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)Independent Practice Associations: A partnership, corporation, association, or other legal entity that enters into an arrangement for the provision of services with persons who are licensed to practice medicine, osteopathy, and dentistry, and with other care personnel. Under an IPA arrangement, licensed professional persons provide services through the entity in accordance with a mutually accepted compensation arrangement, while retaining their private practices. Services under the IPA are marketed through a prepaid health plan. (From Facts on File Dictionary of Health Care Management, 1988)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)Capitation Fee: 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.Preferred Provider Organizations: 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.Economic Competition: 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.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.CaliforniaHealth Care Sector: Economic sector concerned with the provision, distribution, and consumption of health care services and related products.United StatesWashingtonHealth 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)Insurance Selection Bias: Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.Fees, Medical: Amounts charged to the patient as payer for medical services.OregonHealth Facility Merger: The combining of administrative and organizational resources of two or more health care facilities.Northwestern United States: The geographic area of the northwestern region of the United States. The states usually included in this region are Idaho, Montana, Oregon, Washington, and Wyoming.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.Employer Health Costs: That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.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)Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Primary Health Care: 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)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)Group Practice, Prepaid: An organized group of three or more full-time physicians rendering services for a fixed prepayment.Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.Competitive Medical Plans: 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)Medicare Part C: 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.Insurance, Physician Services: 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".Utilization Review: 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.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.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.Risk Sharing, Financial: Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.Health Services Accessibility: 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.IsraelGatekeeping: The controlling of access to health services, usually by primary care providers; often used in managed care settings to reduce utilization of expensive services and reduce referrals. (From BIOETHICS Thesaurus, 1999)Physician Incentive Plans: Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.Group Practice: 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.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.Economics, Medical: 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.Ambulatory Care: 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.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.Organizations, Nonprofit: Organizations which are not operated for a profit and may be supported by endowments or private contributions.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.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.MassachusettsPublic Health: 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.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)Preventive Health Services: Services designed for HEALTH PROMOTION and prevention of disease.State Health Plans: 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.Deductibles and Coinsurance: 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.Drug Costs: 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).Hospitals, Proprietary: Hospitals owned and operated by a corporation or an individual that operate on a for-profit basis, also referred to as investor-owned hospitals.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)Salaries and Fringe Benefits: The remuneration paid or benefits granted to an employee.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).Fees and Charges: Amounts charged to the patient as payer for health care services.MichiganColoradoHealth Services: Services for the diagnosis and treatment of disease and the maintenance of health.Attitude of Health Personnel: Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.Hospital Administration: Management of the internal organization of the hospital.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.Drug Utilization Review: Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.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.Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.Case Management: A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Physician's Practice Patterns: Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.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.Health Services Misuse: Excessive, under or unnecessary utilization of health services by patients or physicians.Child Health Services: Organized services to provide health care for children.Specialization: An occupation limited in scope to a subsection of a broader field.Medicine: The art and science of studying, performing research on, preventing, diagnosing, and treating disease, as well as the maintenance of health.WisconsinPhysicians: Individuals licensed to practice medicine.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.Reimbursement Mechanisms: Processes or methods of reimbursement for services rendered or equipment.Formularies as Topic: Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.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.Patient Acceptance of Health Care: The seeking and acceptance by patients of health service.Drug Prescriptions: Directions written for the obtaining and use of DRUGS.MinnesotaQuestionnaires: 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.Patient Satisfaction: 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.Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.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.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.Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.Consumer Participation: Community or individual involvement in the decision-making process.Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.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.Mental Health: The state wherein the person is well adjusted.Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease.Attitude to Health: Public attitudes toward health, disease, and the medical care system.Quality Assurance, Health Care: 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.Medical Records: Recording of pertinent information concerning patient's illness or illnesses.New YorkHealth: The state of the organism when it functions optimally without evidence of disease.Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural.Diabetes Mellitus: A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.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.Hospitalization: The confinement of a patient in a hospital.World Health Organization: A specialized agency of the United Nations designed as a coordinating authority on international health work; its aim is to promote the attainment of the highest possible level of health by all peoples.Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure.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.Job Satisfaction: Personal satisfaction relative to the work situation.Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.Health Planning: Planning for needed health and/or welfare services and facilities.Physicians, Family: Those physicians who have completed the education requirements specified by the American Academy of Family Physicians.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.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.Risk Adjustment: The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)Sampling Studies: Studies in which a number of subjects are selected from all subjects in a defined population. Conclusions based on sample results may be attributed only to the population sampled.Time Factors: Elements of limited time intervals, contributing to particular results or situations.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.World Health: The concept pertaining to the health status of inhabitants of the world.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.Program Evaluation: 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.Patient Education as Topic: The teaching or training of patients concerning their own health needs.Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen.Health Knowledge, Attitudes, Practice: 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).Interviews as Topic: 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.Mammography: Radiographic examination of the breast.Health Personnel: 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)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.Risk Factors: 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.Emergency Service, Hospital: Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.Drug Utilization: The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis.Infant, Newborn: An infant during the first month after birth.Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends.Guideline Adherence: Conformity in fulfilling or following official, recognized, or institutional requirements, guidelines, recommendations, protocols, pathways, or other standards.Practice Guidelines as Topic: 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.Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable.Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Evaluation Studies as Topic: Studies determining the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies. For drugs and devices, CLINICAL TRIALS AS TOPIC; DRUG EVALUATION; and DRUG EVALUATION, PRECLINICAL are available.Group Purchasing: A shared service which combines the purchasing power of individual organizations or facilities in order to obtain lower prices for equipment and supplies. (From Health Care Terms, 2nd ed)Public Health Administration: Management of public health organizations or agencies.Medical Records Systems, Computerized: Computer-based systems for input, storage, display, retrieval, and printing of information contained in a patient's medical record.Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time.Income: Revenues or receipts accruing from business enterprise, labor, or invested capital.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.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)Risk: The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavorable outcome.Occupational Health: The promotion and maintenance of physical and mental health in the work environment.Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.Health Status Disparities: Variation in rates of disease occurrence and disabilities between population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, or gender and populations identified geographically or similar measures.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.Smoking: Inhaling and exhaling the smoke of burning TOBACCO.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.National Health Programs: Components of a national health care system which administer specific services, e.g., national health insurance.Delivery of Health Care, Integrated: 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)Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group.Health Care Rationing: Planning for the equitable allocation, apportionment, or distribution of available health resources.Health Priorities: Preferentially rated health-related activities or functions to be used in establishing health planning goals. This may refer specifically to PL93-641.Public Health Practice: The activities and endeavors of the public health services in a community on any level.Mental Health Services: Organized services to provide mental health care.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.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.Breast Neoplasms: Tumors or cancer of the human BREAST.Asthma: A form of bronchial disorder with three distinct components: airway hyper-responsiveness (RESPIRATORY HYPERSENSITIVITY), airway INFLAMMATION, and intermittent AIRWAY OBSTRUCTION. It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea (DYSPNEA, PAROXYSMAL).

