Health Science: Healthcare Delivery Systems, Hospital Organization, and Paying for Healthcare

Vocabulary practice flashcards covering health science concepts from Unit 5 and Unit 6: hospital departments, delivery systems, healthcare pathways, government agencies, and insurance/payment systems.

Department of Health (Dept. of Health)

A public health agency that provides specific services to the community, including immunizations, health education, environmental inspections, and disease control.

OSHA

A federal regulatory agency mainly concerned with preventing and managing job-related illnesses and injuries.

AHRQ

A federal agency mainly concerned with the improvement of quality, safety, efficiency, and effectiveness of healthcare services.

FDA

A federal agency responsible for regulating all food and drug products sold to the public to ensure safety and efficacy.

CDC

A division of the USDHHS dedicated to studying the cause, spread, and control of infectious and chronic diseases.

NIH

A federal agency division responsible for conducting and supporting biomedical research on new and existing diseases appearing in the United States.

USDHHS (United States Department of Health and Human Services)

The primary federal agency responsible for protecting the health of all Americans and dealing with new health problems that emerge in the United States.

WHO (World Health Organization)

An international agency that compiles statistics, tracks disease outbreaks (such as the Zika virus), and coordinates public health initiatives throughout the world.

Admissions Department

The hospital department responsible for registering patients for inpatient admission, outpatient tests, and procedures, while collecting vital demographic and billing information.

Central Supply

The hospital department that manages receiving, storing, and distributing medical supplies and equipment, as well as the sterile processing of surgical instruments.

Anesthesia Department

The clinical service that ensures patient safety before, during, and after surgery by administering anesthetics, managing pain, monitoring vital signs, and overseeing surgical recovery.

Pediatrics Department

The medical department dedicated to providing comprehensive care, examinations, vaccinations, and disease treatment for infants, children, and adolescents under 18 years of age.

Cardiology Department

The specialty hospital department focused on diagnosing, treating, and preventing diseases and disorders of the heart and blood vessels.

Radiology Department

The diagnostic department that utilizes advanced imaging technologies (such as CT, MRI, Ultrasound, Mammography, and Nuclear Medicine) for disease detection, diagnosis, and treatment.

Neonatology Department

A subspecialty medical unit providing advanced, specialized critical care for sick and premature newborn infants.

Critical Care / Intensive Care Unit (ICU)

A specialized hospital unit providing intensive, high-level life support and continuous monitoring by a multidisciplinary team for patients with life-threatening illnesses or injuries.

Emergency Department (ED / ER)

A 24/7 hospital facility equipped to provide immediate, unscheduled care and stabilization for patients experiencing acute trauma, severe bleeding, heart attacks, strokes, or life-threatening conditions.

Pre-Surgical Testing (Pre-Op)

A clinical department that assesses a patient's physical health, medical history, medications, and diagnostic tests (such as EKGs and blood work) prior to surgery to minimize surgical risks.

Post-Anesthesia Care Unit (PACU)

The specialized hospital unit where surgical patients are closely monitored, treated, and stabilized immediately following anesthesia and surgery.

Renal Dialysis

A specialized treatment service that uses hemodialysis or peritoneal dialysis machines to cleanse blood of waste products and excess fluid in patients experiencing chronic kidney failure.

Orthopedics Department

The medical specialty focused on diagnosing, treating, and rehabilitating injuries and diseases of the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles.

Laboratory / Pathology Department

The diagnostic unit responsible for clinical pathology (analyzing bodily fluids), anatomical pathology (examining surgical tissue/cells), and forensic pathology (determining cause of death).

Medical/Surgical Department (Med-Surg)

A broad hospital unit that provides care, symptom management, medication administration, and wound care for adult patients recovering from surgery or managing acute and chronic illnesses.

Hospice

Specialized end-of-life care that prioritizes comfort, pain relief, and quality of life over curative treatment for terminally ill patients.

Acute Care

Short-term medical treatment provided for patients experiencing severe injuries, sudden episodes of illness, or urgent medical conditions.

Ambulatory Care

Medical care provided on an outpatient basis that does not require an overnight stay, covering diagnostic tests, consultations, and minor treatments.

Home Care

Medical and supportive healthcare services delivered directly within a patient's residence.

Inpatient Care

Hospital care that requires formal admission and an overnight stay for continuous treatment, complex procedures, and continuous medical monitoring.

Outpatient Care

Healthcare services, routine procedures, tests, or emergency visits where the patient returns home on the same day without an overnight stay.

Teaming

A collaborative approach in healthcare where professionals work together across different systems and specialties in a coordinated effort to improve patient outcomes.

Hospital Board of Directors

The top governing body of a hospital hierarchy, consisting of community leaders, medical professionals, and business executives responsible for setting hospital policies and making major financial decisions.

Organizational Structure

The defined levels of management and hierarchy within a hospital that clarify reporting lines, maintain the chain of command, and promote operational efficiency.

Therapeutic Services

A health science career pathway primarily focused on changing the health status of the patient over time through direct care, treatment, counseling, and patient education.

Diagnostic Services

A health science career pathway concerned with assessing a patient's health status at a particular point in time through tests, imaging, and evaluations.

