Amounts charged to the patient as payer for medical services.
A listing of established professional service charges, for specified dental and medical procedures.
Amounts charged to the patient as payer for dental services.
Services for the diagnosis and treatment of disease and the maintenance of health.
The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.
Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.
Organized services to provide mental health care.
Health care programs or services designed to assist individuals in the planning of family size. Various methods of CONTRACEPTION can be used to control the number and timing of childbirths.
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.
Diagnostic, therapeutic and preventive health services provided for individuals in the community.
Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.
Organized services to provide health care for children.
Services designed for HEALTH PROMOTION and prevention of disease.
The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.
Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.
Organized services to provide health care to expectant and nursing mothers.
Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.
Health care services related to human REPRODUCTION and diseases of the reproductive system. Services are provided to both sexes and usually by physicians in the medical or the surgical specialties such as REPRODUCTIVE MEDICINE; ANDROLOGY; GYNECOLOGY; OBSTETRICS; and PERINATOLOGY.
Outside services provided to an institution under a formal financial agreement.
The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.
Coded listings of physician or other professional services using units that indicate the relative value of the various services they perform. They take into account time, skill, and overhead cost required for each service, but generally do not consider the relative cost-effectiveness. Appropriate conversion factors can be used to translate the abstract units of the relative value scales into dollar fees for each service based on work expended, practice costs, and training costs.
Diagnostic, therapeutic and preventive mental health services provided for individuals in the community.
A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
Services specifically designed, staffed, and equipped for the emergency care of patients.
Concept referring to the standardized fees for services rendered by health care providers, e.g., laboratories and physicians, and reimbursement for those services under Medicare Part B. It includes acceptance by the physician.
The concept concerned with all aspects of providing and distributing health services to a patient population.
Organized services for the purpose of providing diagnosis to promote and maintain health.
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Contracts between an insurer and a subscriber or a group of subscribers whereby a specified set of health benefits is provided in return for a periodic premium.
Services offered to the library user. They include reference and circulation.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
Organized services to provide health care to adolescents, ages ranging from 13 through 18 years.
Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)
Health services, public or private, in urban areas. The services include the promotion of health and the delivery of health care.
A general concept referring to the organization and administration of nursing activities.
A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
Processes or methods of reimbursement for services rendered or equipment.
Insurance providing benefits for the costs of care by a physician which can be comprehensive or limited to surgical expenses or for care provided only in the hospital. It is frequently called "regular medical expense" or "surgical expense".
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)
The organization and administration of health services dedicated to the delivery of health care.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
The seeking and acceptance by patients of health service.
Organized services to provide health care to women. It excludes maternal care services for which MATERNAL HEALTH SERVICES is available.
Health care provided to individuals.
Organized services to provide diagnosis, treatment, and prevention of genetic disorders.
Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.
The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)
The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.
A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.
Alternative health care delivery mechanisms, such as PREFERRED PROVIDER ORGANIZATIONS or other health insurance services or prepaid plans (other than HEALTH MAINTENANCE ORGANIZATIONS), that meet Medicare qualifications for a risk-sharing contract. (From Facts on File Dictionary of Health Care Management, 1988)
State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.
Components of a national health care system which administer specific services, e.g., national health insurance.
Federal, state, or local government organized methods of financial assistance.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.
Services designed to promote, maintain, or restore dental health.
Application of marketing principles and techniques to maximize the use of health care resources.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.
Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)
Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.
Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.
Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Health care provided to specific cultural or tribal peoples which incorporates local customs, beliefs, and taboos.
The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies.
The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.
Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.
Health services for employees, usually provided by the employer at the place of work.
Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.
Planning for needed health and/or welfare services and facilities.
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
The prices a hospital sets for its services. HOSPITAL COSTS (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care.
Devices which are very resistant to wear and may be used over a long period of time. They include items such as wheelchairs, hospital beds, artificial limbs, etc.
Total pharmaceutical services provided by qualified PHARMACISTS. In addition to the preparation and distribution of medical products, they may include consultative services provided to agencies and institutions which do not have a qualified pharmacist.
A health care system which combines physicians, hospitals, and other medical services with a health plan to provide the complete spectrum of medical care for its customers. In a fully integrated system, the three key elements - physicians, hospital, and health plan membership - are in balance in terms of matching medical resources with the needs of purchasers and patients. (Coddington et al., Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship, 1994, p7)
Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)
Social and economic factors that characterize the individual or group within the social structure.
Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.
Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
Process of shifting publicly controlled services and/or facilities to the private sector.
The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.
Management of public health organizations or agencies.
Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.
Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.
Descriptions and evaluations of specific health care organizations.
Individuals licensed to practice medicine.
Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice.
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
The area of a nation's economy that is tax-supported and under government control.
Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.
A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.
A vehicle equipped for transporting patients in need of emergency care.
Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.
An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.
A method of examining and setting levels of payments.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
Those facilities which administer health services to individuals who do not require hospitalization or institutionalization.
A loose confederation of computer communication networks around the world. The networks that make up the Internet are connected through several backbone networks. The Internet grew out of the US Government ARPAnet project and was designed to facilitate information exchange.