Use of out-of-plan services by Medicare members of HIP. (1/1026)

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.  (+info)

Hypertension, antihypertensive medication use, and risk of renal cell carcinoma. (2/1026)

To investigate whether diuretic medication use increases risk of renal cell carcinoma (RCC), the authors conducted a case-control study of health maintenance organization members in western Washington State. Cases (n = 238) diagnosed between January 1980 and June 1995 were compared with controls (n = 616) selected from health maintenance organization membership files. The computerized health maintenance organization pharmacy database provided information on medications prescribed after March 1977. Additional exposure information was collected from medical records. For women, use of diuretics was associated with increased risk of RCC (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.0-3.1), but the association was not independent of a diagnosis of hypertension (adjusted for hypertension, OR = 1.1, 95% CI 0.5-2.1). Similarly, nondiuretic antihypertensive use was associated with increased risk, but only when unadjusted for hypertension. For men, neither diuretic nor nondiuretic antihypertensive use was associated with risk of RCC. A diagnosis of hypertension was clearly associated with RCC risk for women (OR = 2.5, 95% CI 1.2-5.1), but not men (OR = 1.3, 95% CI 0.7-2.5). High systolic and diastolic blood pressures were associated with increased risk in both sexes. These results do not support the hypothesis that use of diuretic medication increases RCC risk; they are more consistent with an association between RCC and high blood pressure.  (+info)

The changing elderly population and future health care needs. (3/1026)

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.  (+info)

Raising the bar: the use of performance guarantees by the Pacific Business Group on Health. (4/1026)

In 1996 the Pacific Business Group on Health (PBGH) negotiated more than two dozen performance guarantees with thirteen of California's largest health maintenance organizations (HMOs) on behalf the seventeen large employers in its Negotiating Alliance. The negotiations put more than $8 million at risk for meeting performance targets with the goal of improving the performance of all health plans. Nearly $2 million, or 23 percent of the premium at risk, was refunded to the PBGH by the HMOs for missed targets. The majority of plans met their targets for satisfaction with the health plan and physicians, as well as cesarean section, mammography, Pap smear, and prenatal care rates. However, eight of the thirteen plans missed their targets for childhood immunizations, refunding 86 percent of the premium at risk.  (+info)

Financial incentives and drug spending in managed care. (5/1026)

This study estimates the impact of patient financial incentives on the use and cost of prescription drugs in the context of differing physician payment mechanisms. A large data set was developed that covers persons in managed care who pay varying levels of cost sharing and whose physicians are compensated under two different models: independent practice association (IPA)-model and network-model health maintenance organizations (HMOs). Our results indicate that higher patient copayments for prescription drugs are associated with lower drug spending in IPA models (in which physicians are not at risk for drug costs) but have little effect in network models (in which physicians bear financial risk for all prescribing behavior).  (+info)

Waking the health plan giant: Group Health Cooperative stops counting sheep and starts counting key tobacco indicators. (6/1026)

Implementing a comprehensive approach to decreasing tobacco use in a large health plan requires hard work and commitment on the part of many individuals. We found that major organisational change can be accomplished and sustained. Keys to our success included our decision to remove access barriers to our cessation programmes (including cost); obtaining top leadership buy-in; identifying accountable individuals who owned responsibility for change; measuring key processes and outcomes; and finally keeping at it tenaciously through multiple cycles of improvement.  (+info)

Health maintenance organizations in developing countries: what can we expect? (7/1026)

Health maintenance organizations (HMOs) are a relatively new and alternative means of providing health care, combining a risk-sharing (insurance) function with health service provision. Their potential for lowering costs has attracted great interest in the USA and elsewhere, and has raised questions regarding their applicability to other settings. Little attention, however, has been given to critically reviewing the experience with HMOs in other countries, particularly concerning their introduction to settings other than the USA. This paper first reviews the current experience of HMOs in low- and middle-income countries, including Argentina, Bolivia, Brazil, Colombia, Ecuador, Uruguay, Chile and Indonesia. Secondly, the paper reviews the USA experience with HMOs: prerequisites for the establishment of HMOs in the USA are identified and discussed, followed by a review of the performance of HMOs in terms of cost containment, integration of care and quality of care for the elderly and poor. The analysis concludes that difficulties may arise when implementing HMOs in developing countries, and that potential adverse effects on the overall health care delivery system may occur. These should be avoided by careful analyses of a nation's health care system.  (+info)

