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an approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both. The term typically refers to HMOs and PPOs. This process aims to prevent unnecessary treatment by requiring enrollees to obtain approval for nonemergency hospital care and denying payment for wasteful treatment.
managed care
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a prepaid plan that both finances and delivers health care. Enrollees do not file claims. Checkups and other forms of preventative care typically are covered. Enrollees generally must use the plan's providers or face financial penalties. In this process, providers are paid a fixed sum, eliminating the financial incentive to overtreat.
Health Maintenance Organization (HMO)
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a group of providers, usually hospitals and doctors, who agree to provide health care to subscribers for a negotiated fee, which is usually discounted. In this process, the provider is subject to peer review and strict use controls in exchange for a consistent volume of patients and speedy turnaround on claim payments.
Preferred Provider Organization (PPO)
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a health insurance program for (1) people who are 65 years of age or over and eligible for Social Security benefits; (2) qualified railroad retirement beneficiaries; (3) people eligible for Social Security disability; (4) certain workers with end-stage renal disease; and (5) merchant seamen.
Medicare
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A federally aided, state administered program that provides medical benefits for certain low-income persons in need of health and medical care.
Medicaid
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A cost-sharing requirement that provides that the insured will assume a portion of the costs of covered services.
Coinsurance
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A payment system under which hospitals are paid a fixed sum per case according to a schedule of diagnosis-related groups.
Prospective payment system
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A method of classifying patients' illnesses according to principal diagnosis and treatment requirements for the purpose of establishing payment rates. Under Medicare each DRG has its own payment rate, which a hospital is paid regardless of the actual cost of treatment. The rate is payment in full, nonnegotiable, and not subject to appeal.
Diagnosis-related groups
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The amount of loss or expense that must be incurred by a person who is insured before an insurer will assume any liability for all or part of the remaining cost of covered services. Deductibles may be fixed dollar amounts or the value of specified services (eg. two days of hospital care or one visit to a physician).
deductible
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Insurance that covers medical expenses not covered by separate health insurance held by the insured.
Supplemental health insurance
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The portion of the charge that the patient must pay.
co-payment
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An employer that pays medical costs directly rather than through an insurance company.
self-insured employer
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a much criticized aspect of the existing health care system in which hospitals and other providers bill indemnity insurers higher rates to recover the costs of charity care and to make up for discounts given to HMOs, PPOs, Medicare, and Medicaid.
Cost-shifting
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Payment made by a third part (eg. government or private commercial insurance).
reimbursment
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The condition that is chiefly responsible for the patient's need for health care services. This process determines the payment the hospital receives for Medicare.
Principal diagnosis
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Procedures to be used by doctors, hospitals, and other health professionals for treating various conditions to ensure the most effective care.
practice guidelines
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Detailed procedures for care that are specified to the disease or condition and type of patient.
protocol
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An end result of the health care process; a measurable change in the patient's state of health or functioning.
Outcome
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An approach to evaluation that takes into account both costs and outcomes of intervention for a specific purpose. The analysis is especially useful for comparing alternative methods of intervention.
cost-effectiveness analysis
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professionals manipulate the spine and other joints through which the nervous system passes to enable the body to heal from within.
chiropractic medicine
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goal of these professionals is to establish balance among the dosha so pathogens are not the main object of treatment but the person's overall integration and resistance is the concern.
Ayurveda
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manipulation to improve blood flow for healing.
Massage therapy
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symptoms are seen as signals or trouble in the flow of Chi.
Chinese medicine
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Researchers have shown this herb to be superior to dimenhydrinate in reducing symptoms of motion sickness.
Ginger
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A form of medicine that uses return to nature in regulating breathing, exercise, bathing, and elimination of poisonous products in the system to raise vitality of the patient to a proper standard of health.
Naturopathic
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A nature based paradigm that views health as a function of a balanced harmonious flow of chi and illness results when there is a blockage or imbalance in the flow of chi.
chinese medicine
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contains lycopene which is one of natures most powerful antioxidants
tomatoes
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the mysterious mechanisms by which the power of suggestion can result in a physiological change
mind/body
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professionals use lengthy questionnaires for diagnosis and determine your regime (rasayana) of herbs, meditation, yoga, and breathing exercises.
