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Health Care Management - Key Terms Ch 1, 2, 3


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Managed Care
Managed Care is a mechanism of providing health care services in which a single organization takes on the management of financing, insurance, delivery, and payment.
Health Maintenance Organization
Preferred Provider Organization
(Member) Refers to the individual covered under the plan
Military health plan that offers 3 options: TRICARE Prime, Extra, and Standard
Item-based pricing
market justice
The principle of market justice places the responsibility for the fair distribution of health care on the market forces in a free economy.
social justice
Social justice emphasizes the well-being of the community over that of the individual; thus the inability to obtain medical services because of a lack of financial resources would be considered unjust.
Consists of a set of interrelated and interdependent components designed to achieve some common goals.
system structure
Helps one understand that the structure of health care services in the US is based on foundations, provide logical arrangement, and demonstrate a progression from inputs to outputs.
system processes
Hospitals, clinics, and nursing homes associated with distinct health conditions.
system outcomes
Refer to the critical issues and concerns surrounding what the health services system has been able to accomplish, or not accomplish, in relation to its primary objective.
system outlooks
Projections in the future of accomplishment of desired system outcomes
medical model
The medical model presupposes the existence of illness or disease. It therefore emphasizes clinical diagnosis and medical intervention in the treatment of disease or its symptoms.
health care delivery
The delivery of medical care or illness care
World Health Organization
The optimum capacity of an individual to perform his or her expected social roles and tasks, such as work, school, and doing household chores.
holistic medicine
Seeks to treat the individual as a whole person
holistic health
Incorporates the spiritual dimension as a fourth element in addition to the physical, mental, and social aspects necessary for optimal health.
acute conditions
Relatively severe, episodic (of short duration), and often treatable. ex: heart attack
subacute conditions
postacute, requiring further treatment after a brief stay in the hospital. ex: head trauma care
chronic conditions
Less severe but of long and continuous duration. ex: asthma, diabetes, and hypertension
quality of life
the overall satisfaction with life during and following a person's encounter with the health care delivery system.
planned rationing
Existed in almost all cities of moderate size and run by the local government. It was a place where the destitute and disruptive elements of society were confined.
John Hopkins
University that took the lead in further reforming medical education when it opened its school.
Flexner Report
Based on an inspection of medical schools.
American Medical Association
Blue Cross plans
A hospital insurance plan designed for teachers at Baylor Univ.
Medicare Part A
Designed to use Social Security funds to finance hospital insurance and short-term nursing home coverage after discharge from a hospital
Medicare Part B
Designed to cover physicians' bills through government-subsidized insurance in which the elderly would pay part of the premiums
Intended to cover the eligible poor, would be financed through federal matching funds to the states based on financial needs determined by each state's per capita income.
Blue Shield plans
Plan designed to pay physician fees.

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