Unit 4 Study Guide

Question 1

Primary Care

Answer 1

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

Question 2

Secondary Care

Answer 2

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

Question 3

Tertiary Care

Answer 3

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

Question 4

Deductible

Answer 4

the amount that an individual or family is responsible for paying before being eligible for insurance payments

Question 5

Coinsurance

Answer 5

The percentage of the charges that the insured is responsible for paying

Question 6

Copayment

Answer 6

An amount that the insured is responsible for paying even when the service is covered by insurence

Question 7

Premium

Answer 7

The price paid by the purchaser for the insurance policy on a monthly or yearly basis

Question 8

Licensure

Answer 8

Granted by a governmental authority that provides permission to engage in an activity, such as the practice of a health professional

Question 9

Credentialing

Answer 9

A general term indicating a process of verifying that an individual has the desirable or required qualification to practice a profession

Question 10

Certification

Answer 10

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

Question 11

Accreditation

Answer 11

A process applied to educational institutions, healthcare institutions, and governmental health departments, to define and enforce required structures, processes, and outcomes

Question 12

Private, not-for-profit hospitals

Question 13

Local/State Government run hospitaals

Question 14

For-profit hospitals

Question 15

Federal government run hospitals

Question 16

Outpatient facilities

Answer 16

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

Question 17

Negligence law

Answer 17

A body of law designed to protect individuals from harm

Question 18

Malpractice

Question 19

Medicare

Answer 19

A federal health insurance system that covers most individuals 65+ as well as the disabled and those with end-stage renal disease

Question 20

Medicaid

Answer 20

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

Question 21

Medigap

Answer 21

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

Question 22

SCHIP

Answer 22

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

Question 23

Fee-for-service

Answer 23

A system of reimbursement of health services provided based on charges for health services actually provided to pts

Question 24

Capitation

Answer 24

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

Question 25

Episode of Care

Question 26

Salary

Question 27

Pay for Performance

Question 28

Quality Assurance

Question 29

Electronic Health Records

Question 30

Affordable Care Act

Answer 30

US Legislation passed on 2010 that made major changes tot he US health insurance system

Question 31

Describe the levels of care in the US from primary-tertiary with examples

Question 32

Why is there a nursing shortage in the US?

Question 33

Understand which professions require certification and licensure and which do not

Question 34

Understand and describe pt safety efforts

Question 35

What professional field was the first to formalize education and professional requirements

Question 36

How to PH professionals try to prevent problems from happening/recurring?

Question 37

Understand the eara