Prof. Eng. 2: Ch. 1-3

Provider

any entity that delivers health care services and can either independently bill for those services or is tax supported

Reimburesment

amount insurer pays provider

medicare

National Health Insurance program for the elderly and disabled.

medicaid

Federal program that provides medical benefits for low-income persons.

premium cost sharing

Refers to the common practice by employers that require their employees to pay a portion of the health insurance cost.

health-care reform

Facilitated access to care for millions of uninsured Americans

universal coverage

Health insurance coverage for all citizens.

utilization

quantity of health care consumed

managed care

A system that combines the financing and the delivery of appropriate, cost-effective health care services to its members.

enrolee

the person covered by plan

health plan

covered services that the enrollee is entitled to

free market

a competitive market characterized by the unencumbered operation of the forces of supply and demand and where numerous buyers and sellers freely interact

demand

quantity of health care purchased

moral hazard

When the act of insuring an event increases the likelihood that the event will happen

provider-induced demand

Providers' ability to create demand for services that are financed through insurance.

phantom providers

Practitioners who generally function in an adjunct capacity. The patient does not receive direct services from them. They bill for their services separately, and the patients often wonder why they have been billed. Examples include anesthesiologists, radiologists, and pathologists.

single-payer system

a national health care program in which the financing and insurance functions are taken over by the federal government

national health insurance

the government finances health care through general taxes, but the actual care is delivered by private providers

national health system

A tax supported national health care program in which the government finances and also controls the service infrastructure

socialized health insurance

government mandated contributions by employers and employees finance health care

system

a set of interacting parts that, when functioning properly, achieve a desired result

medical model

defines health as the absence of illness or disease

health care

a variety of services believed to improve a person's health and well-being

holistic health

emphasizes the well-being of every aspect of what makes a person whole and complete

holistic medicine

an approach to health care that emphasizes prevention of illness and takes into account a person's entire physical and social environment

quality of life

overall satisfaction that a person gets from the health care delivery system

epidimiology triangle

host-->agent-->environment

acute condition

Relatively severe, episodic (of short duration), and often treatable. It is subject to recovery and treatment is generally provided in a hospital

subacute condition

less severe phase of an acute illness

chronic condition

persists over time and is not severe

Health Risk Appraisal

Risk factors associated with host, agent, environment, and their health consequences are evaluated through this process

iatrogenic illnesses

diseases resulting from medical treatment

public health

Deals with broad societal concerns about ensuring conditions that promote optimum health for society as a whole by influencing the social, economic, political, and medical care factors that affect health and illness. The objective of public health is to prevent disease, prolong life, and promote health through organized community effort.

environmental health

preventing the spread of disease through water, air, and food

Bioterrorism

Encompasses the use of chemical, biological, and nuclear agents to cause harm to relatively large civilian populations.

surge capacity

The ability of a healthcare facility or system to expand its operations to safely treat an abnormally large influx of patients.

Morbidity

disease rates within a group

mortality

death rate

cases

Refers to individuals who acquire a certain disease or condition.

incidence

The number of new cases of a condition during a given period of time.

epidemic

Large numbers of people who get a specific disease from a common source

prevalence

the total number of cases of a disorder occurring in a population over a specific period of time

instrumental activities of daily living (IADLs)

the activities of daily living needed for independent living

crude rates

total population

social resources

Social contacts that can be relied upon for support, such as family relatives, friends, neighbors, and members of a religious congregation. They are indicative of adequacy of social relationships

market justice

leaves the fair distribution of health care up to the market forces in a free economy

demand side rationing

rationing by ability to pay

supply side rationing

Restricting the availability of expensive medical technology and specialty care.

almshouse

a home for the poor, supported by charity or public funds.

pesthouse

a hospital for people suffering from infectious diseases, especially the plague.

fee-for-service

The practice of billing separately for each individual type of service performed.

cultural authority

The general acceptance of professional judgment as valid. Physicians' cultural authority is reflected in the reliance placed on their evaluation of signs and symptoms, diagnosis of disease, and suggested prognosis.

organized medicine

Concerted activities of physicians through the American Medical Association

gatekeeping model

Model requiring initial contact with a generalist and the generalist's referral to a specialist for access to specialty care.

voluntary health insurance

Private health insurance (in contrast to government-sponsored compulsory health insurance).

prepaid plan

A contractual arrangement under which a provider must provide all needed services to a group of members in exchange for a fixed monthly fee paid in advance.

socialized medicine

a medical care system in which the government owns and operates most medical facilities and employs most physicians

cross-subsidization

use of high prices and profits on one product to subsidize low prices on another product

balance bill

charge the patient the amount above the program's set fees and recoup the difference