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U.S. Health Care Systems Questions
with Detailed Verified Answers
Access
Answer:
The ability of persons needing health services to obtain
appropriate care in a timely manner. Can you get medical
care when you need it? If yes, you have access to medical
care. Access is not the same as health insurance coverage,
although insurance coverage is a strong predictor of
access for primary care services.
Capitation
Answer:
A reimbursement mechanism under which the provider is
paid a set monthly fee per enrollee (sometimes referred to
as per member per month or PMPM rate), regardless of
whether or not an enrollee sees the provider and
regardless of how often an enrollee sees the provider.
Enrollee
Answer:
A person enrolled in a health plan, especially in a
managed care plan.
Integrated delivery system (IDS)
Answer:
A network of organizations that provides or arranges to
provide a coordinated continuum of services to a defined
population and is willing to be held clinically and
fiscally accountable for the outcomes and health status of
the population serviced.
Item-based pricing
Answer:
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Refers to the costs of ancillary services that often
accompany major procedures such as surgery. Package
pricing: Bundling of fees for an entire package of related
services.
Long-term care
Answer:
A variety of individualized, well-coordinated services
that are designed to promote the maximum possible
independence for people with functional limitations. These
services are provided over an extended period to meet the
patients' physical, mental, social, and spiritual needs,
while maximizing quality of life.
Managed care
Answer:
A system that integrates the functions of financing,
insurance, delivery, and payment and uses mechanisms to
control costs and utilization of services.
Market justice
Answer:
A distributional principle according to which health
care is most equitably distributed through the market
forces of supply and demand, rather than government
interventions. See social justice.
Medicaid
Answer:
A joint federal-state program of health insurance for
the poor.
Medicare
Answer:
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A federal program of health insurance for the elderly,
certain disabled individuals, and people with end-stage
renal disease.
Need
Answer:
The amount of medical care that medical experts believe
a person should have to remain or become healthy.
Social justic
Answer:
A distribution principle, according to which health care
is most equitably distributed by a government-run national
health care program. See market justice.
Socialized medicine
Answer:
Any large-scale government-sponsored expansion of health
insurance or intrusion in the private practice of
medicine.
Children's Health Insurance Program (CHIP)
Answer:
Provide low-income family with children with health
insurance coverage that covers access to health care
services.
TRICARE
Answer:
A program that is financed by the military. This
insurance plan permits the beneficiaries to receive care
from both private and military medical care facilities.
Veterans Integrated Service Networks (VISNs)
Answer:
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Responsible for coordinating the activities of the
hospitals, outpatient clinics, nursing homes, and other
facilities located within its jurisdiction.
Acute condition
Answer:
Relatively severe, episodic (of short duration), and
often treatable. It is subject to recovery, and treatment
is generally provided in a hospital.
Behavioral factors
Answer:
Individual lifestyles are also a key determinant of
health. For example, diet, exercise, a stress-free
lifestyle, risky or unhealthy behaviors, and other
individual choices have been found to play a major role in
most of the significant health problems of today.
Chronic condition
Answer:
Less severe but of long and continuous duration. The
patient may not fully recover. The disease may be kept
under control through appropriate medical treatment, but
if left untreated, the condition may lead to severe and
life-threatening health problems. Examples include asthma,
diabetes, and hypertension.
Demand-side rationing
Answer:
Prices and ability to pay ration the quantity and type
of health care services people consume.
Determinants of health
Answer:
U.S. Health Care Systems Questions
with Detailed Verified Answers
Access
Answer:
The ability of persons needing health services to obtain
appropriate care in a timely manner. Can you get medical
care when you need it? If yes, you have access to medical
care. Access is not the same as health insurance coverage,
although insurance coverage is a strong predictor of
access for primary care services.
Capitation
Answer:
A reimbursement mechanism under which the provider is
paid a set monthly fee per enrollee (sometimes referred to
as per member per month or PMPM rate), regardless of
whether or not an enrollee sees the provider and
regardless of how often an enrollee sees the provider.
Enrollee
Answer:
A person enrolled in a health plan, especially in a
managed care plan.
Integrated delivery system (IDS)
Answer:
A network of organizations that provides or arranges to
provide a coordinated continuum of services to a defined
population and is willing to be held clinically and
fiscally accountable for the outcomes and health status of
the population serviced.
Item-based pricing
Answer:
, Page | 2 Click here for more: Scholarsnexus - Stuvia US
Refers to the costs of ancillary services that often
accompany major procedures such as surgery. Package
pricing: Bundling of fees for an entire package of related
services.
Long-term care
Answer:
A variety of individualized, well-coordinated services
that are designed to promote the maximum possible
independence for people with functional limitations. These
services are provided over an extended period to meet the
patients' physical, mental, social, and spiritual needs,
while maximizing quality of life.
Managed care
Answer:
A system that integrates the functions of financing,
insurance, delivery, and payment and uses mechanisms to
control costs and utilization of services.
Market justice
Answer:
A distributional principle according to which health
care is most equitably distributed through the market
forces of supply and demand, rather than government
interventions. See social justice.
Medicaid
Answer:
A joint federal-state program of health insurance for
the poor.
Medicare
Answer:
, Page | 3 Click here for more: Scholarsnexus - Stuvia US
A federal program of health insurance for the elderly,
certain disabled individuals, and people with end-stage
renal disease.
Need
Answer:
The amount of medical care that medical experts believe
a person should have to remain or become healthy.
Social justic
Answer:
A distribution principle, according to which health care
is most equitably distributed by a government-run national
health care program. See market justice.
Socialized medicine
Answer:
Any large-scale government-sponsored expansion of health
insurance or intrusion in the private practice of
medicine.
Children's Health Insurance Program (CHIP)
Answer:
Provide low-income family with children with health
insurance coverage that covers access to health care
services.
TRICARE
Answer:
A program that is financed by the military. This
insurance plan permits the beneficiaries to receive care
from both private and military medical care facilities.
Veterans Integrated Service Networks (VISNs)
Answer:
, Page | 4 Click here for more: Scholarsnexus - Stuvia US
Responsible for coordinating the activities of the
hospitals, outpatient clinics, nursing homes, and other
facilities located within its jurisdiction.
Acute condition
Answer:
Relatively severe, episodic (of short duration), and
often treatable. It is subject to recovery, and treatment
is generally provided in a hospital.
Behavioral factors
Answer:
Individual lifestyles are also a key determinant of
health. For example, diet, exercise, a stress-free
lifestyle, risky or unhealthy behaviors, and other
individual choices have been found to play a major role in
most of the significant health problems of today.
Chronic condition
Answer:
Less severe but of long and continuous duration. The
patient may not fully recover. The disease may be kept
under control through appropriate medical treatment, but
if left untreated, the condition may lead to severe and
life-threatening health problems. Examples include asthma,
diabetes, and hypertension.
Demand-side rationing
Answer:
Prices and ability to pay ration the quantity and type
of health care services people consume.
Determinants of health
Answer:
