Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Insurance Coverage: Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)Insurance: Coverage by contract whereby one part indemnifies or guarantees another against loss by a specified contingency.Insurance, Long-Term Care: Health insurance to provide full or partial coverage for long-term home care services or for long-term nursing care provided in a residential facility such as a nursing home.Insurance, Life: Insurance providing for payment of a stipulated sum to a designated beneficiary upon death of the insured.Insurance Carriers: Organizations which assume the financial responsibility for the risks of policyholders.Insurance Pools: 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.Medically Uninsured: Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.Insurance Selection Bias: Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.Insurance, Dental: Insurance providing coverage for dental care.Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.Insurance, Health, Reimbursement: Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)Health Benefit Plans, Employee: Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.Insurance, Liability: Insurance against loss resulting from liability for injury or damage to the persons or property of others.Insurance Claim Reporting: The design, completion, and filing of forms with the insurer.Insurance, Major Medical: 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, Accident: Insurance providing coverage for physical injury suffered as a result of unavoidable circumstances.United StatesNational Health Insurance, United StatesUniversal Coverage: Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions.Insurance, Hospitalization: Health insurance providing benefits to cover or partly cover hospital expenses.Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.Health Insurance Portability and Accountability Act: Public Law 104-91 enacted in 1996, was designed to improve the efficiency and effectiveness of the healthcare system, protect health insurance coverage for workers and their families, and to protect individual personal health information.Medicaid: Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.National Health Programs: Components of a national health care system which administer specific services, e.g., national health insurance.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.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.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.Eligibility Determination: Criteria to determine eligibility of patients for medical care programs and services.Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.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.Insurance, Psychiatric: Insurance providing benefits to cover part or all of the psychiatric care.Medical Assistance: Financing of medical care provided to public assistance recipients.Fees and Charges: Amounts charged to the patient as payer for health care services.Financing, Personal: Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.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".Patient Protection and Affordable Care Act: An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.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)Insurance, Disability: Insurance designed to compensate persons who lose wages because of illness or injury; insurance providing periodic payments that partially replace lost wages, salary, or other income when the insured is unable to work because of illness, injury, or disease. Individual and group disability insurance are two types of such coverage. (From Facts on File Dictionary of Health Care Management, 1988, p207)Health Insurance Exchanges: State-provided health insurance marketplaces established under the PATIENT PROTECTION AND AFFORDABLE CARE ACT.Social Security: Government sponsored social insurance programs.Child Health Services: Organized services to provide health care for children.Income: Revenues or receipts accruing from business enterprise, labor, or invested capital.Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.Healthcare Disparities: Differences in access to or availability of medical facilities and services.Poverty: A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.State Government: The level of governmental organization and function below that of the national or country-wide government.Tax Exemption: Status not subject to taxation; as the income of a philanthropic organization. Tax-exempt organizations may also qualify to receive tax-deductible donations if they are considered to be nonprofit corporations under Section 501(c)3 of the United States Internal Revenue Code.Aid to Families with Dependent Children: Financial assistance provided by the government to indigent families with dependent children who meet certain requirements as defined by the Social Security Act, Title IV, in the U.S.TaiwanHealth Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Health Services: Services for the diagnosis and treatment of disease and the maintenance of health.Health Care Sector: Economic sector concerned with the provision, distribution, and consumption of health care services and related products.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)Models, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.Financing, Government: Federal, state, or local government organized methods of financial assistance.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.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.Income Tax: Tax on the net income of an individual, organization, or business.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.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)Federal Government: The level of governmental organization and function at the national or country-wide level.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.Employer Health Costs: That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.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.CaliforniaHealth 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)Blue Cross Blue Shield Insurance Plans: Prepaid health and hospital insurance plan.Reimbursement Mechanisms: Processes or methods of reimbursement for services rendered or equipment.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.Insurance, Surgical: A specific type of health insurance which provides surgeons' fees for specified amounts according to the type of surgery listed in the policy.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)Medical Indigency: 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.Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.Managed Competition: A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.Mandatory Programs: Programs in which participation is required.Privatization: Process of shifting publicly controlled services and/or facilities to the private sector.Medical Savings Accounts: Tax-exempt trusts or custodial accounts established by individuals with financial institutions for saving money for future medical expenses.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)Politics: Activities concerned with governmental policies, functions, etc.Employment: The state of being engaged in an activity or service for wages or salary.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.Public Sector: The area of a nation's economy that is tax-supported and under government control.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)Insurance, Nursing Services: Insurance providing benefits for the costs of care provided by nurses, especially nurse practitioners and nurse clinicians.Social Welfare: Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.Hispanic Americans: Persons living in the United States of Mexican (MEXICAN AMERICANS), Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. The concept does not include Brazilian Americans or Portuguese Americans.Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.Rate Setting and Review: A method of examining and setting levels of payments.Disabled Children: Children with mental or physical disabilities that interfere with usual activities of daily living and that may require accommodation or intervention.Compensation and Redress: Payment, or other means of making amends, for a wrong or injury.Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Catastrophic Illness: An acute or prolonged illness usually considered to be life-threatening or with the threat of serious residual disability. Treatment may be radical and is frequently costly.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.Government Regulation: Exercise of governmental authority to control conduct.Retirement: The state of being retired from one's position or occupation.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.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.Malpractice: 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)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.Single-Payer System: An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs. (From Slee and Slee, Health Care Reform Terms, 1993, p106)Taxes: Governmental levies on property, inheritance, gifts, etc.Cost Allocation: The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.Workers' Compensation: Insurance coverage providing compensation and medical benefits to individuals because of work-connected injuries or disease.Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs.Patient Acceptance of Health Care: The seeking and acceptance by patients of health service.Family Characteristics: Size and composition of the family.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).Labor Unions: Organizations comprising wage and salary workers in health-related fields for the purpose of improving their status and conditions. The concept includes labor union activities toward providing health services to members.Continental Population Groups: Groups of individuals whose putative ancestry is from native continental populations based on similarities in physical appearance.Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.Preventive Health Services: Services designed for HEALTH PROMOTION and prevention of disease.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.Hospitalization: The confinement of a patient in a hospital.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.OregonMultivariate 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.Social Justice: An interactive process whereby members of a community are concerned for the equality and rights of all.Questionnaires: 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.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.Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.Not-For-Profit Insurance Plans: Health insurance plans that are not intended to generate profit.Consumer Participation: Community or individual involvement in the decision-making process.New JerseyDemography: Statistical interpretation and description of a population with reference to distribution, composition, or structure.Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.Fees, Medical: Amounts charged to the patient as payer for medical services.Vulnerable Populations: Groups of persons whose range of options is severely limited, who are frequently subjected to COERCION in their DECISION MAKING, or who may be compromised in their ability to give INFORMED CONSENT.Economics, Dental: Economic aspects of the dental profession and dental care.GermanySocial Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income.Child Welfare: Organized efforts by communities or organizations to improve the health and well-being of the child.Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982).African Americans: Persons living in the United States having origins in any of the black groups of Africa.Inflation, Economic: An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.Liability, Legal: Accountability and responsibility to another, enforceable by civil or criminal sanctions.Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.MassachusettsDental Health Services: Services designed to promote, maintain, or restore dental health.Infant, Newborn: An infant during the first month after birth.Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.Cost of Illness: The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.Pensions: Fixed sums paid regularly to individuals.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.FloridaBankruptcy: The state of legal insolvency with assets taken over by judicial process so that they may be distributed among creditors.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.Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.Republic of Korea: The capital is Seoul. The country, established September 9, 1948, is located on the southern part of the Korean Peninsula. Its northern border is shared with the Democratic People's Republic of Korea.Physician's Practice Patterns: Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.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.New YorkCompetitive 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)Work Capacity Evaluation: 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.European Continental Ancestry Group: Individuals whose ancestral origins are in the continent of Europe.WashingtonGhana: A republic in western Africa, south of BURKINA FASO and west of TOGO. Its capital is Accra.Genetic Privacy: The protection of genetic information about an individual, family, or population group, from unauthorized disclosure.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.Healthcare Financing: Methods of generating, allocating, and using financial resources in healthcare systems.Financing, Organized: All organized methods of funding.Comprehensive Health Care: Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients.Confidentiality: The privacy of information and its protection against unauthorized disclosure.Government Programs: Programs and activities sponsored or administered by local, state, or national governments.Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.Physicians: Individuals licensed to practice medicine.Public Opinion: The attitude of a significant portion of a population toward any given proposition, based upon a measurable amount of factual evidence, and involving some degree of reflection, analysis, and reasoning.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.Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations.Dental Care for Children: The giving of attention to the special dental needs of children, including the prevention of tooth diseases and instruction in dental hygiene and dental health. The dental care may include the services provided by dental specialists.Community Health Centers: Facilities which administer the delivery of health care services to people living in a community or neighborhood.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.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.Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease.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)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.Choice Behavior: The act of making a selection among two or more alternatives, usually after a period of deliberation.Health Services Administration: The organization and administration of health services dedicated to the delivery of health care.Educational Status: Educational attainment or level of education of individuals.Reimbursement, Incentive: A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.China: A country spanning from central Asia to the Pacific Ocean.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.Efficiency, Organizational: The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.Attitude to Health: Public attitudes toward health, disease, and the medical care system.Mammography: Radiographic examination of the breast.Emergency Service, Hospital: Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.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.Hospital Charges: The prices a hospital sets for its services. HOSPITAL COSTS (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care.Models, Organizational: 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.Patient Credit and Collection: Accounting procedures for determining credit status and methods of obtaining payment.Emigration and Immigration: The process of leaving one's country to establish residence in a foreign country.Continuity of Patient Care: Health care provided on a continuing basis from the initial contact, following the patient through all phases of medical care.Korea: Former kingdom, located on Korea Peninsula between Sea of Japan and Yellow Sea on east coast of Asia. In 1948, the kingdom ceased and two independent countries were formed, divided by the 38th parallel.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.Privacy: The state of being free from intrusion or disturbance in one's private life or affairs. (Random House Unabridged Dictionary, 2d ed, 1993)