The corporate practice of health care ... a panel discussion. (8/1026)

The pros and cons of treating health care as a profit-making business got a lively airing in Boston May 16, when the Harvard School of Public Health's "Second Conference on Strategic Alliances in the Evolving Health Care Market" presented what was billed as a "Socratic panel." The moderator was Charles R. Nesson, J.D., a Harvard Law School professor of 30 years' standing whose knack for guiding lively discussions is well known to viewers of such Public Broadcasting Service series as "The Constitution: That Delicate Balance. "As one panelist mentioned, Boston was an interesting place for this conversation. With a large and eminent medical establishment consisting mostly of traditionally not-for-profit institutions, the metropolis of the only state carried in 1972 by liberal Presidential candidate George McGovern is in one sense a skeptical holdout against the wave of aggressive investment capitalism that has been sweeping the health care industry since the 1994 failure of the Clinton health plan. In another sense, though, managed care-heavy Boston is an innovative crucible of change, just like its dominant HMO, the not-for-profit but merger-minded Harvard Pilgrim Health Care. Both of these facets of Beantown's health care psychology could be discerned in the comments heard during the panel discussion. With the permission of the Harvard School of Public Health--and asking due indulgence for the limitations of tape-recording technology in a room often buzzing with amateur comment--MANAGED CARE is pleased to present selections from the discussion in the hope that they will shed light on the business of health care.  (+info)