Health Informatics

A multidisciplinary health science pathway that combines healthcare with data analytics to manage patient records, computer information systems, and billing data.

Support Services

A hospital career pathway responsible for maintaining a clean, sanitary, functional, and therapeutic environment for healthcare delivery, including housekeeping, maintenance, and food services.

Biotechnology Research and Development

A career pathway focused on applying bioscience research to human health, studying diseases, developing new pharmaceuticals, and engineering innovative medical devices.

Premium

The regular fee paid monthly or annually by an individual or employer to an insurance company to keep an active health insurance policy.

Copay

A predetermined, flat fee paid out-of-pocket by an insured individual at the time a medical service is rendered, such as an office visit or prescription refill.

Insurance Deductible

The specific dollar amount that an individual must pay out-of-pocket for covered medical services before the insurance company begins paying its share.

Coinsurance

The specified percentage of medical costs that the patient remains responsible for paying after meeting their annual deductible.

Out of Pocket Maximum

The maximum amount of money a policyholder pays out-of-pocket in a year, after which the insurance provider pays 100% of all covered medical expenses.

Insurance Claim

A formal request submitted by a patient or healthcare provider to an insurance company requesting payment for rendered medical services.

Reimbursement

The monetary amount paid by an insurance company or Medicare to healthcare providers for delivering medical care.

Pre-existing Condition

An illness, injury, or medical condition that an individual was diagnosed with or treated for before enrolling in a new health insurance plan.

Preauthorization

A cost-containment requirement where insurance approval must be obtained prior to receiving non-essential treatments, diagnostic tests, or specialist referrals in order to receive coverage.

Fee-For-Service

A traditional payment model where medical providers bill and receive payment for each individual test, visit, or procedure performed, which lacks inherent cost-containment incentives.

Direct Pay

A payment method where the patient pays healthcare providers directly out of pocket without using health insurance.

Managed Care

A healthcare delivery and payment system established in response to rising costs that negotiates provider contracts, emphasizes preventive care, and limits unnecessary procedures.

Health Maintenance Organization (HMO)

A managed care plan that requires patients to choose a Primary Care Physician, stay within an established provider network, and obtain specialist referrals to receive coverage.

Preferred Provider Organization (PPO)

A managed care plan offering lower costs when visiting contracted in-network providers, while still allowing patients to visit out-of-network physicians without a referral for a higher fee.

Exclusive Provider Organization (EPO)

A managed care hybrid plan that covers services only if provided by doctors within its network (except during emergencies), without requiring specialist referrals.

Point of Service (POS)

A managed care hybrid plan requiring patients to select an in-network primary care physician who manages referrals, while retaining the option to seek out-of-network care at higher cost.

Primary Care Provider (PCP)

A general practitioner who serves as a patient's first point of contact and act as a gatekeeper in managed care to approve and coordinate specialized care.

Medicare

A federal health insurance program created by Congress in 1965 under the Social Security Administration for individuals aged 65 and older, as well as certain younger disabled individuals.

Medicaid

A joint federal and state assistance program that provides free or low-cost medical coverage to low-income individuals, families, pregnant women, the elderly, and disabled persons.

CMS (Centers for Medicare & Medicaid Services)

The federal agency that administers Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace.

Veterans Health Administration (VA)

The largest integrated healthcare system in the United States, providing comprehensive medical care to military veterans, especially those with service-related disabilities.

Diagnostic Related Groups (DRGs)

A government-imposed cost-control system that classifies hospital cases into fixed payment categories, encouraging hospitals to become efficient and eliminate over-treatment.

Affordable Care Act (ACA)

A comprehensive healthcare reform law signed in 2010 to improve care access by banning coverage denial for pre-existing conditions and allowing young adults to stay on parental plans until age 26 (or 27).

Disability Income Insurance

Insurance coverage that replaces a portion of an employee's regular income (typically around 60%) if they become unable to work due to an injury or illness.

Worker's Compensation Insurance

State-mandated insurance that pays medical expenses, lost wages, and rehabilitation costs for employees who suffer job-related injuries or illnesses.

Non-Profit Health Care Institution

Healthcare facilities operating as charities to provide community care; they are exempt from most taxes but still pay Social Security and Medicare taxes.

Proprietary Health Care Institution

For-profit healthcare facilities that operate like conventional commercial businesses and are required to pay local, state, and federal taxes.

Expenditures

Any money spent in the process of running a business; in healthcare, expenditures are divided into financing, technology and supplies, facilities, and personnel.

ICD-10 Codes

Standardized diagnostic code numbers assigned to diseases and medical conditions used to determine and justify billing charges submitted by providers.

CPT Code (Current Procedural Terminology)

A standardized medical code set used to document and report medical, surgical, and diagnostic procedures and services for billing.

Defensive Medicine

The clinical practice of ordering additional diagnostic tests, treatments, and procedures primarily to protect healthcare providers against potential malpractice lawsuits.

Cross-Training

The practice of training healthcare professionals in multiple clinical or technical competencies to improve efficiency and reduce organizational labor costs.