healthcare delivery systems test Flashcards
What is the percentage of healthcare jobs in America
9%
What is the western medical model?
assumes that
What is the wellness model?
The prevention of disease and maintenance of your well being This is what we are moving toward.
For-Profit
Owner obtains money from the profits of the agency. They are subject to taxation and likely to offer more profitable medical services. Ex- our hospital
The joint commission-
To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.
what are specialty hospitals?
Hospitals created for a specific purpose. For example cancer hospitals or children’s hospitals, rehabilitation hospitals.
Ambulatory Facilities (Urgent Care)-
Provides diagnostic and treatment services that were previously performed in hospitals. Ex: Urgent care clinics, outpatient clinics, and optical centers.
Long Term Care Facilities-
Mainly care for elderly patients or individuals with disabilities or handicap. Example: Nursing home provides basic physical care
Extended Care Facilities-
Provides skilled nursing care and rehabilitation. For patients that may be in a coma or need a lot of medical attention.
Assisted Living Facilities-
Independent living they provide basic services such as meals and housekeeping and basic medical care.
Home-health care
Providing care for patients from their home.
Hospice
Provides palliative care to dying patients and their families
World Health Organization (WHO)
sponsored by the united nations they investigate serious health problems throughout the WORLD
Public Health System-
Provides immunizations, environment health and sanitation, they provide services to state and local communities and are apart of human services.
Veteran’s Administration-
Provides insurance and medical for the retired members of the military
Non-Profit Agencies
They are voluntary agencies they deal with specific diseases and PROVIDE FUNDING for research, promote, education, influence laws, and create standards. Ex: March of dimes that cares for polio victims and American heart association
Purpose of a chain of command
Indicates areas of responsibility, should lead to the most efficient operation of the facility, can be complex in larger facilities or simple in smaller facilities.
What is a premium
It is the cost of insurance monthly
What is Co-Pay?
specific amount of money that a patient pays every time he/she seeks medical care.
What is a deductible?
A specific amount of money that the patient must pay for medical care before the insurance plan pays
What is co-insurance?
It is the percentage of covered medical care that will be paid by the insurance plan and amount that will be paid by patient
HMO( Health Maintenance Organization)
You pay a monthly premium, co-pay is required every time you seek medical care, there is NO DEDUCTIBLE. FOCUS’ ON PREVENTATIVE CARE. They detect disease early but patient can only use doctors within that network or pays larger amount for out of network.
PPO(Preferred provider organization)
Offered to employees of large corporations, employee contracts with certain health care agencies, industry/company can provide health care at lower rates, patients have lower co-pay as long as in approved providers.
Medicare-
Insurance provider covering hospital care for people over the age of 65 or with disability of any age who have SS benefits and end stage kidney failure. Follows a 80%-20% coverage. Has 4 part.
What is part A of Medicare-
What is part A of Medicare-
What is part B of Medicare-
Covers doctor’s visits, outpatient services, and therapy
what is part C of Medicare-
This plan is optional it helps pay for costs of medical services covered by type a and b but you have to pay additional and extra money.
What is part D of Medicare-
Provides coverage for medications
What is medicaid-
Offered to people with low income, the state determines what care will be paid for and who is eligible, no age restrictions, CHIP is available to children of families who do not qualify for Medicaid.
What is worker’s compensation?
Provides medical care for workers injured on the job, employers pay premium to the state, no cost to the employee/patient
What is Tricare
Insurance plan for members of the military and their families.
This insurance model requires you to select from a list of “approved providers” before you can see a specialist
This insurance model requires you to select from a list of “approved providers” before you can see a specialist
___________ is a group of selected health care providers who offer comprehensive services at preset reimbursement levels
PPO- preferred provider orgainizaton
Managed care networks are required to provide quality care at the:
Managed care networks are required to provide quality care at the:
What is managed care?
insurance designed specifically to control the cost of healthcare.
What type of insurance is employer sponsored
What type of insurance is employer sponsored
self advocacy is:
Speaking up for one’s self
Patient compliance is:
follow the directions of your healthcare provider if he/she says to not eat pork for whatever reason your need to follow instructions for your own health
Provider obligations are:
To provide clear, accurate information and allow the patient to tell your their experience don’t jump to conclusions and try to figure it out. Allow patient to participate in treatment decisions.
Consumer Obligations are:
Practice health behaviors, participate in healthcare decisions, follow health care plans.
