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.
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.
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.
The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.
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 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.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
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.
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)
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.
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.
Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.
Processes or methods of reimbursement for services rendered or equipment.
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.
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)
Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice.
Pricing statements presented by more than one party for the purpose of securing a contract.
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".
A republic in western Africa, north of NIGERIA and west of CHAD. Its capital is Niamey.
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.
A specific type of health insurance which provides surgeons' fees for specified amounts according to the type of surgery listed in the policy.
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.
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.
A course of action or principle adopted or proposed by a government, party, business, or individual that concerns human interactions with nature and natural resources.
Process of shifting publicly controlled services and/or facilities to the private sector.
Descriptive terms and identifying codes for reporting medical services and procedures performed by PHYSICIANS. It is produced by the AMERICAN MEDICAL ASSOCIATION and used in insurance claim reporting for MEDICARE; MEDICAID; and private health insurance programs (From CPT 2002).
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)
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.
A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.
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.
Federal, state, or local government organized methods of financial assistance.
Insurance against loss resulting from liability for injury or damage to the persons or property of others.
Individuals licensed to practice medicine.
Health care provided to individuals.
Payment for a service or for a commodity such as a body part.
A republic in western Africa, south and east of MALI and west of NIGER. Its capital is Ouagadougou. It was formerly called Upper Volta until 1984.
Accounting procedures for determining credit status and methods of obtaining payment.
A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions.
Descriptions and evaluations of specific health care organizations.
The remuneration paid or benefits granted to an employee.
Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.
A republic in eastern Africa bounded on the north by RWANDA and on the south by TANZANIA. Its capital is Bujumbura.
Facilities where dental care is provided to patients.
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)
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
Programs designed by management to motivate employees to work more efficiently with increased productivity, and greater employee satisfaction.
The system of all phenomena in space and time; the totality of physical reality. It is both a scientific and philosophic concept appearing in all historic eras. (Webster 2d; Dr. James H. Cassedy, NLM History of Medicine Division)
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.
The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.
Various branches of dental practice limited to specialized areas.
Reproduction of data in a new location or other destination, leaving the source data unchanged, although the physical form of the result may differ from that of the source.
Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.
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.
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)
An interactive process whereby members of a community are concerned for the equality and rights of all.
Components of a national health care system which administer specific services, e.g., national health insurance.
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).
Persons whose profession is to give legal advice and assistance to clients and represent them in legal matters. (American Heritage Dictionary, 3d ed)
Revenues or receipts accruing from business enterprise, labor, or invested capital.
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.
An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs. (From Slee and Slee, Health Care Reform Terms, 1993, p106)
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.
Outside services provided to an institution under a formal financial agreement.
Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.
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).
Management of public health organizations or agencies.
Financing of medical care provided to public assistance recipients.
A country in western Africa, east of MAURITANIA and south of ALGERIA. Its capital is Bamako. From 1904-1920 it was known as Upper Senegal-Niger; prior to 1958, as French Sudan; 1958-1960 as the Sudanese Republic and 1959-1960 it joined Senegal in the Mali Federation. It became an independent republic in 1960.
Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.
Facilities designed to serve patients who require surgical treatment exceeding the capabilities of usual physician's office yet not of such proportion as to require hospitalization.
Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.
The area of a nation's economy that is tax-supported and under government control.
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.
Financial support for training including both student stipends and loans and training grants to institutions.
The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.
A republic in southern Africa, east of ZAMBIA and BOTSWANA and west of MOZAMBIQUE. Its capital is Harare. It was formerly called Rhodesia and Southern Rhodesia.
Educational programs for dental graduates entering a specialty. They include formal specialty training as well as academic work in the clinical and basic dental sciences, and may lead to board certification or an advanced dental degree.
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.
The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.
The concept concerned with all aspects of providing and distributing health services to a patient population.
The technology of transmitting light over long distances through strands of glass or other transparent material.