  • Health Maintenance Organizations (HMOs). (gmatclub.com)
  • Doctor: Health Maintenance Organizations (HMOs) should not be used to replace traditional fee-for-service methods of delivering health care. (gmatclub.com)
  • The less health care that HMOs deliver, the greater the profit these companies receive. (gmatclub.com)
  • b)An effective way for HMOs to cut health care delivery costs is to prevent diseases from occurring by providing considerable amounts of preventive health care. (gmatclub.com)
  • c) If HMOs deliver less health care, competitive pressures will force these companies to lower the rates they charge for health care coverage, returning the profit margin to former levels. (gmatclub.com)
  • Second, there is a fear that while select black physicians will be "gobbled" up by multi-physician health maintenance organizations (HMOs), those that do not want to or are not asked to join such groups will lose their practices. (thefreedictionary.com)
  • TO LOWER COSTS, MEDICARE AND MEDICAID ARE encouraging their beneficiaries to enroll in health maintenance organizations (HMOs). (thefreedictionary.com)
  • Health maintenance organization (HMO): HMOs offer prepaid, comprehensive health coverage for both hospital and physician services. (sfgate.com)
  • They trace their origins to the early 20th century, but became more popular after the Health Maintenance Organization Act of 1973 . (thefreedictionary.com)
  • Nixon responded to a healthcare funding crisis in 1970 when healthcare was 7.1% of GDP and passed the Health Maintenance Organisation Act 1973. (sochealth.co.uk)
  • Over the past few years, third-party payers, such as large employer-based benefit plans, health maintenance organizations and traditional insurers, have increasingly found a new profit source--recoveries from prescription-drug overcharge litigation. (thefreedictionary.com)
  • health maintenance organization subject to requirements for certain insurers. (nv.us)
  • But Gilead has come under fire, from insurers and Congress, for Sovaldi's $1,000-a-pill price at a time when U.S. healthcare spending is under scrutiny and President Barack Obama's Affordable Care Act aims to make health coverage accessible to everyone. (reuters.com)
  • She called Kaiser's discount on Sovaldi "modest" and said state Medicaid programs and private health insurers "are going to have to make very serious tradeoffs just based on a single manufacturer's decision on pricing a drug because they can. (reuters.com)
  • Insurers and state officials running the Medicaid health program for the poor fear a multibillion-dollar tab from Sovaldi alone. (reuters.com)
  • Investment bank Leerink Partners estimates the drug's cost could trim as much as 10 percent from the earnings of publicly traded health insurers. (reuters.com)
  • United States Department of Health and Human Services. (umich.edu)
  • The purpose of the National Health Interview Survey (NHIS) is to obtain information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive. (umich.edu)
  • Members must use participating providers for all health services. (sfgate.com)
  • to provide health services. (sfgate.com)
  • Like other providers, Beth Abraham is looking to position itself geographically in order to be a more effective competi tor," notes Jeffrey G. Blumengold, partner in charge of health-care services at accounting firm M.R. Weiser & Co. (crainsnewyork.com)
  • CONCLUSIONS Frequent callers represent a unique group of patients with high utilization of health care services. (annfammed.org)
  • Better targeted patient education and referral to other support services may decrease the number of calls and utilization of health services. (annfammed.org)
  • Health services researchers typically identify high utilizers by their number of visits to the office. (annfammed.org)
  • These are defined as a medical insurance group that provides health services for a fixed annual fee. (sochealth.co.uk)
  • HMO: or health maintenance organization , is a medical insurance and health care plan that offers a specific list of doctors and hospitals from whom members must receive their care. (thefreedictionary.com)
  • An HMO contracts with health care providers, including doctors, hospitals and others. (sfgate.com)
  • A nonprofit organization that offers health insurance to a group of persons and charges members of the group the same monthly premium. (thefreedictionary.com)
  • NRS 695C.057 Applicability of certain provisions concerning portability and availability of health insurance. (nv.us)
  • Large companies that offer their employees insurance through health maintenance organizations can expect their costs to rise 9.8% next year, the largest increase in five years, a new study shows. (calhospital.org)
  • It is an organisation that provides or arranges managed care for health insurance, self-funded health care benefits plans, individuals, or other entities, acting as a liaison with healthcare providers on a prepaid basis. (sochealth.co.uk)
  • They are a Health Maintenance Organization which was established with the objective of becoming the HMO of choice for corporate entities and all subscribing enrolees, who want good quality healthcare accessed through a technology enabled platform that will enhance the whole customer experience. (myjobmag.com)
  • The largest provider in the Maryland-Washington area is the first healthcare system to join a network leveraging Cerner's electronic health record and HealtheIntent platforms to support clinical research. (healthdatamanagement.com)
  • As an additional precaution, NCHS requires, under section 308(d) of the Public Health Service Act (42 U.S.C. 242m), that data collected by NCHS not be used for any purpose other than statistical analysis and reporting. (umich.edu)
  • It's an outrageous price for a therapy that has huge public health implications. (reuters.com)
  • In the wake of the novel coronavirus outbreak, the HHS Office for Civil Rights is detailing how patient information can be shared to protect public health under the HIPAA privacy rule. (healthdatamanagement.com)
  • Because of Beth Abraham's expertise in capitation and its ability to generate a surplus, many health-care facilities have approached the Bronx hospital about joint ventures. (crainsnewyork.com)
  • The Department of Veterans Affairs' Palo Alto Health Care System is on the verge of becoming the world's first 5G-enabled hospital. (healthdatamanagement.com)
  • The 1975 Health Maintenance Organization (HMO) Supplement provides variables from the core Person File (see HEALTH INTERVIEW SURVEY, 1975 [ICPSR 7672]) including sex, age, race, marital status, veteran status, education, income, industry and occupation codes, and limits on activity. (umich.edu)
  • NRS 695C.165 Eligibility for coverage: Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan. (nv.us)
  • NRS 695C.167 Eligibility for coverage: Certain accommodations to be made when child is covered under health care plan of noncustodial parent. (nv.us)
  • What's required is a network of Preventive Health Maintenance Organizations (PHMO) to provide prepaid care for a wide range of alternative or simply relaxing treatments. (thefreedictionary.com)
  • First 20 months' experience with use of metformin for type 2 diabetes in a large health maintenance organization. (diabetesjournals.org)
  • d)Fee-for-service methods of delivering health care have perverse incentives to provide unnecessary health care at inflated costs. (gmatclub.com)
  • NRS 695C.123 Contracts with certain federally qualified health centers. (nv.us)
