Post on 11-Jan-2016
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CHAPTERS 8 AND 9
UNIT V FLASHCARDS
capitation
A system in which doctors are paid a set annual fee for
each patient in their practice, regardless of how many times they see their
patients or what services the doctors provide for their
patients.
convergence hypothesis
The thesis that health care systems become increasingly similar over time because of
similar scientific, technological, economic, and epidemiological pressures.
defensive medicine
Tests and procedures that doctors perform primarily to protect themselves against
lawsuits rather than to protect their patients’ health.
diagnosis related groups (DRG’s)
System established by the federal government that sets, for all
Medicaid and Medicare patients and for each possible diagnosis, an
average length of hospital stay and cost of inpatient treatment. Under the DRG system, hospitals are paid the established cost for
each patient with a given diagnosis regardless of the actual
cost of treatment.
entrepreneurial system
A system based on capitalism and free
enterprise.
fee-for-service
insurance
Insurance that reimburses patients for all or part of the costs of the health care services they have
purchased.
health maintenance organizations
(HMOs)
Organizations that provide health care based on prepaid
group insurance. Patients pay a fixed yearly fee in
exchange for a full range of health care services,
including hospital care as well as doctor’s services.
primary care
Health care provided by physicians and others who
are trained to offer treatment and prevention services
when individuals first seek health care and, ideally, as part of an ongoing provider-
patient relationship.
pseudobulbar affect
Refers to uncontrollable laughing or crying unrelated
to individuals’ emotional state, and can be caused by
various disabling neurological conditions.
universal coverage
Health care systems that provide access to health
care for all legal residents of a nation.
utilization review
A system in which insurance companies require doctors to get approval before ordering
certain tests, performing surgery, hospitalizing a
patient, or keeping a patient hospitalized more than a given number of days.