D391 Exam 1 Questions With Correct Answers!!
healthcare ecosystem
a system composed of elements that create a community
healthcare system
an organization of individuals, institutions, and resources that deliver services to clients
stakeholders
a group of people with a common interest, especially in a business
provider
a person or institution that performs a service; for example, a healthcare worker performs health
services.
healthcare producers
diverse individuals with various skills and knowledge who provide services to patients
product
multiple client services and treatment in the healthcare system
licensure
education and qualifications for healthcare providers
payers
individuals or organizations who cover the costs of healthcare services, either through self-pay or
insurance companies
purchasers
an individual or organization that purchases healthcare coverage on behalf of their employees
investors
individuals or organizations who invest in healthcare services
, National Committee for Quality Assurance (NCQA)
monitors payer organizations
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
helps improve and monitor providers' quality of care
U.S. Department of Health and Human Services
government organization that protects consumers from harm
government regulations
helps reduce harm to healthcare patients and employees
health insurance
payment for health services
fee-for-service
providers receive payment for services performed
health maintenance organizations
a model in which providers are paid capitation payments, restricting patients to a preferred list of
providers and controlling access to care
insurance risk
an event covered by insurance; the risk of payment is borne by the insurer, so insurance
companies work hard to manage risk for both individuals and groups
insurance expenses
payments such as deductibles, premiums, and co-pays
moral hazards
situation in which individual incurs no consequence for a decision, allowing for extravagant
choices such as using more medical services than are necessary
healthcare ecosystem
a system composed of elements that create a community
healthcare system
an organization of individuals, institutions, and resources that deliver services to clients
stakeholders
a group of people with a common interest, especially in a business
provider
a person or institution that performs a service; for example, a healthcare worker performs health
services.
healthcare producers
diverse individuals with various skills and knowledge who provide services to patients
product
multiple client services and treatment in the healthcare system
licensure
education and qualifications for healthcare providers
payers
individuals or organizations who cover the costs of healthcare services, either through self-pay or
insurance companies
purchasers
an individual or organization that purchases healthcare coverage on behalf of their employees
investors
individuals or organizations who invest in healthcare services
, National Committee for Quality Assurance (NCQA)
monitors payer organizations
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
helps improve and monitor providers' quality of care
U.S. Department of Health and Human Services
government organization that protects consumers from harm
government regulations
helps reduce harm to healthcare patients and employees
health insurance
payment for health services
fee-for-service
providers receive payment for services performed
health maintenance organizations
a model in which providers are paid capitation payments, restricting patients to a preferred list of
providers and controlling access to care
insurance risk
an event covered by insurance; the risk of payment is borne by the insurer, so insurance
companies work hard to manage risk for both individuals and groups
insurance expenses
payments such as deductibles, premiums, and co-pays
moral hazards
situation in which individual incurs no consequence for a decision, allowing for extravagant
choices such as using more medical services than are necessary
