Ch. 22&23 study guide

Heath care costs are evenly distributed among everyone?

Not true. About 10% of the patients incur 80% of the costs. It is estimated that about 75% of total health care costs come from patients with chronic conditions

What is free for free service?

The physician determined what actions to take and the insurance companies paid for the services

Medicaid

A federal and state assistance program that pays for health care services for people who cannot afford them. Limited income.

Medicare

Established in 1965 provides health insurance for people aged 65 and older and others with disabilities who qualify for social security

HMO (Health Maintenance Organization)

A prepaid medical group practice plan that provides a predetermined medical care benefit package. HMOs are both insurers and providers of health care.

Capitation

System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a pe

Copay

a fixed fee you pay for specific medical services

Describe what a negotiated fee is with health care providers

Pre-agreed upon amounts that are negotiated between health care providers and insurance companies to pay for specific services. They may cover all or only a percentage of the providers actual charges. Depending on the type of plan, the patient pays the di

T OR F? Poor work habits can increase the malpractice lawsuits filed from patients?

True

What is quality improvement?

Using data to monitor outcomes of care and using methods to improve quality and safety of health care systems

What is the highest expense in for a healthcare organization?

Personnel (labor costs) refers to the individuals who work in all areas associated with the functioning of the health care delivery system.
The total cost of the salaries of all the health care professionals is often the largest cost incurred by a facilit

What is the major concern in the U.S. today for health care costs?

That we spend more per person in health care than any country and our quality of care and patient satisfaction are below those of many other counties.

Cross-trained

educated in several different skills across (health care) disciplines