A republic in western Africa, lying between GHANA on its west and BENIN on its east. Its capital is Lome.
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.
Government-controlled hospitals which represent the major health facility for a designated geographic area.
Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.
A vehicle equipped for transporting patients in need of emergency care.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Hospitals controlled by various types of government, i.e., city, county, district, state or federal.
Activities concerned with governmental policies, functions, etc.
A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium.
Difficulty in SWALLOWING which may result from neuromuscular disorder or mechanical obstruction. Dysphagia is classified into two distinct types: oropharyngeal dysphagia due to malfunction of the PHARYNX and UPPER ESOPHAGEAL SPHINCTER; and esophageal dysphagia due to malfunction of the ESOPHAGUS.
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.
Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.
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.
Hospitals located in a rural area.
Delivery of the FETUS and PLACENTA under the care of an obstetrician or a health worker. Obstetric deliveries may involve physical, psychological, medical, or surgical interventions.
Organized services for the purpose of providing diagnosis to promote and maintain health.
Institutions which provide medical or health-related services.
Insurance providing coverage for dental care.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
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.
An occupation limited in scope to a subsection of a broader field.
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)
Waste products which threaten life, health, or the environment when improperly treated, stored, transported, disposed of, or otherwise managed.
Detailed account or statement or formal record of data resulting from empirical inquiry.
A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.
Diagnostic, therapeutic and preventive health services provided for individuals in the community.
The organization and operation of the business aspects of a physician's practice.
Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.
A republic in eastern Africa, south of SUDAN and west of KENYA. Its capital is Kampala.
Control of drug and narcotic use by international agreement, or by institutional systems for handling prescribed drugs. This includes regulations concerned with the manufacturing, dispensing, approval (DRUG APPROVAL), and marketing of drugs.
Government sponsored social insurance programs.
All organized methods of funding.
Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures.
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)
The legal authority or formal permission from authorities to carry on certain activities which by law or regulation require such permission. It may be applied to licensure of institutions as well as individuals.
The observation and analysis of movements in a task with an emphasis on the amount of time required to perform the task.
Uniform method for health care providers and medical suppliers to report professional services, procedures, and supplies. It consists of alphanumeric codes and modifiers for the use of all public and private health insurers. It is developed by the Centers for Medicare and Medicaid Services.
Programs and activities sponsored or administered by local, state, or national governments.
The seeking and acceptance by patients of health service.
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)
Educational institutions for individuals specializing in the field of dentistry.
A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.
An agency of the PUBLIC HEALTH SERVICE concerned with the overall planning, promoting, and administering of programs pertaining to maintaining standards of quality of foods, drugs, therapeutic devices, etc.
Those facilities which administer health services to individuals who do not require hospitalization or institutionalization.
Failure of a professional person, a physician or lawyer, to render proper services through reprehensible ignorance or negligence or through criminal intent, especially when injury or loss follows. (Random House Unabridged Dictionary, 2d ed)
A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases.
Exercise of governmental authority to control conduct.
Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.
Drugs which have received FDA approval for human testing but have yet to be approved for commercial marketing. This includes drugs used for treatment while they still are undergoing clinical trials (Treatment IND). The main heading includes drugs under investigation in foreign countries.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
A republic in western Africa, south of BURKINA FASO and west of TOGO. Its capital is Accra.
Freedom of equipment from actual or potential hazards.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
Childbirth taking place in the home.
Organized services to provide health care to expectant and nursing mothers.
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.
Geographic area in which a professional person practices; includes primarily physicians and dentists.
Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form.
Organized services to provide health care for children.
Compliance with a set of standards defined by non-governmental organizations. Certification is applied for by individuals on a voluntary basis and represents a professional status when achieved, e.g., certification for a medical specialty.
The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.
An evaluation procedure that focuses on how care is delivered, based on the premise that there are standards of performance for activities undertaken in delivering patient care, in which the specific actions taken, events occurring, and human interactions are compared with accepted standards.