CHAPTERS 8 AND 9

UNIT V FLASHCARDS

capitation

A system in which doctors are paid a set annual fee for

each patient in their practice, regardless of how many times they see their

patients or what services the doctors provide for their

patients.

convergence hypothesis

The thesis that health care systems become increasingly similar over time because of

similar scientific, technological, economic, and epidemiological pressures.

defensive medicine

Tests and procedures that doctors perform primarily to protect themselves against

lawsuits rather than to protect their patients’ health.

diagnosis related groups (DRG’s)

System established by the federal government that sets, for all

Medicaid and Medicare patients and for each possible diagnosis, an

average length of hospital stay and cost of inpatient treatment. Under the DRG system, hospitals are paid the established cost for

each patient with a given diagnosis regardless of the actual

cost of treatment.

entrepreneurial system

A system based on capitalism and free

enterprise.

fee-for-service

insurance

Insurance that reimburses patients for all or part of the costs of the health care services they have

purchased.

health maintenance organizations

(HMOs)

Organizations that provide health care based on prepaid

group insurance. Patients pay a fixed yearly fee in

exchange for a full range of health care services,

including hospital care as well as doctor’s services.

primary care

Health care provided by physicians and others who

are trained to offer treatment and prevention services

when individuals first seek health care and, ideally, as part of an ongoing provider-

patient relationship.

pseudobulbar affect

Refers to uncontrollable laughing or crying unrelated

to individuals’ emotional state, and can be caused by

various disabling neurological conditions.

universal coverage

Health care systems that provide access to health

care for all legal residents of a nation.

utilization review

A system in which insurance companies require doctors to get approval before ordering

certain tests, performing surgery, hospitalizing a

patient, or keeping a patient hospitalized more than a given number of days.