The role of dentists in dentistry. (1/41)

The extent to which dentists influence the outcomes of dental care, compared to the effects of dental technology or patient variation, has not been well studied. A review of the literature on the personality and value structures of dentists and dental students reveals general trends involving preferences of concrete, utilitarian, unambiguous, and conventional situations that are classified and judged in terms of their potential for dentists' power and control and for relationships of helping others but avoiding mutual dependency. These findings are summarized in a hypothesis that dentists seek situations where they can exercise control and establish paternalistic relationships with others. The evidence about career satisfaction of dentists is difficult to interpret. Between 20 percent and 50 percent of dentists report that they would not choose to enter the profession again if given a chance. Yet the number leaving the profession voluntarily is less than the number of career changers in the general population by a factor of about 1 to 15. Career satisfaction of practitioners can be partially predicted from an understanding of dentists' personality and values. Factors such as uncooperative patients, incompetent staff, and government and insurance intrusions are major dissatisfiers; they threaten dentists' core need for control. Factors such as quality of work, which is under the control of dentists, are major satisfiers. The personalities and values of dentists and the expression of these in professional norms may function to limit our understanding of dentistry. Based on this analysis, eight predictions are offered about the profession.  (+info)

The unbearable lightness of healthcare policy making: a description of a process aimed at giving it some weight. (2/41)

OBJECTIVES: To investigate whether a structured process to involve policy makers in designing a research project on a return to work insurance policy would yield evidence that was relevant, useful, and used in policy decisions. STUDY DESIGN: Case study. SETTING: Norway. PARTICIPANTS: Two researchers from the National Institute of Public Health and four representatives from respectively the National Insurance Administration, Norwegian Confederation of Trade Unions, Confederation of Norwegian Business and Industry, and Norwegian Medical Association. INTERVENTION: Structured discussions of the research, including the objectives, interventions, design, and interpretation of the results. RESULTS: The participants succeeded in designing and completing a cluster randomised controlled trial through the participatory process. Intermediary results from the trial have been used in practical planning within the National Insurance Administration, but there are few indications that the main results of the trial have been used. CONCLUSIONS: This approach of involving policy makers in the research planning process when political or organisational values are at stake did not succeed in this case. The salient explanations for this are conflicting interests of the organisations involved in the process and the research findings were in conflict with those interests.  (+info)

What price medical malpractice insurance? (3/41)

