Health Professions, Institutions, and Insurance Systems

Vocabulary flashcards covering health workforce credentialing, care delivery levels, quality measures, payment systems, malpractice elements, and healthcare delivery models based on the lecture transcript.

Accreditation

The evaluation process that determines whether an educational institution or program meets established quality standards.

Licensure

Legal permission granted by a state government to practice a profession.

Certification

A credential demonstrating expertise in a profession or specialty, such as board certification for physicians or specialty certification for nurses.

Credentialing

The verification process used by employers and insurers to review education, training, licenses, certifications, and professional history.

Doctor of Public Health (DrPH)

A graduate degree that generally emphasizes advanced public health leadership and practice.

PhD in Public Health

A graduate degree that generally emphasizes research, theory development, and university teaching.

Licensed Practical or Vocational Nurse (LPN/LVN)

A nurse who completes an approved practical-nursing program and provides basic care under supervision.

Advanced Practice Registered Nurse (APRN)

A category of nurses including nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists.

Primary Care

Accessible, first-contact, continuous, comprehensive, and coordinated care, including routine exams, vaccinations, screenings, and chronic-disease management.

Secondary Care

Specialized care generally provided after a referral, such as treatment by a cardiologist, dermatologist, or general surgeon.

Tertiary Care

Highly specialized, technology-intensive care, such as organ transplantation, major trauma care, complex cancer treatment, or neurosurgery.

Fee-for-Service

A payment method where the professional is paid separately for each visit, test, or procedure.

Capitation

A payment model where a clinician or organization receives a fixed amount per patient for a defined period.

Case-Based Payment

A payment model where a single payment covers an entire hospitalization or episode of care.

Bundled Payment

A single payment that covers multiple services across an episode of care, encouraging coordination while transferring some financial risk to providers.

Critical Access Hospitals

Small rural facilities that meet federal conditions intended to preserve healthcare access in isolated communities.

Federally Qualified Health Center (FQHC)

A facility that delivers comprehensive community-based care and serves patients regardless of their ability to pay.

Healthcare Quality

The degree to which services improve desired health outcomes and are consistent with current professional knowledge.

Structure Measures

Healthcare quality metrics that examine the care environment, such as staffing, equipment, accreditation, and electronic-record capacity.

Process Measures

Healthcare quality metrics that evaluate whether recommended care occurred, such as vaccination or timely antibiotic administration.

Outcome Measures

Healthcare quality metrics that examine results such as mortality, infection, complications, functional improvement, and readmission.

Medication Reconciliation

The process of comparing medication lists during care transitions to prevent omissions, duplication, and interactions.

Duty (Medical Malpractice)

A legal element of malpractice where a professional relationship creates an obligation to provide appropriate care.

Breach (Medical Malpractice)

A legal element of malpractice where provided care falls below the relevant professional standard.

Causation (Medical Malpractice)

A legal element of malpractice where a breach of care actually and legally contributes to a patient's injury.

Medicare Part A

A component of Medicare financed mainly through payroll taxes that serves adults 65 and older and certain disabled individuals.

Medicaid

A program jointly financed by federal and state governments and administered by states within federal rules to cover low-income populations.

Children's Health Insurance Program (CHIP)

A jointly funded federal and state program covering eligible children in families whose income is too high for Medicaid but who lack affordable coverage.

Health Maintenance Organization (HMO)

A managed-care model that combines or closely manages financing and delivery using provider networks, primary-care coordination, and prospective payment.

Preferred Provider Organization (PPO)

A health plan that offers discounted networks while normally permitting out-of-network care at a higher patient cost.

COBRA

A federal option allowing enrollees to temporarily continue employer coverage after qualifying events, typically requiring the enrollee to pay most or all of the premium.

National Health Service (NHS)

The United Kingdom's healthcare system financed mainly through general taxation, providing residents broad services generally without charge at the point of use.