Major Characteristics of U.S. Health Care Delivery

Vocabulary flashcards defining key components, subsystems, models, and characteristics of the U.S. health care delivery system based on Chapter 1 notes.

Health Care Delivery

Refers to the major components of the system, the processes that enable people to receive health care, and the provision of health care services to patients.

Universal Access

National health insurance programs present in most developed countries that provide routine and basic health care, run by the government and financed through general taxes.

Managed Care

The dominant health care delivery system in the United States, financed primarily by employers and government, where an MCO functions like an insurance company to manage service utilization and provider payment.

Managed Care Organization (MCO)

An entity that functions like an insurance company, contracting with enrollees under a health plan to provide covered health care services.

Enrollee

An individual (member) who is covered under a managed care health plan.

Health Plan

A contractual arrangement between an MCO and an enrollee that includes a list of covered health services and utilizes selected primary care general practitioners as gatekeepers.

Gatekeeper

A primary care general practitioner selected by a health plan to control and manage the utilization of medical services.

TriCare

A military-financed health care system that covers families, dependents, or retired military personnel.

VA Health Care System

One of the largest and oldest ($1946$) organized health systems in the world, available to retired veterans and focused on hospital, mental health, and long-term care.

Veterans Integrated Service Networks (VISN)

The $23$ geographically distributed networks into which the VA system is organized, each coordinating its own services and receiving federal funds.

Vulnerable Populations

Also known as special populations; groups with health needs but inadequate resources to address them, including the poor, uninsured, minority groups, specific immigration statuses, or geographically/economically disadvantaged communities.

Safety Net

Public health insurance programs and safety net providers offering comprehensive medical and enabling services to vulnerable populations who cannot otherwise access routine care.

Bureau of Primary Health Care (BPHC)

A federal agency that provides support for community health centers serving migrant farm workers, the homeless, public housing residents, and children.

Medicare

One of the largest sources of public health insurance in the United States, serving the elderly, disabled individuals, and patients with end-stage renal disease.

Medicaid

The third largest source of health insurance in the United States, providing coverage for low-income adults, children, the elderly, and the disabled.

Children's Health Insurance Program (CHIP)

A public health program that provides health insurance coverage to children residing in uninsured families.

Integrated Delivery System

A network of health care providers and organizations that provides coordinated health care to a defined population and is held responsible for its health outcomes and health status.

Accountable Care Organization (ACO)

A model of an integrated health care organization designed to coordinate services, manage costs, and improve quality across a population.

Long-Term Care (LTC)

Medical and nonmedical care provided to individuals who are chronically ill or have a disability, projected to be required by more than $12\text{ million}$ Americans by $2020$.

Access

The ability of an individual to obtain health care services when needed.

Free Market

An economic environment in which multiple independent buyers and sellers operate, unrestrained competition occurs on price and quality, and consumers directly bear service costs.

Market Justice

A principle governing the distribution of health care services based on market forces, individual purchasing ability, and economic demand in a free market.

Social Justice

A principle governing the distribution of health care services based on societal responsibility and equitable access to necessary care regardless of ability to pay.

Defensive Medicine

Practice behavior where health care providers take extra precautions—such as prescribing additional tests or appointments—to protect themselves against potential legal risk and lawsuits.

National Health Insurance (NHI)

A national health system model used in countries like Canada, where core care is delivered by private providers but financing is tightly consolidated and coordinated by the government.

Socialized Health Insurance System

A health care model used in countries like Germany, financed through government-mandated employer and employee contributions (sickness funds) and delivered by independent private arrangements.

National Health System (NHS)

A tax-supported national health system model used in Great Britain, where the government manages delivery infrastructure, operates most medical institutions, and employs most providers.

Systems Framework

A logical, organized approach outlining system foundations, resources, processes, outcomes, and outlook to explain the structure of U.S. health care delivery from inputs to outputs.