Unit 1: Health Communication

Capitation

A set fee paid to cover a person’s health needs, regardless of the care actually required.

Catastrophic Cap

An upper limit on the amount of out-of-pocket expense an insurance subscriber is required to pay each year.

Copay

The portion of a health care bill the patient is required to pay when services are rendered.

Deductible

The amount of out-of-pocket medical expense an insured individual is required to pay before receiving financial assistance from the insurer. For example, you may pay the first $500 of an ER bill, and insurance will pay 80% if the remaining cost.

Diagnosis-related groups (DRGs)

Flat-rate reimbursement amounts for specified inpatient hospital procedures

Fee-for-service

The practice of paying a care provider for specific care provided, as opposed to a capitated amount paid in advance regardless of services rendered.

Health Maintenance Organization (HMO)

A managed care organization that offers enrollees a variety of health services for a set monthly fee and copays. Care providers are usually employed directly by the HMO and provide services only to HMO members.

Third-party payer

A benefits provider (usually an insurance company) who is separate from the patient and care provider. Common with traditional indemnity insurance but less common in managed care.

Universal Coverage

The provision that all citizens (and in some countries, all temporary residents and visitors) are assured of health care.

Insurance Premium

A membership fee paid by subscribers in a conventional insurance or managed care plan. Usually deduced from one’s paycheck.

Health Savings Account (HSA)

A tax-exempt savings plan in which people can set aside money to pay for medical bills. People qualify for an HSA if they are a part of a high deductible health plan. Money saved can be used over many years

High Deductible Health Plan (HDHP)

A managed care plan with lower than average premiums but higher deductibles and out-of-pocket spending caps. Most HDHPs qualify members to establish an HSA.

Individual Mandate

A rule requiring everyone to have health insurance

Managed Care

A health care system in which income, resources, and health services are supervised by a managing body, such an an HMO or PPO. Patients pay the organization a set fee (premium) each month to receive health services.

Multi-payer

A system in which health insurance is provided by a variety of sources, usually including both private companies and government programs. May involve universal coverage or not. Typically funded by a mix of individual contributions and taxes.

Preferred Provider Organization (PPO)

A managed care organization that pays independent care providers a discounted fee for each service they provide to PPO members. Patients may visit providers not on the preferred list, but they pay higher fees to do so.

Prospective Payment Structure

A system in which reimbursements are established in advance rather than after care has been provided.

Single-Payer

a system of universal coverage in which one source (a government agency or a privately run nation health insurance plan) pays the bills for everyone’s health care. Usually funded by tax dollars.

Health

The state of complete physical, mental and social well-being.

Communication

Transmission and exchange of information

Transactional Model of Communication

reciprocal - sending and receiving messages

1. Collaborative Sense Making

2. Multiple Layers of Meaning

3. Context and Culture

Health Communication

Study and use of communication strategies to inform and influence individual and community decisions that enhance health

Socio-Ecological Model of Health

1. The Individual → fundamental, personal decisions

2. The social network → relationships, groups

3. The organization → formal groups; workplace, schools, health institutes

4. The community → create more healthy structures and policies

5. The society → norms, values, laws

Biomedical Model

Focus on physical needs, conventional Western medicine, body treated as a machine

Biopsychosocial Model

Considers people’s biology, psychology, and social roles

Sociocultural Model

Health behaviors reflect personal, social, and cultural influences

6 Reasons to Study Health Communication

1. Communication necessary to successful healthcare encounters

2. Media portrayals affect health behaviors

3. Communication affects coping skills

4. Good communication saves time and money

5. Communication helps health care organizations run effectively

6. Healthcare industry growing

Preventive Care

Care a patient receives to prevent illness and disease before it starts

Medicare

Federal health insurance program for elderly/some disabled Americans

Medicaid

Assistance program that serves low-income people of any age

Descartes’ Dualistic Model

Nature of the body and mind are different; separation of Western medicine into two branches

Holistic Medicine

Considered the whole person, combines mind and body

Affordable Care Act (2010)

Individual mandate and universal health care in the US.

Emergency care, outpatient care, inpatient hospitalization, maternity and newborn care, mental health services, prescription drugs, rehabilitation for injury and disease recovery, lab work, pediatric care, and preventive care.

Therapeutic Privilege

The right for doctors to withhold information from patients if they think the information would do more harm than good; only ethical in emergency situations

Blocking

When a provider steers the conversation away from certain topics

Patronizing

Treating patients as inferior

Marginalizing

Treating a patient as less significant because they belong to a marginalized group (race, gender, sexulaity, etc)

Disclosure Decision Making Model

How patients evaluate what they tell a care provider

1. What can I predict?

2. How will they respond?

3. Can I share info effectively?

Collaborative Model of Patient-Caregiver Communication

Active partnership between patient and caregiver; patient is both a problem-solver and decision-maker

Narrative Medicine

Medicine that recognizes that storytelling has profound implications for life and healing

Voice of Lifeworld

Patient perspectives in health care

PACE Method

Patient method for communicating health needs

1. Present information

2. ask questions

3. check understanding

4. express concerns

Informed Consent

Patients are given information (including risks and benefit) about medical procedures to help them decide if they want to accept or refuse treatment

Tertiary Identity

Label that defines simultaneously the illness and a persons alignment to it

Reactions to Illness

1. Supernormal Identity → Illness will not prevent their life

2. Restored Self → the illness has an impact but will not significantly change them

3. Contingent Personal Identity → confronting how the illness has changed their identity

4. Salvaged Self → illness and person become intertwined in identity