module 1 b Health Care Finance Basics: Ownership and Reform

This set of vocabulary flashcards covers health care ownership models and the key provisions and shifts introduced by the Patient Protection and Affordable Care Act (ACA).

Investor-owned (for-profit) business

A form of ownership where investors purchase shares of common stock, possess a right of control, and have a claim on residual earnings and residual liquidation proceeds.

Not-for-profit (nonprofit) corporation

A firm, also called tax-exempt or $501(c)(3)$ or $(c)(4)$ corporations, whose primary goal is defined by a mission statement focused on community service rather than shareholder wealth.

Common stock

Securities purchased by investors to become owners of an investor-owned corporation, providing them with returns in the form of dividends or capital gains.

Shareholder wealth maximization

The primary organizational and financial goal of investor-owned corporations, typically measured by the corporation's stock price.

Financial viability

The primary financial goal of not-for-profit corporations, which focuses on ensuring the organization remains operational to fulfill its mission.

Stakeholders

Individuals or groups who have a financial or other interest in a business; for-profit managers focus on stockholders, while not-for-profit managers must satisfy all such parties.

Patient Protection and Affordable Care Act (ACA)

Legislation passed in $2010$, also known as Obamacare, designed to provide access to affordable health insurance, reduce costs, and improve health care quality.

Health insurance exchanges

Platforms established under the ACA for individuals without other insurance sources to obtain coverage, often through premium subsidies based on income thresholds.

Medicaid expansion

A provision of the ACA designed to increase coverage for low income individuals in states that have approved the expansion.

$26$ years old

The age limit up to which young adults are permitted to remain on their parents’ insurance coverage under the ACA.

$10$ essential health benefits

A requirement of the ACA that insurance plans cover specific services including mental health, maternity care, and emergency care.

Value-based reimbursement

A payment structure that ties compensation to the quality of care provided rather than the volume of services, marking a shift from fee-for-service models.

Accountable Care Organizations (ACOs)

A network of physicians, hospitals, and clinics that share responsibility for coordinated care and tie payments to quality metrics and cost effectiveness.

Medical home (PCMH)

A patient-centered, team-based model of care led by a personal physician who provides continuous and coordinated care to maximize health outcomes.