Got it! Let me break down all the terms with a bit more detail and in simple language:
Healthcare Concepts
1. Primary, Secondary, and Tertiary Prevention
• Primary Prevention: Stopping diseases before they start. Examples include vaccines, eating healthy, and exercising.
• Secondary Prevention: Catching and treating diseases early. Examples are screenings (like mammograms) and routine check-ups.
• Tertiary Prevention: Helping people live better with ongoing illnesses. Examples include rehab for stroke patients or physical therapy after surgery.
2. Iron Triangle
• This describes how healthcare focuses on balancing three things: cost, quality, and access. If you improve one (like quality), it can affect the others (like increasing cost).
3. Determinants of Health
• These are all the factors that affect your health, like:
• Biology: Genes, age, and sex.
• Environment: Where you live, air quality, and access to resources.
• Behavior: Smoking, eating habits, and exercise.
• Healthcare Access: Whether you can afford and reach doctors.
4. Medigap
• This is extra health insurance that helps people on Medicare cover costs Medicare doesn’t pay, like copays or deductibles.
Health Insurance Terms
5. Self-Funded (Self-Insurance):
• Instead of buying insurance, some companies pay directly for their employees’ medical bills. This works for big businesses that can afford unexpected costs.
6. Copayments and Coinsurance:
• Copay: A small fixed fee you pay for a visit or medication (e.g., $20 for a doctor visit).
• Coinsurance: You pay a percentage of the bill after meeting your deductible (e.g., 20% of a $1,000 surgery = $200).
7. Medicare Part A, B, C, and D:
• A: Covers hospital stays.
• B: Covers doctor visits and outpatient care.
• C: A combination of A and B, offered through private companies with added benefits.
• D: Helps pay for prescription medications.
8. Health Maintenance Organizations (HMO):
• A strict insurance plan where you must use a network of doctors and get referrals to see specialists. It’s cheaper but less flexible.
9. Preferred Provider Organizations (PPO):
• More flexible insurance that lets you see any doctor, but it costs more. You save money if you stay in-network.
10. Point of Service (POS) Plans:
• Combines HMO and PPO. You can go out-of-network, but you’ll pay more. Referrals are usually required.
11. Carve-Outs:
• These are services not included in regular health plans, like mental health care or vision care. They’re offered separately.
Healthcare Payment Terms
12. Fee-for-Service:
• You’re charged for every service you get (e.g., separate bills for a doctor visit, tests, and medications).
13. Usual and Customary Fees:
• The standard amount insurance companies will pay for a service based on local rates.
14. Medical Loss Ratio:
• The percentage of premium dollars an insurance company spends on actual medical care versus administration or profit. For example, if the ratio is 80%, $0.80 of every dollar goes to your care.
Legal and Ethical Concepts
15. Implied Contracts and Informed Consent:
• Implied Contracts: An unwritten agreement between patients and doctors (e.g., doctors must provide safe care).
• Informed Consent: Doctors explain risks and benefits before you agree to treatment.
16. Intentional Torts:
• Wrongful acts done on purpose in healthcare, like lying about treatments or physically harming a patient.
17. Tort Reform:
• Changing laws to limit how much people can sue doctors or hospitals for mistakes.
18. Patient Bill of Rights:
• Rules to protect patients, such as access to your medical records and the right to refuse treatment.
19. Defensive Medicine:
• Doctors perform extra tests or procedures just to avoid lawsuits, even if they aren’t needed.
20. EMTALA:
• A law requiring hospitals to treat emergency patients, regardless of their ability to pay.
Mental Health Concepts
21. Mental Disorders, PTSD, ADHD:
• Mental Disorders: Conditions like depression, anxiety, or schizophrenia that affect thinking and emotions.
• PTSD: Intense stress and flashbacks after trauma (e.g., soldiers after war).
• ADHD: Trouble paying attention, being overly active, or acting without thinking.
22. Mental Health Commitment Laws:
• Rules that allow or require someone to be hospitalized for mental health treatment, especially if they’re a danger to themselves or others.
23. Mental Health Parity Act:
• Requires health insurance to cover mental health care equally to physical health care.
Ethics and Technology in Healthcare
24. Medical Ethics and Bioethics:
• Medical Ethics: Rules for how doctors should treat patients fairly and safely.
• Bioethics: Big moral questions in medicine, like cloning or using stem cells.
25. Paternalism:
• When doctors or governments make decisions for patients “for their own good” without consulting them.
26. Electronic Health Record (EHR):
• A digital version of your health history that doctors can easily share to improve care.
Healthcare Systems and Policies
27. Accountable Care Organizations (ACO):
• Groups of doctors and hospitals that work together to provide better care at lower costs. They share in any savings or penalties.
28. PPACA (Affordable Care Act):
• A law that made healthcare more affordable and accessible. Key features:
• Individual Mandate: Everyone must have insurance or pay a penalty.
• Insurance Exchanges: Online marketplaces to compare and buy plans.
• Medicaid Expansion: More people qualify for government health insurance.
29. Medical Homes:
• A care model where one primary team handles all your healthcare needs, improving communication and care quality.
30. Bundle Payments:
• Instead of billing separately for every part of a treatment (e.g., surgery, hospital stay), providers are paid one lump sum.
31. Deinstitutionalization:
• Moving people with mental illnesses out of long-term institutions and into community-based care.
Would you like me to explain any specific concept even further?dw
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