  • The Adverse Childhood Experiences Study (ACE study) confirmed the linkage between exposure to adversity in childhood and the risk of chronic disease and poor health outcomes as an adult. (wa.gov)
  • This resembles the definition of Health Maintenance Organisations that emerged in the 1970s. (sochealth.co.uk)
  • OBJECTIVE: To assess adherence to prescribing guidelines, continuation rates, population effects on glycemic control, and occurrence of lactic acidosis during the first 20 months of the availability of metformin in a large health maintenance organization. (diabetesjournals.org)
  • The quality of the doctors and health care centers are carefully monitored to the highest of standards, so plan members know they are getting the best possible care. (thebalancecareers.com)
  • NRS 695C.123 Contracts with certain federally qualified health centers. (nv.us)
  • The Centers for Disease Control and Prevention (CDC) reports that "relatively little progress has been made toward the goal of eliminating racial/ethnic disparities" among a wide range of health indicators (1) . (annals.org)
  • One type of insurance provider that is popular in the health insurance marketplace is a health maintenance organization (HMO), an insurance structure that provides coverage through a network of physicians. (investopedia.com)
  • A health maintenance organization (HMO) is a network or organization that provides health insurance coverage for a monthly or annual fee. (investopedia.com)
  • Beyond health coverage, you can count on us to provide impactful community initiatives and leadership in improving health care. (baycityarea.com)
  • NRS 695C.165 Eligibility for coverage: Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan. (nv.us)
  • NRS 695C.167 Eligibility for coverage: Certain accommodations to be made when child is covered under health care plan of noncustodial parent. (nv.us)
  • You may use this site as your basic guide to better understand your Carewell Health Care Coverage . (carewellhealthsystems.com)
  • Health Insurance eligibility requirements and coverage effective dates vary by employee type. (albany.edu)
  • This plan also includes dental, behavioral health, maternity-related visits, prescription drug coverage and laboratory tests. (benzinga.com)
  • The Health Maintenance Organization ( HMO) Plan limits coverage to care from in-network doctors. (princeton.edu)
  • The U.S. government requires that J-1 visa holders and their dependents have health insurance coverage while at Princeton University as an exchange scholar. (princeton.edu)
  • If medical coverage is waived at Princeton, J-1 visa holders must be covered for health insurance through their home country, institution, or own private policy. (princeton.edu)
  • This plan provides coverage to participants through a network of select health care providers, like physicians and hospitals. (benzinga.com)
  • Our funding options and group health expense accounts offer even more ways to create health coverage on your terms. (anthem.com)
  • a) Each enrollee residing in this state is entitled to evidence of coverage under a health care plan. (texas.gov)
  • b) The health maintenance organization shall issue the evidence of coverage, except as provided by Subsection (c). (texas.gov)
  • c) If the enrollee obtains coverage under a health care plan through an insurance policy or a contract issued by a group hospital service corporation, whether by option or otherwise, the insurer or the group hospital service corporation shall issue the evidence of coverage. (texas.gov)
  • d) By agreement between the health maintenance organization, insurer, or group hospital service corporation and the subscriber or person entitled to receive the evidence of coverage, policy, or contract, the evidence of coverage required by this section may be delivered electronically. (texas.gov)
  • An evidence of coverage is not a health insurance policy as that term is defined by this code. (texas.gov)
  • 3) in which the evidence of coverage meets the requirements of the definition of "basic health care services" provided by Section 843.002 . (texas.gov)
  • e) Notwithstanding any other law, Section 1201.062 applies to an evidence of coverage issued by a health maintenance organization. (texas.gov)
  • As a PPO health plan member, you get maximum benefit coverage when you use the PPO network of physicians and hospitals. (csub.edu)
  • The amount of coverage offered for each essential health benefit varies by plan type and insurance company. (progressive.com)
  • At Blue Cross and Blue Shield of Illinois (BCBSIL), we want to help you better understand your health care coverage. (bcbsil.com)
  • If you have a Qualified Health Plan , please select your coverage type below. (bcbsil.com)
  • If you purchased your health insurance plan directly from BCBSIL or through the Health Insurance Marketplace, you have Individual Coverage . (bcbsil.com)
  • If you have health care coverage through your job and your employer has between 1 and 50 full-time employees (FTEs), your insurance is considered Small Group Coverage . (bcbsil.com)
  • More and more people are doing their shopping for health insurance on the Internet, and finding affordable policies and the exact coverage they are looking for. (insurancespecialists.com)
  • Comparing affordable health insurance rates and coverage side by side on Insurancespecialists.com is a huge help! (insurancespecialists.com)
  • It is easy to be led astray and purchase a health insurance policy that is either too much or too little coverage for your needs. (insurancespecialists.com)
  • While more expensive than the other two coverage plans, indemnity health plans allow their clients to choose the doctor and the hospital they want, as long as they are in members of the plan. (insurancespecialists.com)
  • DHS employees may be eligible to enroll in Federal benefits programs available to Federal employees, including healthcare, dental and vision coverage, life insurance, retirement savings accounts, long term care and flexible health savings accounts. (dhs.gov)
  • These plans do not have good coverage for people with health problems who need regular care or tests. (medlineplus.gov)
  • You can only buy a catastrophic plan if you are under age 30 years or can prove you cannot afford health coverage. (medlineplus.gov)
  • Because of these costs, people with diabetes frequently ask how to choose the right health plan with the right coverage at a price they can afford. (diabetesselfmanagement.com)
  • Items in health insurance plan coverage. (diabetesselfmanagement.com)
  • Limited coverage for home health care authorized. (flsenate.gov)
  • Some people have private health insurance coverage either through an employer (often called a group plan) or through an individual policy they've purchased. (lls.org)
  • A Health Maintenance Organization (HMO) provides and/or arranges for the delivery of comprehensive health care services and supplies to its members in a designated geographic service area in exchange for prepaid premiums. (nj.us)
  • These contracts both allow for premiums to be lower than for traditional health insurance-since the health providers have the advantage of having patients directed to them-but they also add additional restrictions to the HMO's members. (investopedia.com)
  • The agreed payment allows an HMO to offer lower premiums than other types of health insurance plans while retaining a high quality of care from its network. (investopedia.com)
  • In response, both private firms that paid for employees' health insurance premiums and governments that were financing care for the poor and the elderly sought mechanisms to control costs. (encyclopedia.com)
