Chapter 3

prototypical managed care structure that encompasses 2 possibilities:

1. a health plan in which providers assume some of the financial risk

2. a health plan that uses primary care providers as gatekeepers

system that seeks to manage the cost of health care, the quality of that health care, and access to care.

based on the belief that helath care costs can be controlled by "managing" the way in which health care is delivered

Title XIX Social Security Amendment

combined federal and state program providing access to care for the poor and medically needy of all ages

private health plans that receive payments from medicare

because of the funding formula, those in Medicare Advantage plans often have extra benefits when compared to the traditional Medicare population

organizations that give an individual access to professional nursing services

the key components oinclude a nurse as chief manager, nursing staff who are accountable and responsible for care and professional practice, and nurses as the primary providers of care

health care plan in which members decide how to receive services at the time of service

combines HMO and indemnity features

As with HMOs, providers are paid through a capitation or risk-based system and, as with preferred provider organizations, individuals can choose a non-plan provider by paying extra

art or science concerned with guiding or influencing governmental policy.

the use of power to promote a change.

the political process determines the decision makers who negotiate a desired outcome

network of providers who agree to deliver services for a discounted fee.

the provider generally incurs no financial risk; the financial burden is on the client rather than the provider

basic health care that emphasizes general health needs rather than specialized care.

involves continual and comprehensive care that includes efforts to keep people as healthy as possible and to prevent disease.

ideally it's delivered in settings close to where people live and work

health care privders ho provide care in the managed care arena.

they can be physicians or midlevel practitioners (physician's assistants, nurse practitioners, or nurse midwives) who provide basic health care services