Prepaid Health Plans: Contracts between an insurer and a subscriber or a group of subscribers whereby a specified set of health benefits is provided in return for a periodic premium.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.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.Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Public 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.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.Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.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)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.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.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Health Planning: Planning for needed health and/or welfare services and facilities.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Insurance Selection Bias: Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.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)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.Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.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.Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)Health Care Sector: Economic sector concerned with the provision, distribution, and consumption of health care services and related products.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)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)Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.United StatesHealth 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.Mental Health: The state wherein the person is well adjusted.Medical Savings Accounts: Tax-exempt trusts or custodial accounts established by individuals with financial institutions for saving money for future medical expenses.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)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)Health Services: Services for the diagnosis and treatment of disease and the maintenance of health.Insurance Carriers: Organizations which assume the financial responsibility for the risks of policyholders.Health: The state of the organism when it functions optimally without evidence of disease.Attitude to Health: Public attitudes toward health, disease, and the medical care system.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.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 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.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.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)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.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)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.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.World Health: The concept pertaining to the health status of inhabitants of the world.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)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.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)Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Health Care Rationing: Planning for the equitable allocation, apportionment, or distribution of available health resources.Consumer Participation: Community or individual involvement in the decision-making process.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).National Health Programs: Components of a national health care system which administer specific services, e.g., national health insurance.Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.Mental Health Services: Organized services to provide mental health care.Employer Health Costs: That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.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.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.Patient Acceptance of Health Care: The seeking and acceptance by patients of health service.Public Health Administration: Management of public health organizations or agencies.Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.OregonPreventive Health Services: Services designed for HEALTH PROMOTION and prevention of disease.Blue Cross Blue Shield Insurance Plans: Prepaid health and hospital insurance plan.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.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)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).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.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.Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.Child Health Services: Organized services to provide health care for children.Attitude of Health Personnel: Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.Gatekeeping: 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)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.Occupational Health: The promotion and maintenance of physical and mental health in the work environment.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.Health Plan Implementation: Those actions designed to carry out recommendations pertaining to health plans or programs.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.Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.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.Women's Health: The concept covering the physical and mental conditions of women.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).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.Organizations, Nonprofit: Organizations which are not operated for a profit and may be supported by endowments or private contributions.Rural Health: The status of health in rural populations.Physician Incentive Plans: Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.Health Literacy: Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.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.Urban Health: The status of health in urban populations.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.State Government: The level of governmental organization and function below that of the national or country-wide government.Community Health Planning: Planning that has the goals of improving health, improving accessibility to health services, and promoting efficiency in the provision of services and resources on a comprehensive basis for a whole community. (From Facts on File Dictionary of Health Care Management, 1988, p299)Health Care Coalitions: Voluntary groups of people representing diverse interests in the community such as hospitals, businesses, physicians, and insurers, with the principal objective to improve health care cost effectiveness.Health Resources: Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.Group Practice, Prepaid: An organized group of three or more full-time physicians rendering services for a fixed prepayment.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, 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)Management Audit: Management review designed to evaluate efficiency and to identify areas in need of management improvement within the institution in order to ensure effectiveness in meeting organizational goals.Fees and Charges: Amounts charged to the patient as payer for health care services.Health Insurance Exchanges: State-provided health insurance marketplaces established under the PATIENT PROTECTION AND AFFORDABLE CARE ACT.Rural Health Services: Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.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)Decision Making, Organizational: The process by which decisions are made in an institution or other organization.CaliforniaHealth Facilities: Institutions which provide medical or health-related services.Regional Health Planning: Planning for health resources at a regional or multi-state level.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.MassachusettsContract Services: Outside services provided to an institution under a formal financial agreement.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.Electronic Health Records: Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online consumer health information that is relevant to the health conditions and treatments related to a specific patient.Health Manpower: The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization.Physicians: Individuals licensed to practice medicine.National Health Insurance, United StatesPolitics: Activities concerned with governmental policies, functions, etc.WashingtonModels, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.Pharmaceutical Services: Total pharmaceutical services provided by qualified PHARMACISTS. In addition to the preparation and distribution of medical products, they may include consultative services provided to agencies and institutions which do not have a qualified pharmacist.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.