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What is managed care? a system of healthcare in which patients agree to visit only certain
doctors and hospitals, and in which the cost of treatment is monitored by a managing company
What is case management? A systematic process used by nurses to ensure client health
and service needs are met
Why are clinical pathways used? To decrease cost (save money)
Name some healthcare settings hospitals, extended care facilities (nursing homes),
ambulatory care centers, home health care agencies, community or public health
centers(schools), independent living facilities
Describe Medicaid government based healthcare for individuals with low income and
children, state run, based on need
Describe Medicare for individuals over 65, receiving SS disability for 2 yrs,
, Part A hospital care, home care, hospice,
Part B healthcare provider services, out patient care, home health, diagnostic services, DME,
ambulance, mental health
Part C combination of A and B
Part D Rx
What is HMO? lower premiums and restricted network of doctors and hospitals
What is PPO? provide medical services at preset, usually lower fees, in return for a large
number of referrals
What is POS? same as HMO, but you can see out-of-network physicians
What is morbidity? the burden or degree of illness associated with a given disease
What is mortality? death rate