  • An HMO is a type of managed care health plan where members choose their physician from a network of approved health care providers which typically results in lower premiums and/or copayments. (cascadehc.org)
  • Health insurance premiums rose 50% between 2008 and 2017, according to the Colorado Division of Insurance. (benzinga.com)
  • Typically, CDHPs have lower premiums but higher deductibles (the amount members pay out-of-pocket for health services before the health plan pays). (anthem.com)
  • This pressure forces other programs either to make their health packages more comprehensive or to reduce their premiums. (thecrimson.com)
  • These plans offer a network of health care providers and low monthly premiums. (medlineplus.gov)
  • In addition, you will not be able to get federal subsidies to help pay the premiums for these private health plans. (diabetesselfmanagement.com)
  • We wanted to determine whether a health maintenance organization's (HMO's) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents' ratings of care. (aappublications.org)
  • HMO's are still one of the more popular health management options that employers offer, for a number of reasons. (thebalancecareers.com)
  • Managed-care programs include Health-maintenance Organizations (HMO's) and Preferred-provider Organizations (PPO's). (animated-teeth.com)
  • This packet summarizes the procedures for incorporating and licensing a domestic, not for profit, health maintenance organization insurer in Wisconsin under ch. 613, Wis. (wi.gov)
  • Health insurance works by splitting the cost of health care between you and your insurer. (progressive.com)
  • It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. (wikipedia.org)
  • The Federal Government requires employers to include a health maintenance organization in their employees' health benefit plans. (gao.gov)
  • Over the past few years, third-party payers, such as large employer-based benefit plans, health maintenance organizations and traditional insurers, have increasingly found a new profit source--recoveries from prescription-drug overcharge litigation. (thefreedictionary.com)
  • According to the experts in health care, the trend away from traditional fee-for-service health care plans has been steady over the last two decades. (thebalancecareers.com)
  • The US Department of Labor advises that fee-for-service plans accounted for 96% of health care plans offered by medium and large public employers in 1984 and 20 years later they account for less than 15% of employer-provided health insurance. (thebalancecareers.com)
  • Health maintenance organization plans continue to be a strong component of care in the health insurance market today. (thebalancecareers.com)
  • Health insurers are selling more than 100,000 plans at a county level through the Affordable Care Act's marketplaces, at radically different prices and varied designs. (swimincorp.com)
  • But a new analysis from the McKinsey Center for U.S. Health System Reform suggests insurers had some luck in holding down prices if they offered plans that limited a consumer's choice of doctors and hospitals. (swimincorp.com)
  • Plans featuring health maintenance organizations or restricted networks of providers typically had the lowest year-over-year premium increases, according to McKinsey, which sifted through information on the 223,000 plans offered in the marketplaces at the county level over the last two years. (swimincorp.com)
  • The more widely known P.P.O., or preferred provider organization, plans, which typically allow people to go outside their plan's network if they are willing to pay a greater share of the cost, had a median increase of 9 percent. (swimincorp.com)
  • As one of the lowest cost options, Health Maintenance Organization plans can be a great fit depending on your situation. (medicaresolutionslongisland.com)
  • This briefing will explore the rise of consumer wearables as increasingly prevalent tools in health care delivery and as part of patient care plans. (allhealthpolicy.org)
  • Citizens are required to purchase their own health insurance from a private marketplace, while children and the elderly can be covered under free plans from the government. (benzinga.com)
  • Here are the different types of plans you can access: preferred provider (PPO), health maintenance organization (HMO) and point of service plans (POS). (benzinga.com)
  • These plans tend to more complicated because all of your health care referrals must go through your primary doctor and add in more steps between you and treatment. (benzinga.com)
  • Rocky Mountain Health Plans is a nonprofit HMO-based health care system. (benzinga.com)
  • There are different types of plans, including health savings accounts and plans with a high or low deductible. (chiefofleast.com)
  • These types of plans are good for the people who rarely go to the doctor and need little health care. (chiefofleast.com)
  • Private health insurance is allowed, but in six provincial governments only for services that the public health plans do not cover (for example, semi-private or private rooms in hospitals and prescription drug plans). (chiefofleast.com)
  • Introduction to managed care : health maintenance organizations, preferred provider organizations, and competitive medical plans / Robert G. Shouldice. (who.int)
  • The Affordable Care Act (ACA) guidelines stipulate that vision care is an essential benefit for children under age 19 - all plans sold in the Health Insurance Marketplace should include vision care for children. (benzinga.com)
  • The Health Insurance Marketplace does not offer stand-alone plans. (benzinga.com)
  • Vision insurance doesn't use the deductible available with traditional health insurance plans but borrows the idea of copayments. (benzinga.com)
  • Explore Anthem group medical plans, including flexible PPO, POS, and Consumer-Driven Health Plans (CDHP) - all with one of the largest physician and hospital-based networks in Wisconsin. (anthem.com)
  • POS plans are a type of managed care that requires members to choose an in-network physician for a PCP, but like a PPO, patients may go outside the network for health care services. (anthem.com)
  • Curry SJGrothaus LCMcAfee TPabinak C Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. (jamanetwork.com)
  • Most health plans also cover preventive care, including annual physical exams and shots. (progressive.com)
  • Note that the following information is a general overview of information related to insurance and Health Maintenance Organization (HMO) health plans. (bcbsil.com)
  • There are also different health insurance plans to consider, such as Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Indemnity Health Plans. (insurancespecialists.com)
  • Before the rise of managed health care plans, indemnity health plans dominated the health care landscape. (insurancespecialists.com)
  • DHS employees, retirees and their eligible family members may be eligible to access the widest selection of healthcare plans in the country through the Federal Employee Health Benefits program. (dhs.gov)
  • Most insurance companies offer different types of health plans. (medlineplus.gov)
  • Depending on how you get your health insurance, you may have a choice of different types of plans. (medlineplus.gov)
  • High Deductible Health Plans (HDHPs). (medlineplus.gov)
  • These full benefit plans are known as qualified health plans (QHPs). (diabetesselfmanagement.com)
  • This is true for new plans sold both inside and outside the government health insurance marketplace under the ACA. (diabetesselfmanagement.com)