The Medical Review and Advisory Board has been established as a committee of the Commission on Professional Welfare of the California Medical Association to make studies and recommendations toward solution of the growing problems of professional liability insurance and malpractice actions in California. The members of the Board are: Joseph F. Sadusk, Jr., Oakland, Chairman; Wilbur Bailey, M.D., Los Angeles, vice-chairman; Howard W. Bosworth, M.D., Los Angeles; H. I. Burtness, M.D., Santa Barbara; Paul W. Frame, Jr., M.D., Sacramento; Verne G. Ghormley, M.D., Fresno; Carl M. Hadley, M.D., San Bernardino; Joseph J. O'Hara, M.D., San Diego; William F. Quinn, M.D., Los Angeles; Rees B. Rees, M.D., San Francisco; and Bernard Silber, M.D., Redwood City; Mr. Rollen Waterson, 564 Market Street, San Francisco 4, is executive secretary, and Mr. Howard Hassard is legal counsel.  (+info)

Genetic discrimination and the law. (4/41)

The use of genetic tests can lead to genetic discrimination, discrimination based solely on the nature of an individual's genotype. Instances of the discriminatory uses of genetic tests by employers and insurance companies have already been reported. The recently enacted Americans with Disabilities Act of 1990 (ADA), together with other federal and state laws, can be used to combat some forms of this discrimination. In this article we define and characterize genetic discrimination, discuss the applicability of the various relevant federal and state laws, including the ADA, in the areas of employment and insurance discrimination, explore the limitations of these laws, and, finally, suggest some means of overcoming these limitations.  (+info)

Analysis of your professional liability insurance policy. (5/41)

The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following:1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field.2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances.3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage.4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for "latent liability" claims as the years go along-certainly for his lifetime.5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000.6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service.7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage.8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice.9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors.  (+info)

Inadequate follow-up for abnormal Pap smears in an urban population. (6/41)

PURPOSE: To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. METHODS: Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions. RESULTS: Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared with private insurance (OR 1.9, 95% CI 1.01-3.5). After 12 months, 26% of women with abnormal Pap smears still had not received follow-up. CONCLUSIONS: In a predominantly urban minority population, the overall rate of inadequate follow-up for abnormal Pap smears was high at 38%. Programs to address follow-up of abnormal cervical cytology should focus on minority populations, especially younger and all low-income women.  (+info)

State legislative efforts to regulate use and potential misuse of genetic information. (7/41)

The purpose of this study was to review existing and proposed legislation specifically intended to regulate the collection, use, and potential misuse of genetic data. The study encompasses laws relating to confidentiality, informed consent, discrimination, and related issues. It excludes from consideration legislation relating to medical records generally that may bear indirectly on genetic information. It also excludes both legislation relating to the regulation of DNA data collection for law enforcement purposes and state laws relating to the confidentiality of data collected by newborn-screening programs. While relatively few laws that explicitly regulate the treatment of genetic information have been enacted to date, a considerable amount of activity is currently underway in the nation's legislatures. Although most of the bills under consideration are not comprehensive in scope, they reflect a growing societal awareness that the uncontrolled dissemination and use of genetic data entails significant risks.  (+info)

Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. (8/41)

BACKGROUND: The authors used the American Society of Anesthesiologists Closed Claims Project database to identify specific patterns of injury and legal liability associated with regional anesthesia. Because obstetrics represents a unique subset of patients, claims with neuraxial blockade were divided into obstetric and nonobstetric groups for comparison. METHODS: The American Society of Anesthesiologists Closed Claims Project is a structured evaluation of adverse anesthetic outcomes collected from closed anesthesia malpractice insurance claims of professional liability companies. An in-depth analysis of 1980-1999 regional anesthesia claims was performed with a subset comparison between obstetric and nonobstetric neuraxial anesthesia claims. RESULTS: Of the total 1,005 regional anesthesia claims, neuraxial blockade was used in 368 obstetric claims and 453 of 637 nonobstetric claims (71%). Damaging events in 51% of obstetric and 41% of nonobstetric neuraxial anesthesia claims were block related. Obstetrics had a higher proportion of neuraxial anesthesia claims with temporary and low-severity injuries (71%) compared with the nonobstetric group (38%; P +info)

