Final Exam Flash cards
primary care
treat common health problems/ preventative measures
secondary care
problems that require more specialized clinical expertise
ex: hospital care
tertiary care
care of complex disease states
inpatient
hospital services
outpatient
ambulatory care
dr. offices
urgent care
preventative care
care to stop a person from getting a certain disease
custodial LTC
involve assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADL)
non custodial LTC
basically “skilled” care
care that requires work from a trained health care professionals
who does medicaid cover
poor
who does medicare cover
elderly and permanently disabled
what does medicare part A cover
inpatient services
hospitalization
skilled nursing facility
skilled care in home health care services “not custodial”
hospice care
how is medicare stuctured
parts a b c d
what does medicare part B cover
out patient services
medical expenses
physician services
physical, occupational, and speech therapy, medical equipment, dx tests, coinsurance lab services
and preventative care
medicare part C
medicare advantage
advantage plans to reduce OOP costs.
offers what regular medicare offers, and a little more
offered by private health insurance plans
what does medicare part D
pays for prescription drugs.
what does not count towards donut whole
premium
dispensing fee
non covered drug spend
what does medicaid cover
nursing home care
custodial care
do cover some home health care, but 24 hour custodial coverage
Germany health care coverage
90% of citizens covered by a”mandatory sickness funds”
provided by employers
canada health care coverage
public, tax financed, single payer HC system.
federal govt provides 33% of funding
long wit times for MRI’s.
prohibits private insurance for coverage of services provided by gvt funded insurance
UK national health coverage
public, tax funded, allows private insurance, but cant use public and private insurance at the same time
japan national health coverage
if employer has >700 employees, employer based insurance plan
if employer has <700, enroll in single national health insurance plan operated by the national govt
community based insurance for self employed and retirees
out of pocket
direct reimbursement for consumer good/ service
premium
amount of money charged by a company for active coverage
like a membership fee
deductible
amount you must pay before your insurance pays anything
modes of paying for health care in the US.
from most used to least used
government financing
employment based private insurance
out of pocket payment
impact of being uninsured
more avoidable hospitalizations
later diagnosis of life threatening conditions
more seriously ill when hospitalized
fewer preventative services
higher mortality
less care and worse health outcomes
impact of underinsurance
62% of bankruptcies in US due to inability to pay medical bills
caused by medicare coverage gaps an long term coverage gaps
cost sharing (The share of costs covered by your insurance that you pay out of your own pocket. )reduces ambulatory care utilization
general reimbursement models
fee for service
per diem
per episode
per patient
modes unique to HCP group
fee for service
billed for services offered
per diem
per day
per episode
according to diagnosis, you get paid a certain amount. paid based on what they are treating.
per patient
you get paid a fixed amount per patient
what is primary reimbursement model for pharmacies
FFS