  • In addition, plans must limit how much you pay out of pocket for benefits and must provide certain health services aimed at preventing disease at no charge. (diabetesselfmanagement.com)
  • Setting Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network. (bmj.com)
  • Following the approval of the federal Center for Medicare and Medicaid Services ( CMS, formerly the Health Care Financing Administration (HCFA)) on 06/07/1995, recipients of Aid for Families with Dependent Children (AFDC) were required to select an HMO for the provision of their health care services and supplies. (nj.us)
  • An HMO is an organized public or private entity that provides basic and supplemental health services to its subscribers. (investopedia.com)
  • In the United States a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. (wikipedia.org)
  • It is this inclusion of services intended to maintain a member's health that gave the HMO its name. (wikipedia.org)
  • Some services, such as outpatient mental health care, are limited, and more costly forms of care, diagnosis, or treatment may not be covered. (wikipedia.org)
  • The provision of health care services on the basis of prepaid rates provides incentives for the organization to emphasize preventive medicine to reduce overall health care costs. (gao.gov)
  • As of December 31, 1976, it was providing comprehensive health care services to 6,016 members. (gao.gov)
  • I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session. (confex.com)
  • United States Department of Health and Human Services. (umich.edu)
  • The purpose of the National Health Interview Survey (NHIS) is to obtain information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive. (umich.edu)
  • Managed-care companies such as health maintenance organizations and preferred provider organizations must select and retain qualified physicians who will provide quality services to their sub scribers, according to Margolis & Co. (thefreedictionary.com)
  • This codebook describes the contents of a data file from the Health Insurance Experiment (HIE), a large social experiment conducted by The RAND Corporation from 1974 to 1982 under a grant from the U.S. Department of Health and Human Services. (rand.org)
  • The health maintenance organization (HMO) and Seattle fee-for-service (FFS) visits files contain data concerning the use of inpatient and outpatient health services by Seattle FFS participants and participants enrolled in Group Health Cooperative of Puget Sound, a large prepaid group practice in Seattle. (rand.org)
  • The new program, known as TennCare, operates as a special demonstration project authorized by the Secretary of Health and Human Services under the waiver authority conferred on him by Section 1115 of the Social Security Act, 42 U.S.C. § 1315. (openjurist.org)
  • 1) "Adverse determination" means a determination by a health maintenance organization or a utilization review agent that health care services provided or proposed to be provided to an enrollee are not medically necessary or are not appropriate. (tx.us)
  • 2) "Basic health care services" means health care services that the commissioner determines an enrolled population might reasonably need to be maintained in good health. (tx.us)
  • 4) "Capitation" means a method of compensating a physician or provider for arranging for or providing a defined set of covered health care services to certain enrollees for a specified period that is based on a predetermined payment per enrollee for the specified period, without regard to the quantity of services actually provided. (tx.us)
  • B) that consists in part of providing or arranging for health care services on a prepaid basis through insurance or otherwise, as distinguished from indemnifying for the cost of health care services. (tx.us)
  • 13) "Health care services" means services provided to an individual to prevent, alleviate, cure, or heal human illness or injury. (tx.us)
  • This retrospective, cohort study included members ≥ 21 years old from the Maccabi Healthcare Services, a large health maintenance organization in Israel, who were diagnosed with FM from 2008 through 2011. (jrheum.org)
  • Therefore, an HMO is an organization that has the sole purpose of providing equal access to health care services in exchange for members agreeing to certain terms. (thebalancecareers.com)
  • DefinitionIllustrative caselaw A health care delivery system where the provider offers a participant a comprehensive range of health services for a fixed premium. (cornell.edu)
  • Even before the enactment of the law, an organization called Group Health, Inc., had been providing medical services to its subscribing members since 1957. (mnhs.org)
  • Workplace wellness programs are increasingly adopted by companies for their value in improving the health and well-being of their employees, as are school health services in order to improve the health and well-being of children. (chiefofleast.com)
  • As per the Constitution of Canada, health care is mainly a provincial government responsibility in Canada (the main exceptions being federal government responsibility for services provided to aboriginal peoples covered by treaties, the Royal Canadian Mounted Police, the armed forces, and Members of Parliament). (chiefofleast.com)
  • Under the Canada Health Act, the federal government mandates and enforces the requirement that all people have free access to what are termed "medically necessary services," defined primarily as care delivered by physicians or in hospitals, and the nursing component of long-term residential care. (chiefofleast.com)
  • Four provinces allow insurance for services also mandated by the Canada Health Act, but in practice there is no market for it. (chiefofleast.com)
  • Inpathy, Aetna's in-network telemental health services provider (also known as Televideo): Call (800) 442-8938. (princeton.edu)
  • The briefest definition of an HMO is A corporation which provides health services to enrollees on a prepayment per capita basis. (uncg.edu)
  • The health services may be provided by the corporation or may be subcontracted in part or in whole. (uncg.edu)
  • It would not be wise or logical or feasible or probably even legal to use the entire facilities of Moses Cone Hospital as a prepaid provider of-health services. (uncg.edu)
  • Making appropriations for the Departments of Labor, Health and Human Services, and Education, and related agencies, for the fiscal year ending September 30, 1995, and for other purposes. (govtrack.us)
  • Use of services by diabetes patients in managed care organizations. (jamanetwork.com)
  • Stat., that makes available to its enrolled participants in consideration for predetermined periodic fixed payments, comprehensive health care services performed by providers selected by the organization. (wi.gov)
  • Health insurance typically covers a wide range of medical services, including doctor and hospital visits, emergency care, and more. (progressive.com)
  • Bear in mind, these are broad categories of health services. (progressive.com)
  • Some health care services require preapproval or prior authorization from your insurance provider before care is given (emergency services don't need preapproval). (progressive.com)
  • In the US, health care services for the elderly are funded mainly by Medicare , Medicaid , the Veterans Health Administration , private insurance , and out-of-pocket payments. (merckmanuals.com)
  • In addition, many states offer health-related benefits and programs, such as subsidies for transportation, housing, utilities, telephone, and food expenses, as well as help at home and nutrition services. (merckmanuals.com)
