Unit 4 Study Guide Flashcards
Primary Care
traditionally refers to the first contact providers of care who are prepared to handle the great majority of common problems for which patients seek care
Secondary Care
refers to specialty care provided by clinicians who focus on one or a small number of organ systems or on a specific type of service, such as obstetrics or anesthesiology
Tertiary Care
a type of healthcare often defined in terms of the type of institution in which it is delivered, often an academic or specialized health center. This type of care may also be defined in terms of the type of problem that is addressed, such as trauma centers, burn centers, or neonatal intensive care
Deductible
the amount that an individual or family is responsible for paying before being eligible for insurance payments
Coinsurance
The percentage of the charges that the insured is responsible for paying
Copayment
An amount that the insured is responsible for paying even when the service is covered by insurence
Premium
The price paid by the purchaser for the insurance policy on a monthly or yearly basis
Licensure
Granted by a governmental authority that provides permission to engage in an activity, such as the practice of a health professional
Credentialing
A general term indicating a process of verifying that an individual has the desirable or required qualification to practice a profession
Certification
A nongovernmental process designed to ensure competence by individual health professionals based upon completion of educational requirements and performance on an examination or other evaluation procedure
Accreditation
A process applied to educational institutions, healthcare institutions, and governmental health departments, to define and enforce required structures, processes, and outcomes
Private, not-for-profit hospitals
Local/State Government run hospitaals
For-profit hospitals
Federal government run hospitals
Outpatient facilities
A healthcare facility in the US in which pt’s can remain for fewer than 24 hrs. Include the offices of clinicians, general and specialty clinics, emergency departments, and a range of new types of community-based diagnostic and treatment facilities
Negligence law
A body of law designed to protect individuals from harm
Malpractice
Medicare
A federal health insurance system that covers most individuals 65+ as well as the disabled and those with end-stage renal disease
Medicaid
A federal-state programs that covers groups defined as categorically needy as well as groups that may be covered at the discretion of the state, including those defined as medically needy, such as those in need of nursing home care
Medigap
A supplemental health insurance linked to Medicare and designed to cover all or most of the charges that are not covered by Medicare, including the 20% copayment required for many outpatient services
SCHIP
A federally funded health insurance program that provides funds to the states to use to expand or facilitate the operation of Medicaid or for other uses to serve the health needs of lower income children
Fee-for-service
A system of reimbursement of health services provided based on charges for health services actually provided to pts
Capitation
A system of reimbursement for healthcare based upon a flat payment per time period for each person for whom a provider of care assumes responsibility for providing healthcare services, regardless of the services actually provided
Episode of Care
Salary
Pay for Performance
Quality Assurance
Electronic Health Records
Affordable Care Act
US Legislation passed on 2010 that made major changes tot he US health insurance system
Describe the levels of care in the US from primary-tertiary with examples
Why is there a nursing shortage in the US?
Understand which professions require certification and licensure and which do not
Understand and describe pt safety efforts
What professional field was the first to formalize education and professional requirements
How to PH professionals try to prevent problems from happening/recurring?
Understand the eara
