Health Promotion: Chapter 3

Political/Economic Influences on Health

- Policy: determine desired outcomes - Economics: how and to whom resources distributed - Governmental Programs: Social Security Act, Medicare, Medicaid

Scientific Health Influences

- Public health change from sanitation to biological control of communicable disease (1800s) - Antibiotics decreased infectious disease; more chronic disease with aging (mid 20th century) - New emphasis on infectious disease due to antibiotic-resistant organisms; bioterrorism (MRSA, VRE)

US Health Trends

- Successes in infection, other diseases - Concerns: sedentary lifestyle, obesity, chronic illness - Health disparities persistent - Vulnerable populations due to age, education, language, location - Work environment changes identified for a safer US health care system

Health Influences of Special Populations

- Vulnerable populations/greatest risk: Minorities - lower quality care, even when insured - Health: related to SES, education, lifestyle

Medicare

A federal health insurance program that finances medical care for people over 65, disabled individuals who are entitled to Social Security benefits, and people with end-stage renal disease requiring dialysis or a kidney transplant

Accountable Care Organizations/ACO

A health care organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

High-deductible Health Insurance Plans/HDHPs

A health insurance plan with lower premiums and higher deductibles than a traditional health plan

Preferred Provider Organizations/PPO

A managed care plan n the private sector that has a preselected list of providers who have agreed to provide health services for those individuals enrolled in the plan. They agree to deliver services for a fee-for-service discounted rate.

Gatekeeper

A physician or APN who provides primary care and who makes referrals for emergency services or specialty care

Hospitalist

A physician whose professional focus is caring for the hospitalized individual

Health Insurance Exchanges

A set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies

Managed Care

A system that seeks to manage the cost of health care, the quality of that health care, and access to care. It is based on the belief that health care costs can be controlled by "managing" the way in which health care is delivered

Concierge Care

A type of primary care medical practice in which physicians charge individual clients a membership fee in return for enhanced health care services or amenities.

Health Maintenance Organizations/HMO

Deliver comprehensive health maintenance and treatment services to a group of enrolled individuals who prepay a fixed fee. It accepts responsibility for the organization, financing, and delivery of health care services for all enrolled members.

Primary Care Provider/PCP

Health care providers who provide care in the managed care arena. They can be physicians or midlevel practitioners (physicians' assistants, nurse practitioners, or nurse midwives) who provide basic health care services

Health Savings Accounts/HSA

Health care reimbursement accounts established for the employee

Indemnity Insurance Plan

How things were done before 1990s. A person would choose a physician or care provider and receive care, and the provider would bill the individual's insurance company or be paid on a fee-for-service basis.

Fee-for-Service

Individual health care payment arrangement in which the person pays for each visit

Insurance

Individual payment to a fund to provide protection for each contributor against financial losses resulting from an unlikely, but possible, occurrence

Point-of-Service/POS

Members (for additional fee) can use providers outside the individual's HMO network. Was created in response to concern with restrictions of consumer choice in selecting providers and services.

Nursing Centers

Nurse managed health centers, often situated in medically undeserved rural and urban areas.

Advanced Practice Nurses/APN

Nurses with advanced education beyond the baccalaureate degree who are prepared to manage and deliver health care services to individuals, families, groups, communities, and populations; includes clinical nurse specialists, nurse practitioners, nurse midwives, nurse anesthetists, and others

Independent Practice Associations/IPA

Organizations composed of independent physicians in solo or group practices who provide health care services to members of an HMO in their private offices, eliminating the expense of the staff model HMO, which furnished and owned the facility in which care was provided

Capitation Rate

Rate paid to a physician or group of physicians that is a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care

Affordable Care Act/ACA

The comprehensive health care reform law enacted in March 2010. It requires change in the financing of the health care system. It addresses the issues of affordability, accessibility and the financing of health care, with focused efforts on meeting the needs of vulnerable populations.

Medicaid

Title XIX Social Security Amendment (1965), a combined federal and state program. The program provides access to care for the poor and medically needy of all ages