Ayurveda
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healing is a matter of supporting the body's own healing mechanisms
naturopathic
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professionals who believe illness occurs becuase of disturbance in the nervous system caused by derangements of the musculoskeletal structure.
Osteopathic
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herb that promotes activity of lymphocytes, phagocytes, interferon and increases body's resistance to bacteria.
Echinacea
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a popular remedy for mild depression
St. John's Wort
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an herb that appears to enhance blood flow to brain with individuals who have multi-infarct dementia or Alzheimer's dementia to improve cognitive function.
Gingko
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It contains isoflavones that act as weak estrogens to reduce the risk for breast cancer and osteoporosis.
soy
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tea from this herb may be useful to control diarrhea
blackberry
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an herb that increases photosensitivities so consumers needed to be careful in sunlight.
St. John's Wort
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FDA has issued warnings for this herb because it is a CNS stimulant, it raises blood pressure, causes nervousness, headaches, insomnia, dizziness, vomiting and possibly death.
Ephedra
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Polyphenols in this herb may be useful to decrease risk of esophageal cancer.
Green tea
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an herb that acts as an immunostimulant if taken at onset of a cold but should not be used for more than 10 days
Echinacea
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an anti-inflammatory herb that can cause water retention if consumed in excess
Licorice
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an herb that has been used as a cough remedy because of its stimulating effect on secretions of the bronchial mucosa.
Horehound
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an herb being tested for symptoms of menopause.
black cohash
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a fairly common herb even though its benefits to humans have not been clearly identified
Ginsengs
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used for urinary tract infections
cranberry
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Access by all people at all times to enough food through normal channels for an active healthy lifestyle.
Food Security
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The inability to acquire or consume adequate quality of sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so.
Food Insecurity
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Widespread lack of access to food due to natural disasters, political factors, or war: characterized by a large number of deaths due to starvation and malnutrition.
Famine
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The state of having too little money to meet minimum needs for food, clothing, and shelter.
Poverty
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The dollar amounts below which a family would be viewed as living in poverty
Poverty Threshold
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_________________ is used in the poverty threshold calculations. It reflects a diet that is just barely adequate and is designed for short-term use when funds are extremely low.
Food budget
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____________________ are another version of the federal poverty measure. They are a simplified version of the poverty thresholds and are used for administrative purposes.
poverty guidelines
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Who are the hungry in the US?
- -Working poor
- -The young
- -Ethnic minorities
- -inner cities / rural
- -the new poor (framers)
- -the south
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What are the causes of hunger in the US?
- -alcohol intake
- -mental illness/depression
- -poor management
- -reluctance to accept charity
- -inability to prepare food
- -health problems
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How can we decrease food costs?
- -use of coupons
- -buying foods in season/on-sale
- -buy store brands
- -look at the unit prices
- -buy locally
- -use food expense diary
- -limit the time in the store
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What can an RD or nutrition major do to assist in resolving hunger issues?
- -volunteer
- -counseling
- -write a grant
- -be involved in the farm bill
- -canned fruit/vegetable food drive
- -documenting needs that exist
- -donate left overs
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______________________ administers the 14 US Department of Agriculture (USDA) food assistance programs (1) Goals are to provide needy people with access to a more nutritious diet. (2) To improve the eating habits of the nation's children. (3) To stabilize farm prices through the distribution of surplus foods.
FNS (Food and Nutrition Service)
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Government program that provides cash, commodities or services to all qualifying low income individuals or households. Eg. food stamps
Entitlement program
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_________________ serves as a food guide for a nutritious diet at a minimal cost-used as the basis for food stamp allotments and is maintained by the USDA's Center for Nutrition Policy and Promotion
Thrifty Food Plan (TFP)
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Nonprofit community organizations that collect surplus commodities from the government and edible but often unmarketable foods from private industry for use by nonprofit charities, institutions and feeding programs at nominal cost
Food Banks
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Small feeding operations attached to existing organizations such as churches, civic groups, or nonprofit agencies that serve prepared meals that are consumed onsite. They generally do not require clients to show identification.
