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- 4. A federally funded health insurance program for the disabled, personas with end-stage renal disease, and persons age 65 and older who qualify for social security benefits.
- 6. Health Insurance this is usually provided through an individual’s employer and part of the cost is paid by the employer and part by the employee.
- 7. This refers to a common method of reimbursement for health care services based on a pre-determined fixed price per case or diagnosis. In 1983, a revolution began in health care financing in order to control rapidly rising health care costs. Medicare (which is the largest single payer of hospital charges ) moved from a fee-for-service reimbursement to a PPS (prospective payment system) based on DRGs. For example – instead of the hospital sending a bill to Medicare for a patient admitted and treated for pneumonia and each x ray, lab test, antibiotic were billed as a fee for service, now the hospital is only reimbursed whatever the flat fee for pneumonia DRG is . If the patient happened to stay longer and need more care than a typical pneumonia patient, the hospital lost money. If the patient's hospital costs were less than the pre-set DRG amount, the hospital makes a profit. The goal of hospitals are cost effective care and shorter stays so they make a profit.
- 8. payer system one payer, usually the government, pays all health care expenses for citizens, funded by taxes. They also make all decisions about covered treatments , drugs, and services. Sometimes referred to as Universal Health Care. In this system all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate and the citizens receive the same health benefits , regardless of their ability to pay. Canada uses this type of system. Interestingly, the governor of the state of Vermont attempted this type of system for their state in 2010 but that plan died in 2014 and never made it off the ground because of funding and mixed support from the citizens of Vermont.
- 10. this term refers to a method of reimbursing heath care providers where the insurance company pays the provider a set payment each month to provider health care services for the patient enrolled in the insurance plan. This is usually a per member per month payment and the services usually include preventative, diagnostic and treatment services.
- 14. payment system health care providers (NPs, physicians, hospitals) are reimbursed for care according to a predetermined “set price per diagnosis”. This amount is paid regardless of how many services are rendered procedure performed . This is the most common method of payment in today’s health care system.
- 15. payment system also known as fee-for-service payment system. Services are billed based on each individual service provided. A negative however is that this system encourages the overuse of health care services because the more procedures/services performed, the more revenue received by the provider. In other words, payment is depending on the quantify of care, rather than the quality of care.
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- 1. A federal statute enacted in 2010 that requires US citizens and legal residents to have health insurance through comprehensive health care reform. Basically, it was founded on the premise that all people should have access to quality health care. This is a major step in the right direction for universal health insurance for all American citizens, esp those previsouly uninsured. However, some people’s insurance costs have been affected by the PPACA implementation and question the fairness of the increases and how it affects them personally.
- 2. a measurement of the total value of goods and services produced in a country
- 3. refers to how your resources are used (energy, time, money) to produce the desired outcome. You may achieve the desired goal but were you efficient or un-efficient in doing so ?
- 4. an economic term that refers to a small or insignificant change in some variable ( example- the number of medical tests performed )
- 5. a jointly sponsored state and federal program that pays for medical services for persons who are elderly, poor, bling, or disabled and for certain families with dependent children who meet specific income guidelines
- 9. if you are effective, you produce the desired outcome
- 11. licensed health care professional (md or np) or an organization (hospital) that provides health care services.
- 12. payer Someone other than the patient and the provider assumes responsibility for payment of health care charges. This is usually an insurance company, like Blue Cross, which is a private insurer. But third party payers can also be public (government) insurers such as Medicare and Medicaid. An individual’s health insurance plan provided by his or her employer is considered a third party payer.
- 13. the federal gov’t agency that administers Medicare and Medicaid.