Countries in the process of change with economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures.
Pricing statements presented by more than one party for the purpose of securing a contract.
Any type of research that employs nonnumeric information to explore individual or group characteristics, producing findings not arrived at by statistical procedures or other quantitative means. (Qualitative Inquiry: A Dictionary of Terms Thousand Oaks, CA: Sage Publications, 1997)
Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.
A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.
Organized services to provide immediate psychiatric care to patients with acute psychological disturbances.
Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.
Amounts charged to the patient as payer for health care services.
Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.
Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.
An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.
Hospitals controlled by various types of government, i.e., city, county, district, state or federal.
The inhabitants of rural areas or of small towns classified as rural.
Computer-assisted mathematical calculations of beam angles, intensities of radiation, and duration of irradiation in radiotherapy.
A province of Canada lying between the provinces of Manitoba and Quebec. Its capital is Toronto. It takes its name from Lake Ontario which is said to represent the Iroquois oniatariio, beautiful lake. (From Webster's New Geographical Dictionary, 1988, p892 & Room, Brewer's Dictionary of Names, 1992, p391)
Cost-sharing mechanisms that provide for payment by the insured of some portion of covered expenses. Deductibles are the amounts paid by the insured under a health insurance contract before benefits become payable; coinsurance is the provision under which the insured pays part of the medical bill, usually according to a fixed percentage, when benefits become payable.
The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development).
Excessive, under or unnecessary utilization of health services by patients or physicians.
An occupation limited in scope to a subsection of a broader field.
A geographic area defined and served by a health program or institution.
A method of data collection and a QUALITATIVE RESEARCH tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions.
Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient.
Institutions which provide medical or health-related services.
Community or individual involvement in the decision-making process.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).
All organized methods of funding.
Activities concerned with governmental policies, functions, etc.
Those actions designed to carry out recommendations pertaining to health plans or programs.
Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.
Facilities which administer the delivery of health care services to people living in a community or neighborhood.
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
Planning for health resources at a regional or multi-state level.
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Health care provided on a continuing basis from the initial contact, following the patient through all phases of medical care.
The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.
The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.
Differences in access to or availability of medical facilities and services.
Men and women working in the provision of health services, whether as individual practitioners or employees of health institutions and programs, whether or not professionally trained, and whether or not subject to public regulation. (From A Discursive Dictionary of Health Care, 1976)
Customer satisfaction or dissatisfaction with a benefit or service received.
The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.
Costs which are directly identifiable with a particular service.
A republic in western Africa, north of NIGERIA and west of CHAD. Its capital is Niamey.
Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
Public attitudes toward health, disease, and the medical care system.
A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
The giving of advice and assistance to individuals with educational or personal problems.
The remuneration paid or benefits granted to an employee.
Persons including soldiers involved with the armed forces.
Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.
Elements of limited time intervals, contributing to particular results or situations.
Revenues or receipts accruing from business enterprise, labor, or invested capital.
A component of the PUBLIC HEALTH SERVICE that provides leadership related to the delivery of health services and the requirements for and distribution of health resources, including manpower training.
Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality.
Functions, equipment, and facilities concerned with the preparation and distribution of ready-to-eat food.
Programs and activities sponsored or administered by local, state, or national governments.
A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions.
An interactive process whereby members of a community are concerned for the equality and rights of all.
Total pharmaceutical services provided to the public through community pharmacies.
A division of the UNITED STATES PUBLIC HEALTH SERVICE that is responsible for the public health and the provision of medical services to NATIVE AMERICANS in the United States, primarily those residing on reservation lands.
Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services.
Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients.
Hospital department responsible for the receiving, storing, and distribution of pharmaceutical supplies.
The confinement of a patient in a hospital.
The interactions between representatives of institutions, agencies, or organizations.
The Balanced Budget Act (BBA) of 1997 establishes a Medicare+Choice program under part C of Title XVIII, Section 4001, of the Social Security Act. Under this program, an eligible individual may elect to receive Medicare benefits through enrollment in a Medicare+Choice plan. Beneficiaries may choose to use private pay options, establish medical savings accounts, use managed care plans, or join provider-sponsored plans.
Preventive health services provided for students. It excludes college or university students.
An infant during the first month after birth.
The interaction of two or more persons or organizations directed toward a common goal which is mutually beneficial. An act or instance of working or acting together for a common purpose or benefit, i.e., joint action. (From Random House Dictionary Unabridged, 2d ed)
The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine HOSPITAL CHARGES (the price the hospital sets for its services).
The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.
The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.
Introduction of changes which are new to the organization and are created by management.
Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.
Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.
Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.
Movable or portable facilities in which diagnostic and therapeutic services are provided to the community.
The interactions between members of a community and representatives of the institutions within that community.
Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level.
A geographic location which has insufficient health resources (manpower and/or facilities) to meet the medical needs of the resident population.
Insurance providing coverage for dental care.
The level of governmental organization and function below that of the national or country-wide government.
CONFORMAL RADIOTHERAPY that combines several intensity-modulated beams to provide improved dose homogeneity and highly conformal dose distributions.