Soup Kitchens
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A national network hunger-relief organization to which the majority of food banks belong
Second harvest
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Nonprofit programs that help to feed people in need by linking sources of unused, unserved cooked and fresh food-such as caterers, restaurants, hotel kitchens, and cafeterias-with social service agencies that serve meals to people who would otherwise go hungry.
Prepared and Perishable Food Programs
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The development and enhancement of sustainable, community-based strategies to ensure that all persons in a community always have access to culturally acceptable, nutritionally adequate food through local nonemergency sources
Community Food Security
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_____________________ such activities as salvaging perishable produce from grocery stores; rescuing surplus prepared food from restaurants and caterers; and collecting nonperishable food from manufacturers, supermarkets, or people's homes. The items recovered are donated to hungry people.
Food Recovery
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The harvesting of excess food from farms, orchards, and packing house to feed the hungry
Gleaning
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Process of policy making
- 1. problem definition or agenda setting
- 2. formulation of alternatives
- 3. policy adoption
- 4. policy implementation
- 5. policy evaluation
- 6. Policy termination
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School breakfast program
nutritious breakfast for students eligibility same as national school lunch program
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special milk program
all students attending school are provided with milk
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summer food service program for children
same as the national school food lunch, but in the summer time. ex. summer camps, homeless, participating in national school sports program, summer school
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food distribution program
improves the diets of school aged children and increases the market for domestically produced foods. (take excess food from grocery stores and sell at a reduced price).
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SNAP
supplemental nutrition assistance program, to improve diet of low income households by increasing their ability to purchase foods.
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Emergency food assistance program
takes commodity crops and makes them available to those in need, unemployed, low income and welfare
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commodity supplemental food program
improves the health of kids under 6 and older adults through donations of food
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Child and adult care food program
assists states in their non-profit food service programs
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healthy eating index
a summary measure of the quality of a person's diet compared to the guidelines.
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current nutrition problems for children and adolescents
decreased consumption of fruit, vegetables and whole grains and increased consumption of sodium and calories from fats and added sugars.
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steps for developing a wellness program
- 1. review the community needs assessment
- 2. define the program goals and objectives
- 3. develop a program plan
- 4. develop a management plan
- 5. identify funding sources
- 6. implement the program
- 7. evaluate
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total diet study
all ages evaluation, chemical analysis of nutrients and contaminants in the US food supply
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YRBS
Youth Risk Behavior Survey, smoking, alcohol use, weight control, exercise and eating practices for individuals in grades 9-12
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Jan 2012 standards for healthy school meals
- increased availability of fruits, vegetables,fat-free and reduced fat milk and whole
- grains, requires reeducation in sodium and saturated fat, and focuses on
- calories control
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Eat smart. Play hard
- designed to convey motivational messages to children involved in food assistance
- programs age 2-18
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Farm-to-school
- provides awareness to children about where food comes from through connections of
- schools with local farmers to improve student health
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Fruits and Veggies-More Matters
make half your plate fruit and veggies, "there a rainbow on my plate"
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Best Bones Forever
campaign targeted towards girls 9-14 to promote bone growth and osteoporosis prevention focuses on calcium, vit. D, and physical activity
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Fuel up to play 60
launched in 2009 encourages consumption of nutrient rich foods and at least 60 minutes of physical activity per day
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kids café
Started in 1993, A program of Feeding America – the largest hunger relief charity in the US, Primary goal is to provide free prepared food and nutrition education to hungry children
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Older Americans Nutrition Program
congregate and home delivered meals (MOW)
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Adult day care food program
provides low income seniors with coupons for food
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very low food insecurity
food insecurity + hunger
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CHIP
children health insurance program, provides free or low cost health coverage for more than 7 million children up to age 19
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ICD
International classification of diseases, codes used by health care providers on billing forms to classify a disease or diagnosis.
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