Health Care System Overview
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Questions and Answers

What is a health care system?

A group of people, agencies, and/or institutions that provide health care services to individuals in a variety of settings.

Who are health care professionals?

Properly trained and licensed or certified providers of health care.

What is the purpose of the health care system?

To improve the health for populations seeking care.

What is a copayment?

<p>The predetermined amount defined by the insurance plan that must be paid each time a health service is accessed.</p> Signup and view all the answers

What is a deductible?

<p>The amount that a person must pay out of his or her own pocket before an insurer will pay any expenses.</p> Signup and view all the answers

What is coinsurance?

<p>The splitting of the cost of health services between an individual and their insurance carrier.</p> Signup and view all the answers

What are diagnosis-related groups (DRGs)?

<p>A statistical system of classifying any inpatient stay into groups for the purposes of payment.</p> Signup and view all the answers

What is the principal diagnosis?

<p>The primary condition that led to the patient being admitted to the hospital.</p> Signup and view all the answers

What are secondary diagnoses?

<p>Complications that may affect the patient's course of treatment or prolong the length of the patient's hospital stay.</p> Signup and view all the answers

What part of the Medicare plan will you need to fill a prescription?

<p>Part D.</p> Signup and view all the answers

Which of the following can be covered by Medicare Part B?

<p>Durable medical equipment (DME).</p> Signup and view all the answers

Medicare Part C, also known as the Medicare Advantage Plan, is run by the government.

<p>False</p> Signup and view all the answers

What is Medicaid?

<p>The largest source of funding for health insurance for low-income families in the United States.</p> Signup and view all the answers

How do individuals qualify for Medicaid?

<p>An individual or a family must earn a salary that's below the poverty level.</p> Signup and view all the answers

What does CHIP stand for?

<p>Children's Health Insurance Program.</p> Signup and view all the answers

At what level is Medicaid managed?

<p>State.</p> Signup and view all the answers

What is TRICARE?

<p>A type of health insurance dedicated to honoring those who have served, or are currently serving, in the military.</p> Signup and view all the answers

Who manages and regulates TRICARE?

<p>Managed and regulated by the Department of Defense.</p> Signup and view all the answers

Does TRICARE cover the families of those who have served, or who are currently serving, in the military?

<p>False</p> Signup and view all the answers

Is TRICARE health insurance for anyone who's a U.S. citizen?

<p>False</p> Signup and view all the answers

Define a preferred provider organization (PPO).

<p>An agreement between entities such as hospitals, doctors, surgery centers, and insurance agencies to provide health care at a reduced amount.</p> Signup and view all the answers

Define health maintenance organization (HMO).

<p>One form of private insurance that provides or arranges managed care for health insurances.</p> Signup and view all the answers

What are the two types of private health insurance?

<p>Health maintenance organizations (HMOs) and preferred provider organizations (PPOs).</p> Signup and view all the answers

What are government health care plans?

<p>Medicare, Medicaid, TRICARE, and CHIP.</p> Signup and view all the answers

How many different parts does Medicare have?

<ol start="4"> <li></li> </ol> Signup and view all the answers

What is a diagnosis-related group?

<p>A system for classifying patients with similar needs for the purpose of determining payment.</p> Signup and view all the answers

Which program is funded by both federal and state governments and serves low-income families?

<p>Medicaid.</p> Signup and view all the answers

What is The Affordable Care Act (ACA)?

<p>Legislation that expands Medicaid coverage to include millions of low-income Americans and makes numerous improvements to both Medicaid and CHIP.</p> Signup and view all the answers

What does the Preexisting Condition Insurance Plan (PCIP) allow?

<p>Allows people with preexisting conditions, such as cancer, to qualify for health insurance.</p> Signup and view all the answers

Study Notes

Health Care System Overview

  • A health care system consists of people, agencies, and institutions that deliver health care services in various settings.
  • Health care professionals are licensed or certified providers trained to deliver health care effectively.

Purpose and Financial Terms

  • The main purpose of the health care system is to enhance the health of populations who seek care.
  • Copayment refers to a fixed amount dictated by an insurance plan that individuals must pay for each health service.
  • A deductible is the total amount a person must pay out of pocket before their insurance pays for any expenses.
  • Coinsurance involves sharing the costs of health services between an individual and their insurance provider.

Diagnosis and Medicare

  • Diagnosis-related groups (DRGs) classify inpatient stays into groups for payment purposes.
  • Principal diagnosis indicates the main condition requiring a patient's hospital admission, while secondary diagnoses are complications that may affect treatment or length of stay.
  • Medicare Part D is necessary for filling prescriptions, while Medicare Part B covers durable medical equipment (DME).

Medicaid and Children's Health

  • Medicaid is the largest federal and state-funded health insurance source for low-income families in the U.S.
  • To qualify for Medicaid, individuals or families must earn below the poverty level, as defined by the Department of Health and Human Services.
  • CHIP stands for Children's Health Insurance Program, focusing on providing health insurance for children.

Military Health Care

  • TRICARE offers health insurance for military service members and their families, managed by the Department of Defense.
  • TRICARE is exclusive to U.S. military personnel and does not cover all U.S. citizens.

Private Health Insurance

  • A preferred provider organization (PPO) allows for reduced health care costs through agreements between various healthcare entities.
  • A health maintenance organization (HMO) arranges managed care for its members and acts as a liaison with providers, operating on a prepaid basis.
  • Two primary forms of private health insurance are HMOs and PPOs.

Government Health Care Plans

  • Government health care plans include Medicare, Medicaid, TRICARE, and CHIP.
  • Medicare consists of four distinct parts that provide various services and coverage options.

Legislation and Health Coverage

  • The Affordable Care Act (ACA) broadened Medicaid coverage and improved services for low-income Americans.
  • The Preexisting Condition Insurance Plan (PCIP) allows individuals with preexisting health conditions to obtain health insurance coverage.

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Description

This quiz explores key concepts in the health care system, including the roles of professionals, financial terms like copayment and deductible, and diagnosis classification under Medicare. Test your knowledge about how health care services are delivered and funded.

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