Shared Flashcard Set

Details

the health care delivery system
chapter 2
23
Nursing
Undergraduate 4
09/22/2009

Additional Nursing Flashcards

 


 

Cards

Term
whos the biggest consumer of of health care and pays for medicare and medicaid?
Definition
the federal government
Term
explain utilization committees
Definition
they are medicare driven, they review admissions based on diagnostics and they identify and eliminate overuse of services
Term

what is the PPS (perspective payment system)?

 

Definition
it eliminates cost based reimbursement
Term
what falls under pps?
Definition
diagnostic groups and capitation where developed
Term
what is cpitation
Definition
a fixed amount per patient of health care plan. it was developed for specific surgeries treatments
Term
what is managed care?
Definition
administrative control over primary health care services for set population
Term
What are RUGs( research utilization groups)/
Definition
they use DRGs in rehabilitation/ long - term care settings
Term
Under the managed care system dos the health care system assume financial risk and do they provide care
Definition
yes
Term
what is the focus of a managed care organization
Definition
the health maintenance by primary physician
Term
What is medicare
Definition
 it is a federal program that takes a SS deduction for any one over 65.  There are 4 parts to medicare
Term
what is part a of the medicare plan?
Definition
it is basic protection (meical surgical and psychiatric costs based on DRG
Term
what is part b of medicare
Definition
it is voluntary medical insurance (physician and output services)
Term
What is part c of the medicare program?
Definition
it is a managed care choice with three service plans
Term
what is part d of the medicare plan?
Definition
it is a prescription drug plan
Term
who benefits from medicaid?
Definition
low income families, health assistance, low-income long term care patients. 
Term
what is a private insurance?
Definition
it is the traditional fee- for services
Term
what does long term care insurance come wiht?
Definition
skilled nursing, intermediate, custodial care and home care
Term
what is a preventive and primary prevention?
Definition
it is preventing illness along with education
Term
what is a primary prevention
Definition
staying healthy
Term
what does secondary and tetiary care focus on?
Definition
they focus on diagnosis and treatment of disease
Term
what are the settings for secondary and tertiary care?
Definition
hospitals, subacute care and rural hospitals
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