities
differences in health outcomes and their causes among groups of people.
Quality-adjusted life year (QALY)
a measure of the burden of disability or morbidity; ranges from 1, perfect health, to 0, death.
Insurance
the pooling of financial resources by groups of people (called risk pools) to share risk.
Premium
the amount is paid (typically monthly or annually) for an insurance policy.
Actuary
a professional with advanced training in mathematics and statistics who analyzes the risk and costs associated with different populations, levels of healthcare access, quality, delivery, and financing,
Community rating
a method of setting insurance premiums that uses general community population (e.g., a metropolitan area) as the risk pool.
Indemnity healthcare plan
a health insurance plan that allows individuals to choose their own healthcare providers, providing the greatest amount of flexibility for users. The plans generally use fee-for-service payment.
Experience rating
a method for setting insurance premiums that clusters people into smaller risk pools determined by health history, age, gender, and other factors to set premiums.
Managed care
a system used by health insurance companies to reduce the costs and improve quality of healthcare.
Moral hazard
a situation in which people have an incentive to increase their risk when they do not bear the full cost of the risk.
Medical loss ratio
the percentage of health premium dollars that a health insurance plan spends on provider payments (e.g., medical and surgical costs) as opposed to administrative costs.
Fully insured company
a company that pays a annual premium to a health insurance firm to provide health healthcare coverage to its employees; in this arrangement, the health insurance company assumes the financial risk.
Self-insured company
a company that offers its own healthcare coverage and retains financial responsibility for all employee healthcare costs; in this arrangement, the company assumes the financial risk.
Stop-loss insurance
an insurance policy that provides protection against large losses for companies that self-fund their employee benefit plans; the policy pays out after a certain threshold of healthcare costs is reached.
Third-party administrator (TPA)
a company that provides claims processing and employee benefits management without assuming any financial risk.
Contractual allowances
the difference between the amount that healthcare providers bill for services and the amount they are paid, based on their contracts with third-pay insurers and government programs such as Medicare and Medicaid; also called contractual adjustments.
Bad debt
charges for services that are billed but uncollectible and are not charity care.
Balance billing
the practice of billing patients for difference between what their health insurance pays and what the healthcare provider charges; also known as surprise billing.
Concierge medicine
a model of healthcare in which patients pay an annual fee or retainer to be apart of a primary care physician’s practice. Patients receive greater physician access and enhanced services. The physician may kill the patient’s health insurance.
Direct primary care (DPC)
a model in which patients pay a flat membership fee for a package of primary care services. The physician does not bill the patient’s health insurance.
Single payer system
a healthcare system that has a single entity that pays healthcare providers.
