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Glossary of Kozier 6: Health Care Delivery Systems

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Case management
a method for delivering nursing care in which the nurse is responsible for a case load of clients across the health care continuum
Coinsurance
an insurance plan where the client pays a percentage of the payment and some other group (eg, employer, government) pays the additional percentage
Critical pathways
multidisciplinary guidelines for client care based on specific medical diagnoses designed to achieve predetermined outcomes
Diagnosis-related groups (DRGs)
a Medicare payments system to hospitals and physicians which establishes fees according to diagnosis
Health care system
the totality of services offered by all health disciplines
Health maintenance organization (HMO)
a group health care agency that provides basic and supplemental health maintenance and treatment services to voluntary enrollees
Independent practice associations (IPAs)
provide care in offices, clients pay a fixed prospective payment and IPA pays the provider. Earnings or losses are assumed by the IPA
Integrated delivery system (IDS)
a system that incorporates acute care services, home health care, extended and skilled care facilities, and outpatient services
Licensed vocational (practical) nurse (LVN/LPN)
a nurse who practices under the supervision of a registered nurse, providing basic direct technical care to clients
Managed care
a method of organizing care delivery that emphasizes communication and coordination of care among all health care team members

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