The big business of health care and you

Health care system

A network of providers, facilities, and insurers that deliver medical services

Third party payer

An entity (usually insurance) that pays for health care services on behalf of the patient

Premium

The monthly amount paid for health insurance coverage

Deductible

The amount a patient must pay out of pocket before insurance pays

Copayment

A fixed amount a patient pays at the time of receiving care

Medicare

A federal health insurance program for people aged 65+ or with disabilities

Medicaid

A joint federal and state program that helps with medical costs for low income individuals

Managed Care

A system that manages cost, utilization, and quality (HMO’s, PPO’s)

Fee for service

A payment model where providers are paid for each service performed

Capitation

A model where a provider is paid a fixed amount per patient per month

Ethical dilemma

A difficult choice between two morally acceptable or unacceptable options

Health care fruad

Intentional deception for financial gain, like billing for unprovided services

Abuse in health care

Inappropriate billing or service practice that cause unnecessary costs

Medical necessity

Health services that are necessary for diagnosis or treatment

Cost containment

Efforts to control or reduce healthcare costs