  • Others may require an insurance certificate from Biola because of contractual requirements (e.g., professional liability to set up an internship at a hospital). (
  • Paul is a leading commercial practitioner specialising in construction, professional liability, property damage and insurance. (
  • Construction Professional indemnity Insurance , published by Sweet & Maxwell in 2018. (
  • Such property must be covered on the contractor's/vendor's own property insurance and contractor/vendor agrees to waive right of subrogation against Biola University. (
  • Insurance certificates and additional endorsement pages must be emailed in PDF format to [email protected] . (
  • Until now, no text has introduced GLMs in this context or addressed the problems specific to insurance data. (
  • Using insurance data sets, this practical, rigorous book treats GLMs, covers all standard exponential family distributions, extends the methodology to correlated data structures, and discusses recent developments which go beyond the GLM. (
  • The issues in the book are specific to insurance data, such as model selection in the presence of large data sets and the handling of varying exposure times. (
  • Buy Generalized Linear Models for Insurance Data by Piet de Jong from Australia's Online Independent Bookstore, Boomerang Books. (
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  • You can earn a 5% commission by selling Generalized Linear Models for Insurance Data (International Series on Actuarial Science) on your website. (
  • "Methodical, commercial and someone with great advocacy skills" , he is recommended as a leading silk in Construction as well as Insurance and Reinsurance by Chambers UK and Legal 500 and in Property Damage by Chambers UK. (
  • Simplify insurance verification with search optimization functionality, allowing you to execute multiple searches to ensure the highest likelihood of finding a patient match. (
  • We investigate the design of an optimal Unemployment Insurance program using an equilibrium search and matching model calibrated using data from the reemployment bonus experiments and secondary sources. (
  • We analyzed what would happen if public options became available in U.S. health insurance exchanges. (
  • The second is allowing flat-fee primary care practices, also referred to as Direct Primary Care Medical Homes (DPC for short), to compete within the state-based insurance exchanges. (
  • This relatively little-known provision in the law creates an affordable new choice for individuals and businesses by allowing flat-fee DPC practices to compete within the state-based insurance exchanges. (
  • As the leading provider of professional services to Bermuda's insurance and reinsurance industry, we are ready to help you with your most challenging issues, from strategy to execution. (
  • These informal beginnings led to the establishment of the insurance market Lloyd's of London and several related shipping and insurance businesses. (
  • Both leave sizeable chunks of capacity at Lloyd's of London, the insurance market. (
  • Grange markets its products exclusively through a network of about 3,600 independent agents to offer home, auto, life, and business insurance protection to policyholders. (
  • Salesforce insurance solutions allow policyholders to easily communicate with the right representative with more immediacy and accuracy than traditional channels. (
  • That's why we created a back-to-basics video walking through some basic insurance terms. (
  • The Optimal Payment of Unemployment Insurance Benefits over Time ," Journal of Political Economy , University of Chicago Press, vol. 87(6), pages 1347-1362, December. (
  • The Optimal Payment of Unemployment Insurance Benefits over Time ," Cowles Foundation Discussion Papers 503, Cowles Foundation for Research in Economics, Yale University. (
  • Hi I live in Chicago and was trying to find a better auto insurance one who could handle claims quickly has anyone ever had auto insurance with Lincoln Auto Insurance I was wondering how they handle claims. (
  • Find health insurance options in your state. (
  • Find out more about Cannabis and Insurance. (
  • Find out if Long Term Care insurance is something for you. (
  • The reader will find information on the diverse activities of this industry and on international insurance market trends. (
  • To find out, we interviewed some travel experts who rely on travel insurance and advise others on how to do the same. (
  • You can also start at a One Stop Career Center or call the Department of Labor at (877) US2-JOBS to find your local unemployment insurance agency. (
  • 8. Grown up insurance sector The insurance industry has grown by 83 per cent since the opening up of the sector. (
  • With the industry facing disruption on multiple fronts, our unrivalled strength and specialist insurance resources can help you to focus on the opportunities. (
  • With no modeling or abstraction involved, business terms define in plain business language the industry concepts that are involved in the insurance industry. (
  • Insurance Technologies Corporation (ITC), founded in 1983, is a leading provider of agency marketing , rating and management software and services to the insurance industry, including independent agents and insurance carriers. (
