Insurance, Health
Insurance Coverage
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)
Insurance
Insurance, Long-Term Care
Health insurance to provide full or partial coverage for long-term home care services or for long-term nursing care provided in a residential facility such as a nursing home.
Insurance, Life
Insurance Carriers
Insurance Pools
Medically Uninsured
Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.
United States
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.
Insurance Selection Bias
Insurance Benefits
Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.
Insurance, Health, Reimbursement
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 Benefit Plans, Employee
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.
Insurance, Hospitalization
Health insurance providing benefits to cover or partly cover hospital expenses.
Insurance, Liability
Insurance, Major Medical
Insurance, Accident
Universal Coverage
Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions.
Medicaid
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.
National Health Insurance, United States
National Health Insurance in the United States refers to a proposed system of healthcare financing that would provide comprehensive coverage for all residents, funded through a combination of government funding and mandatory contributions, and administered by a public agency.
Insurance Claim Review
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.
National Health Programs
Components of a national health care system which administer specific services, e.g., national health insurance.
Health Care Reform
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.
Health Services Accessibility
Health Insurance Portability and Accountability Act
Public Law 104-91 enacted in 1996, was designed to improve the efficiency and effectiveness of the healthcare system, protect health insurance coverage for workers and their families, and to protect individual personal health information.
Health Expenditures
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.
Retrospective Studies
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.
State Health Plans
Health Care Costs
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.
Eligibility Determination
Private Sector
Financing, Personal
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
Risk Factors
Medicare
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)
Patient Protection and Affordable Care Act
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.
Socioeconomic Factors
Cohort Studies
Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.
Ambulatory Care
Insurance, Physician Services
Cost Sharing
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)
Patient Discharge
The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.
Logistic Models
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.
Health Care Surveys
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
Insurance, Pharmaceutical Services
Social Security
Government sponsored social insurance programs.
Hospital Costs
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).
Patient Readmission
Treatment Outcome
Insurance, Disability
Insurance designed to compensate persons who lose wages because of illness or injury; insurance providing periodic payments that partially replace lost wages, salary, or other income when the insured is unable to work because of illness, injury, or disease. Individual and group disability insurance are two types of such coverage. (From Facts on File Dictionary of Health Care Management, 1988, p207)
Incidence
The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.
Health Insurance Exchanges
State-provided health insurance marketplaces established under the PATIENT PROTECTION AND AFFORDABLE CARE ACT.
Prospective Studies
Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.
California
I'm sorry for any confusion, but "California" is a place, specifically a state on the western coast of the United States, and not a medical term or concept. Therefore, it doesn't have a medical definition.
Taiwan
Poverty
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.
Costs and Cost Analysis
Age Factors
Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.
Heart Failure
A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION.
Managed Care Programs
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.
Follow-Up Studies
Patient Admission
Health Services Research
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)
Cost Control
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)
Databases, Factual
Extensive collections, reputedly complete, of facts and data garnered from material of a specialized subject area and made available for analysis and application. The collection can be automated by various contemporary methods for retrieval. The concept should be differentiated from DATABASES, BIBLIOGRAPHIC which is restricted to collections of bibliographic references.
Multivariate Analysis
A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.
Cost of Illness
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.
Age Distribution
Hospital Charges
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.
Health Services Needs and Demand
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.
Emergency Service, Hospital
Models, Econometric
State Government
Comorbidity
The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
Health Policy
Inpatients
Health Maintenance Organizations
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)
Risk Assessment
Tax Exemption
Status not subject to taxation; as the income of a philanthropic organization. Tax-exempt organizations may also qualify to receive tax-deductible donations if they are considered to be nonprofit corporations under Section 501(c)3 of the United States Internal Revenue Code.
Aid to Families with Dependent Children
Financial assistance provided by the government to indigent families with dependent children who meet certain requirements as defined by the Social Security Act, Title IV, in the U.S.
Data Collection
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.
Fee-for-Service Plans
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)
Delivery of Health Care
The concept concerned with all aspects of providing and distributing health services to a patient population.
Hospital Mortality
Cross-Sectional Studies
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.
Health Care Sector
Drug Costs
Severity of Illness Index
Cost-Benefit Analysis
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.
Income Tax
Tax on the net income of an individual, organization, or business.