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.Federal Government: The level of governmental organization and function at the national or country-wide level.Benchmarking: Method of measuring performance against established standards of best practice.Reimbursement Mechanisms: Processes or methods of reimbursement for services rendered or equipment.Technology, High-Cost: Advanced technology that is costly, requires highly skilled personnel, and is unique in its particular application. Includes innovative, specialized medical/surgical procedures as well as advanced diagnostic and therapeutic equipment.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.Outcome and Process Assessment (Health Care): Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.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.Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.Employee Retirement Income Security Act: A 1974 Federal act which preempts states' rights with regard to workers' pension benefits and employee benefits. It does not affect the benefits and rights of employees whose employer is self-insured. (From Slee & Slee, Health Care Reform Terms, 1993)Drugs, Generic: Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.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.Choice Behavior: The act of making a selection among two or more alternatives, usually after a period of deliberation.Community Health Centers: Facilities which administer the delivery of health care services to people living in a community or neighborhood.Consumer Advocacy: The promotion and support of consumers' rights and interests.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.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.Catchment Area (Health): A geographic area defined and served by a health program or institution.Information Services: Organized services to provide information on any questions an individual might have using databases and other sources. (From Random House Unabridged Dictionary, 2d ed)Organizational Case Studies: Descriptions and evaluations of specific health care organizations.Women's Health Services: Organized services to provide health care to women. It excludes maternal care services for which MATERNAL HEALTH SERVICES is available.Social Responsibility: The obligations and accountability assumed in carrying out actions or ideas on behalf of others.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.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.Disease Management: A broad approach to appropriate coordination of the entire disease treatment process that often involves shifting away from more expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education, and outpatient care. This concept includes implications of appropriate versus inappropriate therapy on the overall cost and clinical outcome of a particular disease. (From Hosp Pharm 1995 Jul;30(7):596)Organizational Objectives: The purposes, missions, and goals of an individual organization or its units, established through administrative processes. It includes an organization's long-range plans and administrative philosophy.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.Provider-Sponsored Organizations: Entities sponsored by local hospitals, physician groups, and other licensed providers which are affiliated through common ownership or control and share financial risk whose purpose is to deliver health care services.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.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.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.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.Social Justice: An interactive process whereby members of a community are concerned for the equality and rights of all.Fees, Pharmaceutical: Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.Public Health Nursing: A nursing specialty concerned with promoting and protecting the health of populations, using knowledge from nursing, social, and public health sciences to develop local, regional, state, and national health policy and research. It is population-focused and community-oriented, aimed at health promotion and disease prevention through educational, diagnostic, and preventive programs.Maternal Health Services: Organized services to provide health care to expectant and nursing mothers.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.Health Occupations: Professions or other business activities directed to the cure and prevention of disease. For occupations of medical personnel who are not physicians but who are working in the fields of medical technology, physical therapy, etc., ALLIED HEALTH OCCUPATIONS is available.Cooperative Behavior: The interaction of two or more persons or organizations directed toward a common goal which is mutually beneficial. An act or instance of working or acting together for a common purpose or benefit, i.e., joint action. (From Random House Dictionary Unabridged, 2d ed)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.Reproductive Health: The physical condition of human reproductive systems.For-Profit Insurance Plans: Health insurance plans that are intended to be for profit.Contracts: Agreements between two or more parties, especially those that are written and enforceable by law (American Heritage Dictionary of the English Language, 4th ed). It is sometimes used to characterize the nature of the professional-patient relationship.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.Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.MinnesotaChronic 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)Hospitals, Voluntary: Private, not-for-profit hospitals that are autonomous, self-established, and self-supported.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.Hospital-Physician Joint Ventures: A formal financial agreement made between one or more physicians and a hospital to provide ambulatory alternative services to those patients who do not require hospitalization.Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.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.Occupational Health Services: Health services for employees, usually provided by the employer at the place of work.Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease.Healthcare Disparities: Differences in access to or availability of medical facilities and services.Program Development: The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development).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.Universal Coverage: Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions.Competitive Bidding: Pricing statements presented by more than one party for the purpose of securing a contract.Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.Insurance Claim Reporting: The design, completion, and filing of forms with the insurer.Privatization: Process of shifting publicly controlled services and/or facilities to the private sector.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.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.Health Services for the Aged: Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.Health Facility Merger: The combining of administrative and organizational resources of two or more health care facilities.Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.Health Services Administration: The organization and administration of health services dedicated to the delivery of health care.Interinstitutional Relations: The interactions between representatives of institutions, agencies, or organizations.Public Health Informatics: The systematic application of information and computer sciences to public health practice, research, and learning.National Institutes of Health (U.S.): An operating division of the US Department of Health and Human Services. It is concerned with the overall planning, promoting, and administering of programs pertaining to health and medical research. Until 1995, it was an agency of the United States PUBLIC HEALTH SERVICE.Financing, Government: Federal, state, or local government organized methods of financial assistance.Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.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.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.Total Quality Management: The application of industrial management practice to systematically maintain and improve organization-wide performance. Effectiveness and success are determined and assessed by quantitative quality measures.Fees, Medical: Amounts charged to the patient as payer for medical services.Organizational Policy: A course or method of action selected, usually by an organization, institution, university, society, etc., from among alternatives to guide and determine present and future decisions and positions on matters of public interest or social concern. It does not include internal policy relating to organization and administration within the corporate body, for which ORGANIZATION AND ADMINISTRATION is available.