  • Aetna 's CEO, Mark Bertolini, has been the most powerful voice in the health insurance industry articulating how their business model has been flawed. (
  • Check out this collection of videos showcasing the best insurance, insurtech, and fintech success stories from the senior executives and industry thought leaders who attended this year's New York World Tour event. (
  • Do you think insurtechs are having a mostly positive or negative effect on the P/C insurance industry? (
  • Do you think young people being hired by the insurance industry today are being overpaid? (
  • Explore our insurance industry ranking and award lists. (
  • COVID-19, Hurricane Season, Cyber Risk: Is the Insurance Industry Ready for a Compound Disaster? (
  • California Organized Investment Network (COIN) Is a Collaborative Effort Between the California Department of Insurance, the Insurance Industry, Community Affordable Housing and Economic Development Organizations, and Community Advocates. (
  • Three digital trends disrupting the insurance industry. (
  • In the insurance industry, the average cost of acquiring a new customer continues to increase. (
  • RIMS provides a formal platform where experts and learners of insurance and risk management can exchange ideas, best practices and industry changes to over 10,000 risk management professionals who operate in more than 120 countries. (
  • More than 90 percent of long-term disabilities aren't linked to work, according to the insurance industry trade group Council for Disability Awareness. (
  • In June 2008, Commerce Group, Inc. was acquired by Mapfre S.A. Mapfre is the largest insurance group in Latin America and has a presence in 43 countries, with about 51,000 agents worldwide. (
  • Health insurance in Theodore Roosevelt's America. (
  • Explainer thanks Paul Dutton of Northern Arizona University, Beatrix Hoffman, author of The Wages of Sickness: The Politics of Health Insurance in Progressive America , Howard Markel of the University of Michigan, and Ronald Numbers of the University of Wisconsin. (
  • The purpose of these SOP's are to demonstrate best practices in managing the risks and insurance issues associated with the activities of the York University community. (
  • The tendency of individuals with poorer-than-average risks to buy and maintain insurance. (
  • With Obamacare there has to be at least one form of medication for a condition and covered by your insurance, so it could be Remicade, Humira, Simponi, etc or all of them. (
  • The U.S. health insurance model frequently costs more and provides less care than systems in other Western nations. (
  • Provide members with a more personalized health insurance experience and better service while managing health care costs. (
  • There are many different ways to buy health insurance, and the costs and benefits vary widely for each one. (
  • Travel insurance is a type of insurance that covers the costs and losses associated with traveling. (
  • Health insurance helps protect you from high medical care costs. (
  • If your child takes a car to school, your insurance costs will rise or fall depending on the location. (
  • Some economists now argue that consumers should pay more out of their own pockets, not only to lower the cost of insurance but because, it is argued, insurance itself is one of the culprits behind rising health care costs. (
  • According to this view, the advantage of insurance - that is shields the patient from disastrously high medical costs - is also something of a drawback because insurance also give the illusion that medical are is free. (
  • Is it true it costs 6 thousand a year to add a teenager to your car insurance in michigan? (
  • The DPC models have a membership model that isn't insurance-based and so they avoid the 40% or more of the costs associated with insurance that doesn't positively impact patient well-being. (
  • If travelling within your country of residence, you can buy cheaper domestic travel insurance within that country, but you may decide that you do not need it at all if you are willing to risk losing costs associated with cancellations and so on. (
  • In the first years of the 20th century, income-replacement insurance was far more common than health insurance, since medical costs were relatively low. (
  • Generally, travel insurance costs between 5 percent and 15 percent of the total cost of your trip. (
  • Insurance is very much a data-driven business, and as such careful records are kept of costs of all types. (
  • Other costs are not so readily estimated, especially in the early years of a given insurance product. (
  • Buying health insurance on your own might be a more expensive option than sharing risk with a larger group of people (such as other students, employees, etc. (
  • NOTE: The VW Up is in insurance group 1 How much would it cost to be put onto someone else's insurance? (
  • The earliest form of insurance is probably marine insurance, although forms of mutuality (group self-insurance) existed before that. (
  • Grange Insurance Services, Inc. served as a general agent in Ohio and conducted all sales efforts and promotions. (
