Government Influence on Health Flashcards
Early health insurance was first really seen when?
early 19th century
what sparked changes in early health insurance?
WWI & Great Depression
What health insurance companies were initially created primarily for elderly protection?
Blue Cross & Blue Shield, Social Security (Medicare & Medicaid)
define Health Maintenance Organizations (HMO)
provider takes some financial risk; patient uses PCPs & pay monthly fee regardless of service used & must go to HMO provider for coverage, if not must pay out of pocket
define Preferred Provider Organizations (PPO)
contract of network of providers to private sector for discounted fee & patient must pay extra fee if using physician outside of network; PPO must approve specialist visit/hospitalizaitions; generally have deductibles & copays
define point-of-service (POS)
providers are paid a pre-set payment based on membership/risk & people choose PCPs @ own risk
define Consolidated Omnibus Budget Reconciliation Act (COBRA)
health insurance protection for those leaving jobs
Health Insurance Portability & Accountability Act of 1996 (HIPAA) covers what
protect PHI, prevents fraud & abuse, administrative supplication & liability reform, application & enforcement of health plan requirements, revenue offsets, & tax-related provisions
define Children’s Health Insurance Program (CHIP)
coverage for low-income families not qualifying for Medicaid & in some states pregnant women; federally & state funded
define Affordable Care Act (ACA)
health insurance for uninsured & improve coverage of insured to focus on illness prevention, wellness, & equal access to healthcare; makes easy to understand insurance benefits & coverage; expanded Medicaid, & shit more
The affordable care act is also called what
Patient Protection & Affordable Care Act (PPACA)
The ACA expanded Medicaid by doing what
making certain preventative health measures free, insurance can’t refuse patient bc of pre-existing condition, children covered by parent until 26, companies must provide insurance if at least 50 workers, & creation of state health care
define the World Health Organization (WHO)
part of the UN w/the goal of worldwide health promotion & improve health access (thru disease prevention, early detection, & treatment)
what functions does WHO does?
coordinate global efforts against health treats & monitors re-emergence of infectious diseases
describe the Centers for Disease Control & Prevention (CDC)
under US Dept. of Health & Human Services w/the goal of improving public health by setting guidelines, disease & disability prevention, infection control, & general safety; performs research & disseminates info to public
define the National Institues of Health (NIH)
under US Dept of Health & Human Services; conducts public health & medical research
define Medicare
covers all people at least 65 yrs, disabled w/SS benefits of at least 2 yrs, & ppl w/end-stage renal disease; composed of 4 parts (A, B, C, D)
define Medicare part A
health insurance contributions from employer & employee
define Medicare part B
pays for doctor fees & other services (preventative or medically necessary) as long as provider accepts; may need to pay premium & deductible?
define Medicare Part C
covers health plans such as HMOs & PPOs
define Medicaire part D
covers prescription drug program to lower cost
Medigap
health insurance help pays expense not covered by Medicare through private companies; patient pays premium & chooses coverage
Medicaid
under social security funded by federal & states where services & qualifications vary by state ; generally for low income, kids who need public assistance, physically disabled & blind
Older Americans Act
protect institutionalized elderly thru ombudsman programs
Ombudsman programs
programs w/representative or spokesperson generally for elderly