Chapter 2 Health Care Systems

Agency for Health Care Policy & Research (AHCPR)

federal agency established to research quality of health care delivery & identify standards of treatment that should be provided by health care facilities.

mental health

facilities that treat patients with mental disorders and diseases. examples are psychiatric hospitals, drug/alcohol abuse and physical abuse treatment centers

health insurance plans

insurance that pays for medical care and involves a premium, co-payment and deductible

Worker's Compensation

a health insurance plan providing treatment for workers injured on the job; also reimburses workers for wages lost due to on-the-job injury

tricare (formerly called CHAMPUS)

us government health insurance plan for all military personnel and family, survivor family, retired members of armed forces

voluntary agencies and non-profit agencies

supported by donations, membership fee, fundraisers and federal or state grants. they provide health services at national, state, and local levels. They focus on one specific disease or group of diseases.

assisted living and independent living

allow individuals who can care for themselves to rent or purchase an apartment in the facility; provides meals, housekeeping, laundry, social events, transportation, and basic medical care

Centers for Disease Control and Prevention (CDC)

another division of the USDHHS; concerned with causes, spread, and control of diseases in populations

clinics

institution that provides care for outpatients; a group of specialists working in cooperation: Type of clinics are Surgical or surgicenters, urgent or emergency care, rehabilitation, specialty, outpatient, health department, medical centers.

dental offices

vary in size from offices that are privately owned by one or more dentists to dental clinics that employ a group of dentists.

emergency care services

provide special care for victims of accidents or sudden illness. Facilities include ambulance, rescue squads, helicopter or airplane, fire dept, ER

Food and Drug Adminstration (FDA)

a federal agency responsible for regulating food and drug products sold to the public

genetic counseling centers

can be an independent facility or located in another facility such as a hospital, clinic or physician's office

health departments

provide health services directed by the US Department of Health and Human Services; also provide specific services needed by the state or local community; examples are immunization, inspections, health education, clinics and other services needed in a com

Health Insurance Portability and Accountability Act (HIPAA)

set of federal regulations adopted to protect the confidentiality of patient information and the ability to retain health insurance coverage

health maintenance organization (HMOs)

both health care delivery systems and types of health insurance. Provide preventive health care for a fee that is usually fixed and prepaid. The disadvantage is that you must use only HMO-affiliated providers or pay it yourself if out of network

home health care

any type of health care provided in a patient's home environment; frequently used by elderly or disabled people, examples are nursing, personal, therapy, homemaking.

hospice

program designed to provide care for the terminally ill while allowing them to die with dignity

hospitals

institution that provides medical or surgical care and treatment for the sick or injured: General hospitals, specialty hospitals, government hospitals, university or college medical centers.

industrial health care centers

(occupational health clinics) are found in large companies or industries; provide health care for employees by performing basic examinations, teaching accident prevention and safety and providing emergency care.

laboratories

room or buildings where scientific tests, research, experiments, or learning takes place

long-term care facilities (LTC or LTCFs)

provide assistance and care for elderly patients, usually called residents. They also provide for individuals with disabilities or handicaps and individuals with chronic or long-term illness. They are residential care, extended or skilled care, independen

managed care

a health care delivery system designed to reduce the cost of health care while providing access to care through designated providers

Medicaid

Government program that provides medical care for people whose incomes are below a certain level and for individuals who are physically disabled or blind

Medicare

Government program that provides medical care for elderly and/or disabled individuals who received 2 years SS benefits; or persons with end-stage renal disease. Type A covers hospital insurance; Type B for Medical insurance (must pay premium and deductibl

Medigap

are insurance plan that serves as supplemental insurance to Medicare; usually pays deductible for Medicare and co-payments of care

National Institute of Health (NIH)

a division of USDHHS; involved in research on disease

Occupational Safety and Health Administration (OSHA)

establishes and enforces standards that protect workers from job-related injuries and illnesses

optical centers

can be individually owned by an ophthalmologist or optometrist or they can be part of a large chain of stores.

organizational structure

encompasses a line of authority or chain of command.

preferred provider organizations (PPOs)

a type of managed care health insurance plan usually provided by large industries or companies to the employees; has in-network providers; you may share 40/60 for out of network providers

rehabilitation

helping restore patients with physical or mental disabilities obtain maximum self-care and function through therapy and education

school health services

found in schools and colleges providing emergency care for victims of accidents and sudden illness; perform tests to check for health conditions such as speech, vision and hearing; promote health education.

U.S. Department of Health and Human Services (USAHHS)

a national agency that deals with the health problems in the United States

World Health Organization (WHO)

an international agency sponsored by the United Nations; compiles statistics and information on disease, publishes health information and investigates and addresses serious health problems throughout the world

medical offices

vary from offices that are privately owned by one doctor to large complexes that operate as corporations and employ many doctors and other health care professionals.

premium

fee the individual pays for insurance coverage, paid to the insurance company.

SCHIP- State Children's Health Insurance Program

established in 1997 to provide health care to uninsured children of working families who earn too little to afford private insurance but too much to be eligible for medicaid.

Five main components of HIPAA

Health care access, portability, and renewability; Preventing health care fraud and abuse, administrative simplification and medical liability reform, Tax-related health provisions; application and enforcement of group health plan requirements; and revenu