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".
Individuals licensed to practice medicine.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Government sponsored social insurance programs.
Assessment of physiological capacities in relation to job requirements. It is usually done by measuring certain physiological (e.g., circulatory and respiratory) variables during a gradually increasing workload until specific limitations occur with respect to those variables.
Amounts charged to the patient as payer for medical services.
Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings.
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.
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)
Health care provided to individuals.
Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workmen's compensation benefits.
A listing of established professional service charges, for specified dental and medical procedures.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
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.
Services for the diagnosis and treatment of disease and the maintenance of health.
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.
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 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)
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.
Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, Sint Maarten, formerly included in the NETHERLANDS ANTILLES.
Processes or methods of reimbursement for services rendered or equipment.
Those physicians who have completed the education requirements specified by the American Academy of Family Physicians.
Coverage by contract whereby one part indemnifies or guarantees another against loss by a specified contingency.
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.
Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.
An occupation limited in scope to a subsection of a broader field.
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)
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.
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 providing for payment of a stipulated sum to a designated beneficiary upon death of the insured.
Conformity in fulfilling or following official, recognized, or institutional requirements, guidelines, recommendations, protocols, pathways, or other standards.
Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.
Cognitive mechanism based on expectations or beliefs about one's ability to perform actions necessary to produce a given effect. It is also a theoretical component of behavior change in various therapeutic treatments. (APA, Thesaurus of Psychological Index Terms, 1994)
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.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
A province of Canada, lying between the provinces of Saskatchewan and Ontario. Its capital is Winnipeg. Taking its name from Lake Manitoba, itself named for one of its islands, the name derived from Algonquian Manitou, great spirit. (From Webster's New Geographical Dictionary, 1988, p724 & Room, Brewer's Dictionary of Names, 1992, p332)
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 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)
Organizations which assume the financial responsibility for the risks of policyholders.
Geographic area in which a professional person practices; includes primarily physicians and dentists.
Providers of initial care for patients. These PHYSICIANS refer patients when appropriate for secondary or specialist care.
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 geographic area defined and served by a health program or institution.
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.
An organization of insurers or reinsurers through which particular types of risk are shared or pooled. The risk of high loss by a particular insurance company is transferred to the group as a whole (the insurance pool) with premiums, losses, and expenses shared in agreed amounts.
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.
The expected function of a member of the medical profession.
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.
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 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.
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.
Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.
The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.
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 providing coverage for dental care.
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 against loss resulting from liability for injury or damage to the persons or property of others.
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.
Components of a national health care system which administer specific services, e.g., national health insurance.
Organized services to provide mental health care.
Organized services to provide health care for children.
The design, completion, and filing of forms with the insurer.
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.
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.
Insurance providing a broad range of medical services and supplies, when prescribed by a physician, whether or not the patient is hospitalized. It frequently is an extension of a basic policy and benefits will not begin until the basic policy is exhausted.
Insurance providing coverage for physical injury suffered as a result of unavoidable circumstances.
Women licensed to practice medicine.
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.
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.
Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.
Diagnostic, therapeutic and preventive health services provided for individuals in the community.
Amounts charged to the patient as payer for health care services.
Health insurance providing benefits to cover or partly cover hospital expenses.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
The interactions between physician and patient.
Services designed for HEALTH PROMOTION and prevention of disease.
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.
The concept concerned with all aspects of providing and distributing health services to a patient population.
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.
Criteria to determine eligibility of patients for medical care programs and services.
The art and science of studying, performing research on, preventing, diagnosing, and treating disease, as well as the maintenance of health.
Health professionals who practice medicine as members of a team with their supervising physicians. They deliver a broad range of medical and surgical services to diverse populations in rural and urban settings. Duties may include physical exams, diagnosis and treatment of disease, interpretation of tests, assist in surgery, and prescribe medications. (from http://www.aapa.orglabout-pas accessed 2114/2011)
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.
Social and economic factors that characterize the individual or group within the social structure.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.