*  Federal Register :: Medicare and Medicaid Programs; Requirements for Physician Incentive Plans in Prepaid Health...

... and certain health maintenance organizations and health insuring organizations contracting with the Medicaid program. It... ... qualified health maintenance organizations and competitive medical plans contracting with the Medicare program, ...

*  Federal Register :: Medicare and Medicaid Programs; Requirements for Physician Incentive Plans in Prepaid Health...

... and 4731 of the Omnibus Budget Reconciliation Act of 1990 that concern physician incentive plans. In the preamble of that rule ...

*  Popular Articles & Stories for January 14, 1993 - latimes

Prepaid Health Plan Unveiled for Medi-Cal DOUGLAS P. SHUIT, TIMES STAFF WRITER. ... Scaled-Down Building Plan for Bluffs Advances : Development: Commission alters coastal plan to remove all property east of ... Plan to Trim City Workweek to Four Days Hits a Snag MIKE WARD, TIMES STAFF WRITER. ... Delta Species Protection Plan Rejected : Environment: Federal officials say the state's proposal falls short of protecting ...

*  Federal Register :: Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity...

... as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered ... This proposed rule would address application of certain requirements set forth in the Public Health Service Act, ... such as prepaid inpatient health plans (PIHPs) or prepaid ambulatory health plans (PAHPs). PIHPs and PAHPs are defined in § ... Mental health and physical health are interrelated, and individuals with poor mental health are likely to have physical health ...

*  Senate considers new reforms of mental health services - Daily Reflector

Such integrated care would deliver better results for less money by using Prepaid Health Plans, Hise said. The PHPs would ... Trillium Health serves Pitt and surrounding counties.. Tucker called Cardinal Innovations, the largest of the seven, "a rogue ... Hise called it "a Herculean task" for the state Department of Health and Human Services to implement the reforms in a two-year ... The original House bill created the six-year transition plan. It passed on a 109-0 vote. Tucker said DHHS supports that bill, ...


Mental health prepaid health plans. [Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and ... Monitoring of mental health prepaid health plans. [Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, ... Mental health prepaid health plans-Minimum standards. [Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41. ... Coordination with a mental health prepaid health plan. [Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41. ...

