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 anesthetistis, and others
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