A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.
The room or rooms in which the physician and staff provide patient care. The offices include all rooms in the physician's office suite.
The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.
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.
Financing of medical care provided to public assistance recipients.
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.
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.
Insurance providing benefits to cover part or all of the psychiatric care.
The physician's inability to practice medicine with reasonable skill and safety to the patient due to the physician's disability. Common causes include alcohol and drug abuse, mental illness, physical disability, and senility.
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.
Health services, public or private, in urban areas. The services include the promotion of health and the delivery of health care.
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)
Differences in access to or availability of medical facilities and services.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
The seeking and acceptance by patients of health service.
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)
Revenues or receipts accruing from business enterprise, labor, or invested capital.
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)
Services specifically designed, staffed, and equipped for the emergency care of patients.
Outside services provided to an institution under a formal financial agreement.
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.
Organized services to provide health care to expectant and nursing mothers.
Federal, state, or local government organized methods of financial assistance.
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.
The capability to perform acceptably those duties directly related to patient care.
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.
Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.
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 for the purpose of providing diagnosis to promote and maintain health.
Diagnostic, therapeutic and preventive mental health services provided for individuals in the community.
Customer satisfaction or dissatisfaction with a benefit or service received.
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.
Organized services to provide health care to adolescents, ages ranging from 13 through 18 years.
The organization and administration of health services dedicated to the delivery of health care.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
Application of marketing principles and techniques to maximize the use of health care resources.
Organized services to provide health care to women. It excludes maternal care services for which MATERNAL HEALTH SERVICES is available.
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)
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)
Economic sector concerned with the provision, distribution, and consumption of health care services and related products.
The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.
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)
The level of governmental organization and function below that of the national or country-wide government.
The organization and operation of the business aspects of a physician's practice.
State-provided health insurance marketplaces established under the PATIENT PROTECTION AND AFFORDABLE CARE ACT.
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.
Services designed to promote, maintain, or restore dental health.
Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income.
A geographic location which has insufficient health resources (manpower and/or facilities) to meet the medical needs of the resident population.
Services offered to the library user. They include reference and circulation.
The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization.
Educational programs designed to inform physicians of recent advances in their field.
Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.
Health care provided on a continuing basis from the initial contact, following the patient through all phases of medical care.
The area of a nation's economy that is tax-supported and under government control.
The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.
The use of one's knowledge in a particular profession. It includes, in the case of the field of biomedicine, professional activities related to health care and the actual performance of the duties related to the provision of health care.
The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups.
A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults.
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.
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.
A general concept referring to the organization and administration of nursing activities.
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.
Organized services to provide diagnosis, treatment, and prevention of genetic disorders.
Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.
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.
The condition in which individuals are financially unable to access adequate medical care without depriving themselves and their dependents of food, clothing, shelter, and other essentials of living.
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.
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.
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.
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 services for employees, usually provided by the employer at the place of work.
A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence.
Process of shifting publicly controlled services and/or facilities to the private sector.
The level of governmental organization and function at the national or country-wide level.
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)
Professional medical personnel approved to provide care to patients in a hospital.
The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.
The confinement of a patient in a hospital.
The state of being engaged in an activity or service for wages or salary.
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.
Public attitudes toward health, disease, and the medical care system.
Those facilities which administer health services to individuals who do not require hospitalization or institutionalization.
The reciprocal interaction of two or more professional individuals.
Activities concerned with governmental policies, functions, etc.
A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium.
Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.
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)
The giving of advice and assistance to individuals with educational or personal problems.
An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.
The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.
Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice.
The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.
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.
Excessive, under or unnecessary utilization of health services by patients or physicians.
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.
A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.
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.
The remuneration paid or benefits granted to an employee.
The inhabitants of rural areas or of small towns classified as rural.
Elements of limited time intervals, contributing to particular results or situations.
The teaching or training of patients concerning their own health needs.
Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).
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).
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.
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.
An infant during the first month after birth.