Utilization Review
Quality of Health Care
Health Status
Sex Factors
Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.
Registries
Federal Government
Influenza, Human
Proportional Hazards Models
Regression Analysis
Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.
Chronic Disease
Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)
Blue Cross Blue Shield Insurance Plans
Prepaid health and hospital insurance plan.
Sex Distribution
Odds Ratio
The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases.
Hospitals, Psychiatric
Special hospitals which provide care to the mentally ill patient.
Seasons
Cost Savings
Population Surveillance
Prevalence
The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.
Ethnic Groups
Outcome Assessment (Health Care)
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).
Economic Competition
Employer Health Costs
That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.
Questionnaires
Wounds and Injuries
Health Services Misuse
Excessive, under or unnecessary utilization of health services by patients or physicians.
Massachusetts
I'm sorry for any confusion, but "Massachusetts" is a geographical location and not a medical term or concept. It is a state located in the northeastern region of the United States. If you have any medical questions or terms you would like me to define, please let me know!
Washington
#### My apologies, but the term 'Washington' is not a medical concept or condition that has a defined meaning within the medical field. It refers to various concepts, primarily related to the U.S. state of Washington or the District of Columbia, where the nation's capital is located. If you have any questions about medical topics or conditions, please feel free to ask!
Insurance, Surgical
A specific type of health insurance which provides surgeons' fees for specified amounts according to the type of surgery listed in the policy.
Poisson Distribution
Medical Indigency
International Classification of Diseases
A system of categories to which morbid entries are assigned according to established criteria. Included is the entire range of conditions in a manageable number of categories, grouped to facilitate mortality reporting. It is produced by the World Health Organization (From ICD-10, p1). The Clinical Modifications, produced by the UNITED STATES DEPT. OF HEALTH AND HUMAN SERVICES, are larger extensions used for morbidity and general epidemiological purposes, primarily in the U.S.
Demography
Germany
Managed Competition
A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)
Continental Population Groups
Hispanic Americans
Persons living in the United States of Mexican (MEXICAN AMERICANS), Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. The concept does not include Brazilian Americans or Portuguese Americans.
Confidence Intervals
Canada
Privatization
Process of shifting publicly controlled services and/or facilities to the private sector.
Denmark
Health Resources
Asthma
Gastroenteritis
INFLAMMATION of any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Causes of gastroenteritis are many including genetic, infection, HYPERSENSITIVITY, drug effects, and CANCER.
Medical Savings Accounts
Morbidity
Oregon
I'm sorry for any confusion, but the term "Oregon" is a geographical location and not a medical concept or condition. It is a state in the Pacific Northwest region of the United States. If you have any questions related to medical topics, I would be happy to help answer those!
Rotavirus Infections
Longitudinal Studies
Catastrophic Illness
Office Visits
Risk
Health Surveys
New Jersey
(I'm assuming you are asking for a play on words related to the state of New Jersey, as "New Jersey" is not a medical term.)
Cost Allocation
Policy Making
Prognosis
Disabled Children
African Americans
Persons living in the United States having origins in any of the black groups of Africa.
Physician's Practice Patterns
Diagnosis-Related Groups
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.
Israel
Group Purchasing
Insurance, Nursing Services
Primary Health Care
Tennessee
I'm sorry for any confusion, but the term "Tennessee" is not a medical concept or condition that has a defined meaning within the medical field. It is a geographical location, referring to a state in the United States. If you have any questions related to healthcare, medicine, or health conditions, I would be happy to help answer those!
Brazil
I'm sorry for any confusion, but "Brazil" is not a medical term or concept, it is a country located in South America, known officially as the Federative Republic of Brazil. If you have any questions related to health, medicine, or science, I'd be happy to help answer those!
Social Welfare
Continuity of Patient Care
Florida
I'm sorry for any confusion, but "Florida" is a geographical location and not a medical term or condition with a specific definition. It is the 27th largest state by area in the United States, located in the southeastern region of the country and known for its diverse wildlife, beautiful beaches, and theme parks. If you have any medical questions or terms that need clarification, please feel free to ask!
European Continental Ancestry Group
Respiratory Syncytial Virus Infections
Ontario
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)
Budgets
Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.
Chi-Square Distribution
A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.
Nursing Homes
Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.
Social Class
A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income.
Myocardial Infarction
Outpatients
Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided.