Health Care Systems
Integrated Health Care System
What is proving primary and secondary care across various health care settings throughout the patient's lifespan?
Medicare VS Medicaid
Medicare is for people over 65 or people with disabilities/chronic and critical health conditions and Medicaid is for eligible low income, medically/physically disabled clients?
Authorization for services
Special services may require preauthorization by insurance company. The review board monitors client services and ensures they are "medically necessary."
Team Nursing
Most common nursing system. A team provides total client care to a group of clients, they are generally grouped by diagnosis or PCP.
Managed Care Systems
What is encouraging wellness, collaborating as they provide care on contact to the resolution or conclusion of the issue?
Private Insurance VS Group Insurance
What is private insurance is a contract people buy themselves and group insurance is a contract offered at a discount to a group?
Cost Control
Managed care pays physicians a set fee to care for a group of clients and limits services the doctor can offer.
Modular Nursing
Similar to team nursing, a team of nurses are assigned to a limited area or specialty. The team leader is an RN who spends time in indirect patient care, LPN provides direct client care.
Health Care System
What is encompassing a complete network of health care providers, facilities, and agencies that serve clients and families within community?
Gov. Sponsored Health Programs
What is Health Department, Social Security Admin, Veterans Affairs, and Indian Health Services?
Service
Managed care establishes criteria that establishes which needs will/will not be covered by insurance.
Functional (task) nursing
The needs of a group of clients are broken down into tasks. The tasks are assigned to the RNs, LPNs, and AUAs.
For-Profit Organization
Self Payment
What is clients paying for their own care with their own resources?
Client Care
You may be required to care for larger numbers of clients in a specific time frame.
Practice Partners
When an RN and an assistant (LPN or AUA) agree to work together with the same schedule and same group of clients.
Non- Profit Organization
What is profits from providing health care services that are re-invested or donated to another non profit org.
Uninsured
What is uninsured people must be treated, they are expected to pay for the services given, most times they can't pay and the hospital must absorb the expenses?
Critical Thinking
With managed nursing, you must evaluate the care you provide continuously. You must create problem solving within your scope of practice so the client's needs are met.