  • RAND's health insurance research began in 1971 with the 15-year Health Insurance Experiment, the only community-based experimental study of how cost-sharing arrangements affect people's use of health services, their quality of care, and their health status. (
  • Insurance business has emerged as one of the prominent financial services during recent times, particularly in developing countries where it could not grow before globalization. (
  • Insurance Technologies Corporation (ITC), a leading provider of marketing, rating and management software and services, announced today the addition of compliance auditing to Insurance Website Builder for MGAs, aggregators and agency clusters. (
  • They are the nation's only fully-unionized provider of multi-line insurance, financial services and administrative products. (
  • Insurance services transform to appeal to the customer of the future. (
  • Insurance and Risk Management Services strives to be a consultative resource to the University community in advising about insurance, claims and paralegal issues relating to Risk Management. (
  • Also, check your credit cards to see what they cover when you purchase travel services using them, such as collision-and-damage waiver insurance for car rentals. (
  • USAA is a diversified insurance and financial services organization that has served the military community since 1922. (
  • refers to financial planning services and financial advice provided by USAA Financial Planning Services Insurance Agency, Inc. (known as USAA Financial Insurance Agency in California), a registered investment adviser and insurance agency, and its wholly owned subsidiary. (
  • If you do not have insurance, we will send you a bill for any amount that you did not pay when you received services at OHSU. (
  • Here's why: If you cause an accident that results in multiple injuries or major property damage, the bills could exceed your insurance limits and you could be sued for the rest. (
  • Enterprise Content Management offers insurance providers the ability to manage documents digitally, maximising responsiveness and improving delivery of service. (
  • How compliance auditing works in Insurance Website Builder: When a member agent makes a change to the content of his or her insurance agency website or creates a new blog post, a link to the new content is sent to the organization's compliance department. (
  • Looking for auto insurance good rates im 21 in Chicago any suggestion? (
  • I'm well aware that New Jersey has high auto insurance, but I wanted to know does anyone have an recommendations on an affordable auto insurance. (
  • Price is the deciding factor for many auto insurance shoppers. (
  • Fortunately Ohio auto insurance rates tend to be well below the national average. (
  • Grange and Geico have the cheapest auto insurance rates in our study for Ohio drivers with poor credit. (
  • If you're able to improve your credit, make sure your auto insurance reruns your credit so that you can get better rates. (
  • Buying only the minimum required auto insurance is one way to reduce your car insurance bill, but it will leave you open to expensive lawsuits that your insurance won't cover. (
  • Erie and Grange has the best rates for Ohio minimum auto insurance in our study. (
  • If you drive, Oregon law requires you to have auto insurance. (
  • Motorcycle collision insurance covers damage to your motorcycle if you are involved in a collision with another vehicle. (
  • Your son would need collision insurance to pay for the damages to his car. (
  • This expository paper describes the factors that contribute to failure of health insurance markets, and the regulatory mechanisms that have been and can be used to combat these failures. (
  • ACE and, even more aggressively, XL now harbour the ambition to be pioneers in "financial insurance", an attempt to bridge the gap between insurance and the capital markets. (
  • Hence the development of "insurance-risk securities", the best example of the convergence between insurance and the capital markets. (
  • The rationale for pre-existing condition exclusions is that medical insurance works the same way other insurances do: that insurance covers fortuitous occurrences, nor ones that are planned, intentional, or predictable. (
  • Tens of thousands of people across the country are losing insurance benefits or electing not to participate at a time when many individuals need it most,' said Mary Boysman, Vice President, Brand Marketing and Advertising, Aspen Dental Management, Inc. 'Many of those people live in communities where Aspen Dental offices are located. (
  • First, insurance considerations suggest that the potential duration of UI benefits would be unlimited under an optimal program. (
  • The Mission of the Bowling Green State University Student Insurance Office is to support and empower students in an inclusive environment to become knowledgeable health care consumers, assist them as they navigate through the health insurance process while achieving their academic goals, and provide a student insurance product at the highest possible benefit level and lowest possible cost. (
  • Dental hygiene is very important and depending on what you need taken care of - you may want to purchase some outside dental insurance. (