  • Collectively, these programs rarely promote integration of acute and long-term care or coordination of health and social services. (merckmanuals.com)
  • PACE includes medical and dental care, adult day care (including transportation to and from the facility), health and personal care at home, prescription drugs, social services, rehabilitation, meals, nutritional counseling, and hospital and long-term care when needed. (merckmanuals.com)
  • PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services. (merckmanuals.com)
  • A life-care community or continuing care retirement community provides housing, health care, and other services under packaged financing and management. (merckmanuals.com)
  • Members of a PPO can receive health care services from a participating medical network at a discount. (insurancespecialists.com)
  • and children's health services (including oral and vision care). (diabetesselfmanagement.com)
  • A primary care physician is typically an individual's first point of contact for all health-related issues. (investopedia.com)
  • Generally, members of an HMO can only see a health care specialist (hematologist, cardiologist, rheumatologist) if they get a referral from their primary care physician, also known as a gatekeeper. (cascadehc.org)
  • Your primary care physician serves as your health care advocate and will help you find the best treatment for physical and mental health problems you might face. (cascadehc.org)
  • OBJECTIVE: The objective of this study was to estimate the effect of Medicare Health Maintenance Organization (HMO) enrollment on hospitalization rates and total inpatient days for ambulatory care-sensitive conditions (ACSCs) after controlling for selection. (rand.org)
  • SUBJECTS: Enrollment data on Medicare beneficiaries in California were linked to hospital discharge data from the California Office of Statewide Health Planning and Development for January through December 1996. (rand.org)
  • In administrative areas an HMO must prove its fiscal soundness, offer a standard grievance procedure to its members and allow open enrollment at specific intervals, regardless of the current health of an applicant. (thecrimson.com)
  • The ideal time to do this is during the open enrollment period with their employer or during the sign-in period for the health market exchanges under the Patient Protection and Affordable Care Act. (diabetesselfmanagement.com)
  • Peterson, Christine E., M. M. Nelsen, and Deborah L. Wesley, Aggregated Claims Series: Volume 4: Codebooks for Health Maintenance Organization and Seattle Fee-for-Service Visits - Outpatient and Inpatient. (rand.org)
  • The costs attributable to the 25 conditions accounted for 78 percent of the health maintenance organization's total direct medical expense for this age-group. (nih.gov)
  • 6) "Complaint" means any dissatisfaction expressed orally or in writing by a complainant to a health maintenance organization regarding any aspect of the health maintenance organization's operation. (tx.us)
  • It's important to know how health insurance is organized and what it will and won't cover before you search how to get health insurance . (benzinga.com)
  • Health Care Utilization in Chronic Obstructive Pulmonary Disease: A Case-Control Study in a Health Maintenance Organization. (jamanetwork.com)
  • Hurley JFrost FGTrinkaus KMBuatti MCEmmett KE Relationship of compliance with hormone replacement therapy to short-term health care utilization in a managed care population. (jamanetwork.com)
  • The diagnoses and mental health utilization associated with their use are explored, and concomitant drug use is investigated. (elsevier.com)
  • 1984 WHO revised the definition of health defined it as "the extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. (chiefofleast.com)
  • High blood pressure (also known as hypertension) is the health condition of having blood pressure readings above 140/90 mmHg, over a number of weeks. (reliancehmo.com)
  • Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. (lww.com)
  • Contact Wolters Kluwer Health, Inc. (lww.com)
  • Pursuant to a legislative requirement, GAO provided an overview of the data and methodology for computing Medicare monthly capitation payments to risk-contract health maintenance organizations (HMO). (gao.gov)
  • An individual who needs to secure health insurance may find a variety of health insurance providers with unique features. (investopedia.com)
  • In many cases, the HMO supports preventative wellness care, which is what health care providers advocate for. (thebalancecareers.com)
  • You'll be given a list of health care providers that you can visit. (benzinga.com)
  • FHCP is a healthcare maintenance organization with a large network of providers. (afionline.org)
  • Being a West Metro Chamber member has been invaluable to the success of our nonprofit organization and allowed us to focus more time on our mission and less time on everything else. (westchamber.org)
  • 3) "Blended contract" means a single document that provides a combination of indemnity and health maintenance organization benefits. (tx.us)
  • Data on detailed provisions of health insurance and retirement benefits for both private industry and state and local government also are available. (bls.gov)
  • Health care workers should help elderly patients learn about health benefits and programs they are entitled to. (merckmanuals.com)
  • Individuals learn about contraceptive methods, including their risks and benefits, as well as how to use them, from a wide variety of sources: friends and family, the electronic and print media, health professionals and the educational materials that they distribute, such institutions as schools and colleges, and numerous community resources. (nap.edu)
  • Just as there was a shift from viewing disease as a state to thinking of it as a process, the same shift happened in definitions of health. (chiefofleast.com)
  • Mental, intellectual, emotional and social health referred to a person's ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living. (chiefofleast.com)
  • A nonprofit organization that offers health insurance to a group of persons and charges members of the group the same monthly premium. (thefreedictionary.com)
  • In this study, exposure to antipsychotic drugs among ambulatory health maintenance organization (HMO) members is described. (elsevier.com)
  • d)Fee-for-service methods of delivering health care have perverse incentives to provide unnecessary health care at inflated costs. (gmatclub.com)
  • What's required is a network of Preventive Health Maintenance Organizations (PHMO) to provide prepaid care for a wide range of alternative or simply relaxing treatments. (thefreedictionary.com)
  • To provide in-depth perspective on some aspects of disparities in health care, we have commissioned 4 brief commentaries (see pages 221-225). (annals.org)
  • health-maintenance organization (HMO) A type of health-care organization developed in the USA, initially on co-operative principles, now increasingly run by profit-making corporations. (encyclopedia.com)
  • Health care concerns have placed the matter high on the national agenda, with calls for reform. (mnhs.org)
  • They are a Health Maintenance Organization which was established with the objective of becoming the HMO of choice for corporate entities and all subscribing enrolees, who want good quality healthcare accessed through a technology enabled platform that will enhance the whole customer experience. (myjobmag.com)