*  More Turn to Prepaid Health Care : Fountain Valley Program Profits as Skepticism Wanes - latimes

Robert Gumbiner a communist because his group practice in Long Beach offered patients a prepaid health care plan for $14 a ... Although the Kaiser Foundation Health Plan had been started in the 1940s, prepaid health plans still were considered " ... Robert Gumbiner a communist because his group practice in Long Beach offered patients a prepaid health care plan for $14 a ... Health care analysts said FHP's commitment to caring for seniors sets it apart from many other plans. Although its general HMO ...

*  Medicaid Spending Expected to Outpace Economic Growth | Medpage Today

Capitation payments and premiums include premiums paid to Medicaid managed care plans, pre-paid health plans, other health plan ... Department of Health and Human Services. Source Reference: CMS Office of the Actuary “2008 actuarial reports on the financial ... More in Public Health & Policy. * Advice for Docs Who Start 'the Gun' Talk ... In 2006, Medicaid represented 40% of federal expenditures on health services. Unlike Medicare, all federal spending on Medicaid ...

*  Social Security History

... establishing a prepaid, voluntary health insurance plan for over two million Federal civilian workers and their dependents, ... December 28, 1956 The Secretary of the Department of Health, Education, and Welfare approved the plan submitted by the ... January 31, 1955 The President's health recommendations to Congress included a reinsurance plan plus expanded research and ... July 3, 1956 Congress passed the National Health Survey Act which authorized the Surgeon General of the Public Health Service ...

*  Science & Medicine Historical Markers - The Historical Marker Database

His modest facility successfully delivered health care to Colorado River Aqueduct workers through a prepaid insurance plan. ... Let our societies spend less money in taking care of the sick, and much more money in promoting the health of the race . . . . ... California (Marin County), Tiburon - Protecting the Public Health. In 1891 the U.S. Marine Hospital Service, now the U.S. ... It was under this tree that participants in the U.S. Public Health Study of Untreated Syphilis in Negro Males in Macon County, ...

*  Russia vs United States Health Stats Compared

Prepaid plans as % of private expenditure on health: Prepaid plans as % of private expenditure on health, 2002 ... Prepaid plans as % of private expenditure on health 14.7% Ranked 36th. 65.7% Ranked 4th. 4 times more than Russia ... Health services , External resources for health , % of total expenditure on health: External resources for health are funds or ... Health services > External resources for health > % of total expenditure on health 0.0 Ranked 145th. 0.0 Ranked 147th. ...

*  Best 30 Health And Wellness in Downtown San Mateo, California with Reviews -

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*  Federal Register :: Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Dental...

... or more commonly referred to as the TRICARE Family Member Dental Plan (TFMDP). The TFMDP limited eligibility to eligible ... This final rule revises the comprehensive CHAMPUS regulation pertaining to the Expanded Active Duty Dependents Benefit Plan, ... Such laws are laws relating to health insurance, prepaid health plans, or other health care delivery or financing methods, ... preemption of State and local laws relating to health insurance, prepaid health plans, or other health care delivery or ...

*  Weight loss | Health & beauty | Trade Me

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*  Key Concepts in VCE Health and Human Development | Trade Me

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*  Other | Health & lifestyle | Trade Me

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*  Health & Fitness By Gemma McMullen Hardcover | Trade Me

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*  Bill Text - SB-239 Medi-Cal: hospitals: quality assurance fees: distinct part skilled nursing facilities.

... the prepaid health plan hospital managed care per diem quality assurance fee rate, or the prepaid health plan hospital Medi-Cal ... B) Managed health care plans do not include any of the following:. (i) Mental health plans contracting to provide mental health ... "Managed health care plan" means a health care delivery system that manages the provision of health care and receives prepaid ... listed for the county organized health system and prepaid health plans identified in the Final Medi-Cal Utilization Statistics ...

*  Recent Headlines (with Excerpts) about 'Health plans - info for employees'

Health plans - info for employees' gathered by ... pre-paid legal assistance, commuter benefits, health and ... Year-End Checklist for Plan Sponsors of Retirement and Group Health Plans. "Over the next few months, employers and plan ... Many Annual Notice Requirements Apply to Employer Group Health Plans in 2014. Checklist and discussion of health plan notice ... for health plans, and the effect of U.S. v. Windsor on both retirement and group health plans. With all the planning, there ...

