Lesson 4 Vocab Flashcards
capitation or population-based funding
a funding system that pays a physician a given amount per patient enrolled, regardless of the number of services performed
clawback
the amount, dollar for dollar, that the federal government cuts health transfer payments to a province or territory that permits extra-billing
extra-billing
charging a patient more than the amount paid by the provincial or territorial health plan for medically necessary service
fee-for-service
a system under which a provider is paid by public health insurance for each insured service rendered to an insured patient. These providers are considered “opted-in” to the public payment system.
global budget
any arrangement in which a facility or provider receives a fixed amount of money for medical services, regardless of patient volume, length of stay, or serviced rendered
locum tenens (locum)
a doctor temporarily taking over another doctor’s practice
managed care
a set of strategies, procedures, and policies designed to control the use of health care services, sometimes by organizing doctors, hospitals, and other providers into groups to improve the quality and cost effectiveness of health care
opted-out
(of a physician) billing patients for services rendered; patients pay the fee to the doctor and submit a claim to the health plan. Very few physicians chose to opt out. This may change, however, if private health care becomes more prevalent and patients can buy private insurance for medically necessary services
opted-in
(of a physician) billing the provincial or territorial plan for health services rendered
orphan patient
patients who do not have a regular doctor
physician incentive
when physicians are monetarily remunerated for maximizing services related to preventative medicine (ex. immunizations, Pap smears, mammograms). This involved encouraging their patients to have screening tests.
primary care groups (PCGs)
a variety of structurally similar groups of physicians or other health professionals working collaboratively under an organizational framework to deliver primary health services. The health professionals may or may not be in one physical location.
primary health care
- integrated health care by a provider who addresses the majority of a patient’s health concerns; 2. treatment administered during the first medical contact for a health concern.
provider
any person or group of persons who delivers a health care service
rostering
establishing a list of patients who agree to participate in a primary health network according to the rules of the province or territory
