Beruflich Dokumente
Kultur Dokumente
NURS 412
Winter 2016
Section 1
1. Health Policy: The aggregate
principles, stated or unstated, that
characterize the distribution of
resources, services, and political
influences that impact the health of
the population.
2. Politics: How we make decisions
for the whole societydecisions
that we enforce with rules, laws,
and money.
3. Stakeholder: Actors (persons or
organizations) who have a vested
interest in the policy that is being
promoted. These interested
parties can usually be grouped
into the following categories:
international, public, national
political, commercial/private,
nongovernmental organization,
labor, users/consumers.
4. Policy Advocacy: Refers to
advocacy tactics, strategies and
initiatives which target changes to
policies and legislation. These
actions seek to establish new
policies, improve existing policies,
or challenge the development of
policies.
5. Lobby: A group of persons who
work together to influence
government decisions that relate to
a particular industry, issue, etc.
6. Policy Implications: Possible
consequences or repercussions of
policy.
7. Affordable Care Act: Provides
Americans with better health
security by putting in place
comprehensive health insurance
reforms that aim to expand
coverage, hold insurance
companies accountable, lower
health care costs, guarantee more
choice, and enhance the quality of
care for all Americans.
8. Health Care Delivery: How health
care services are delivered.
Section 2
10.
Medicaid: A health
insurance program for low-income
families and children, pregnant
women, the elderly, and people
with disabilities. Some states have
expanded this program to cover all
adults below certain income levels.
The federal government provides
part of the funding for this program
and sets guidelines for the
program, and states administer the
program. This programs benefits
vary somewhat between states and
may have a different name in
different states.
11.
Apple Health: Washington
States Medicaid Program
12.
Integration: A term used
by policymakers and administrators
in Washington State to refer to the
law that the state will fully
integrate the financing and
delivery of physical health services,
mental health services and
chemical dependency services in
the Medicaid program through
managed health care by 2020.
13.
Medicare: A Federal health
insurance program for people who
are age 65 or older and certain
younger people with disabilities. It
also covers people with End-Stage
Renal Disease.
Section 3
14.
Fee-for-Service: Health
care provider is paid for each
service rendered
15.
Episode of Illness: One
payment for all services delivered
during one illness/episode
16.
Per Diem Payments:
Payments for one patients services
delivered in a hospital setting in
one day
17.
Capitation Payments: One
payment for each patients care
during a set time interval.
18.
Global Budget: Payment for
all services delivered to all patients
within a set time interval.
19.
Bundled Payment: Bundled
payment is a single payment to
providers or health care facilities
(or jointly to both) for all services
to treat a given condition or
provide a given treatment.
20.
Managed Care: A strategy
that utilizes mixture of cost control
mechanisms: changing the
utilization management, price
discounts, and in some cases
supply controls.
21.
Health Maintenance
Organization (HMO): Works with
a network of providers. Must see
a provider who is contracted with
your insurance company. You will
pay the full cost for seeing a
provider outside the network. You
will need a referral from your
primary care provider to see a
specialist.
22.
Preferred Provider
Organization (PPO): Prefer you
see provider in network. If you
see a provider outside the network
you will pay more to see that
provider, but insurance will pay for
some of the cost. You may not need
a referral to see a specialist.
Section 4
23.
Triple Aim: Improve the
patient experience of care
(including quality and satisfaction);
improve the health of populations;
Section 5
30.
Premium: A monthly fee
which allows you to keep and use
the insurance.
31.
Out of Pocket Costs:
Copayments, coinsurance, and
anything you pay directly to your
provider.
32.
Deductible: A dollar amount
set by your insurance company
which you will need to pay before
your insurance company will share
your healthcare costs with you.
33.
Copay: A set amount you
pay for certain services when you
get them. Your insurance company
pays for the rest. The payment is
paid to your provider. Your
insurance company lets you know
what services require this payment
and when.
34.
Coinsurance: This is similar
to a copay. Instead of a set dollar
amount your insurance company
may have you pay a percent of the
cost of a medical service.
35.
Out-of-pocket maximum:
This is another dollar amount set
by your insurance company. Once
youve paid this set dollar amount
your insurance company will pay
for all of your medical services that
are provided by someone in their
network.
Section 6
36. Ecological Model: Emphasizes the
importance of the social and physical
environments that strongly shape
patterns of disease and injury as well as
our response to them over the entire life
cycle.