Paying for Health Services

These flashcards cover key terms and concepts related to healthcare financing, government-funded health insurance, and types of care reimbursement methods.

Healthcare Financing

The process of funding healthcare through various private payers and public programs.

Medicare

A federal health program primarily for people aged 65 and older, certain disabled individuals, and adults with end-stage renal disease.

Medicaid

A federal-state cooperative health insurance plan for low-income individuals and families who cannot afford healthcare.

Children's Health Insurance Program (CHIP)

A program that provides healthcare coverage for low-income children who do not qualify for Medicaid.

Fee for Service

A payment model where providers are paid for each individual service performed.

Capitation

A payment model where a practitioner or hospital receives a fixed amount for specific services, promoting care management.

Managed Care Organizations (MCOs)

Systems designed to manage cost, quality, and utilization of healthcare services.

Bundled Payments

A single payment covering all costs associated with a specific episode of care.

Accountable Care Organizations (ACOs)

Groups of providers who agree to be accountable for the quality and cost of care for a defined population.

Health Maintenance Organizations (HMOs)

A type of managed care organization that provides health services for a fixed annual fee.

Preferred Provider Organizations (PPOs)

A type of insurance plan that offers a network of preferred providers and allows patients to see out-of-network providers at a higher cost.

Exclusive Provider Organizations (EPOs)

Plans similar to HMOs that do not cover out-of-network services but usually do not require referrals to see specialists.

Government-Funded Health Insurance

Public healthcare programs such as Medicare and Medicaid that provide coverage to specific populations.

Healthcare Expenditures

The total amount spent on healthcare services, including both public and private spending.

Preventive Services

Healthcare services aimed at preventing diseases, such as immunizations and screenings.

Long-term Services and Supports (LTSS)

Assistance provided to individuals needing help with daily living activities, often covered by Medicaid.