Exam1 Flashcards
Primary wellness
reduce risk factors before pathology
secondary wellness
reduce duration of illness or impairment
tertiary wellness
limit degrees of disability in person with chronic disease
primary care
-first contact
secondary care
ER, hospitals
Tertiary care
academic med center, transplant, burn, cancer
ambulatory care
outpatient
restorative care
home, IRF, sub-acute, LTAC
continuing care
assisted living, long term, hospice
primary prevention
before it happens
secondary prevention
reduce duration
tertiary prevention
limit disability with chronic disease
Commercial health insurance
access: everything
cost: most expensive. fee for service
quality: best money can buy
Managed care: access
-payer limits access to the menu of services
PPO, HMO, co-pays
PPO - preferred provider organization
-choice of providers (in and out of network)
HMO - health maintenance organization
closed panel or out-of-network
Managed care: Cost
- employer: purchase plan and pay premium
- employee: pay portion of premium, deductible, coinsurance, and co-payment
- Health saving account (HSA)
Managed care: quality
- affected by the providers on the preferred list
- providers need to balance cost of service with discounted fee schedule
- patient may not get what they need if insurance denies
Tax-funded health care
Social security act. Established medicare (Title 18) and medicaid (title 19) and state children health insurance program (SCHIP)
*made govt largest provider of health care
Tax-funded health care: access
- limited to armed services, disabled, kids, low income, or people over 65
- providers must approve for medicare and medicaid
- access to services when deemed necessary by govt
Medicare: covers who?
> 64 y/o
administered by centers for medicare and medicaid services (CMS)
Medicare A:
- hospital services
- hospital, skilled nursing, home health, hospice
- no premium. annual deductible with daily coinsurance after first 20 days of hospital stay
