American Health Care System — Simple Study Guide

Comprehensive vocabulary flashcards covering the American healthcare system, health insurance financing, social determinants of health, disparities, delivery levels, and public health history.

Health

Physical, mental, and social well-being.

Healthcare system

People and organizations that provide and pay for healthcare.

Biomedical model

A model that focuses on the body's physical problems and treating disease.

Medicine vs. Public health

Medicine treats individual patients, whereas public health protects and improves the health of entire communities.

HMO

A health insurance plan that is usually cheaper, offers fewer choices, and often requires referrals.

PPO

A health insurance plan that is usually more expensive, offers more choices, and usually does not require referrals.

Premium

A monthly payment made for health insurance.

Deductible

The amount you pay out-of-pocket before insurance begins to pay for many services.

Copay

A fixed fee paid for a visit, such as $\$25$.

Coinsurance

The percentage of a medical bill that you are responsible for paying.

Out-of-pocket maximum

The most you have to pay for covered, eligible in-network care in a plan year, not counting premiums.

In-network providers

Healthcare providers contracted with your insurance plan; care received from them is usually cheaper.

Out-of-network providers

Healthcare providers without a contract with your insurance plan; care received from them is usually more expensive.

Risk pooling

A system where many people share the financial cost of healthcare.

Underinsured

Having health insurance coverage but still being unable to afford needed care.

ACA (Affordable Care Act)

A law that expanded insurance access and protected individuals with preexisting conditions.

Cherry picking

A practice where insurers try to attract healthy people who cost less to treat.

Fee-for-service

A payment model where doctors get paid for each individual service provided.

Capitation

A payment model where doctors receive a set payment amount per patient.

Social Determinants of Health (SDOH)

Conditions in which people live, work, learn, and grow that affect health, such as income, education, housing, food, and transportation.

Upstream factors

Root causes of health status and disparities, such as poverty or housing policies.

Downstream factors

Immediate behaviors or health outcomes, such as smoking or diabetes complications.

Health inequality

A difference in health between groups.

Health inequity

An unfair or avoidable difference in health.

Health disparities

Differences in health outcomes between groups.

Health-wealth gradient

The observation that people with more money generally experience better health.

Equality vs. Equity

Equality means everyone receives the same resources, whereas equity means everyone receives the resources they need.

Implicit bias

Unconscious assumptions held about people.

Cultural competence

Having the necessary skills to effectively work with people from different cultures.

Cultural humility

Being open to listening and learning about others while recognizing one's own limitations.

Dawson's model

A healthcare delivery model that organizes healthcare into levels and connects services through referrals.

Primary care

The first place a patient goes for general healthcare.

Secondary care

Specialist medical care, such as care provided by a cardiologist.

Tertiary care

Highly specialized medical care, such as an organ transplant.

Virtual care

Healthcare services delivered through video calls, phone, or online platforms.

Four functions of primary care

First contact (first place to seek care), Continuity (care over time), Comprehensiveness (handles many different health needs), and Coordination (connects you with other providers).

Primary prevention

Preventing disease before it happens, such as through vaccines.

Secondary prevention

Detecting disease early, such as through cancer screening.

Tertiary prevention

Reducing complications after disease has developed, such as through stroke rehabilitation.

Core areas of public health

Promotion (helping people improve health), Protection (protecting people from health threats), and Prevention (stopping disease and injury).

Three essential public health functions

Assessment (finding out what the problem is), Policy development (deciding what should be done), and Assurance (making sure services are available).

Great Sanitary Awakening

A historical period that focused on improved sanitation, clean water, and sewage systems to prevent disease.

Germ theory

The scientific concept that many diseases are caused by microorganisms such as bacteria and viruses.

Epidemiologic transition

The shift that occurs as societies change, where infectious diseases become less dominant and chronic diseases become the major causes of death.

Food and Drug Act (1906)

Legislation that helped protect people from unsafe or mislabeled food and drugs.

Healthy People initiative

A national initiative that sets goals to improve health and reduce disparities, currently operating under the Healthy People 2030 framework.

Moral argument for healthcare

The principle that everyone deserves access to necessary care because health is important for life and well-being.

Social and economic barriers to healthcare

Non-clinical obstacles to care including transportation, lack of time, childcare, language barriers, low income, and lack of nearby providers.