*  Glossary of Compensation Terms - Guidance on Compensation Administration

The amount of a health benefits cost which will not be paid by a plan. For example, a health benefit plan may include a ... Legal Services Plan. A prepaid plan providing to workers and their families a variety of basic legal services (e.g., drafting ... Employee benefit plans include pension plans and employee welfare plans, providing health benefits, disability benefits, death ... Retirement Plan (See Pension Plan.). Retirement Savings - 401(k), 403(b), 457 Plans. Defined contribution benefits plan ...

*  Ellen's Health Food Ltd in Toronto, ON -

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*  Pathways Health Promotion in Blackstock, ON -

Pathways Health Promotion at 3040 Bradburn Rd, Blackstock, ON L0B 1B0 ... SMS and other charges may apply, depending on your phone plan and provider. Please check with your provider about your sms fees ... Pre-paid phones are not supported.. Send. Cancel. To Name:. To Email:. From Name:. From Email:. Send. Cancel. ... What the community has to say about Pathways Health Promotion Add Photo or Video User Photos & Videos. Be the first ...

*  Health Insurance Plans in Ada, OK | Wirefly

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*  Health Insurance Plans in Silver Lake, NY | Wirefly

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DenplanSelf-rated health: Self-rated health (also called Self-reported health, Self-assessed health, or perceived health) refers to both a single question such as “in general, would you say that you health is excellent, very good, good, fair, or poor?” and a survey questionnaire in which participants assess different dimensions of their own health.Contraceptive mandate (United States): A contraceptive mandate is a state or federal regulation or law that requires health insurers, or employers that provide their employees with health insurance, to cover some contraceptive costs in their health insurance plans. In 1978, the U.Public Health Act: Public Health Act is a stock short title used in the United Kingdom for legislation relating to public health.Global Health Delivery ProjectRock 'n' Roll (Status Quo song)Health policy: Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific health care goals within a society."World Health Organization.Lifestyle management programme: A lifestyle management programme (also referred to as a health promotion programme, health behaviour change programme, lifestyle improvement programme or wellness programme) is an intervention designed to promote positive lifestyle and behaviour change and is widely used in the field of health promotion.Beef aging: Beef aging is a process of preparing beef for consumption, mainly by breaking down the connective tissue.List of Parliamentary constituencies in Kent: The ceremonial county of Kent,Drugstore.comHalfdan T. MahlerMunich Reinsurance America: Munich Reinsurance America (also called Munich Re America), formerly known as American Re Corporation before September 2006, is a major provider of property and casualty reinsurance in the United States. Munich Reinsurance America is a subsidiary of Munich Re.Behavior: Behavior or behaviour (see spelling differences) is the range of actions and [made by individuals, organism]s, [[systems, or artificial entities in conjunction with themselves or their environment, which includes the other systems or organisms around as well as the (inanimate) physical environment. It is the response of the system or organism to various stimuli or inputs, whether [or external], [[conscious or subconscious, overt or covert, and voluntary or involuntary.Healthcare in Tanzania: Health care in Tanzania is available depending on one's income and accessibility. People in urban areas have better access to private and public medical facilities.ULTRA (UK agency): ULTRA, the Unrelated Live Transplant Regulatory Authority, was a British agency that regulated organ transplants. According to the official website:Treatment Action Group: Treatment Action Group (TAG) is a US-based HIV/AIDS activist organization formed in 1991 involved with worldwide efforts to increase research on treatments for HIV and for deadly co-infections that affect people with HIV, such as hepatitis C and tuberculosis. The group also monitors research on HIV vaccines and fundamental science aimed at understanding the pathogenesis of HIV/AIDS.School health education: School Health Education see also: Health Promotion is the process of transferring health knowledge during a student's school years (K-12). Its uses are in general classified as Public Health Education and School Health Education.Behavior change (public health): Behavior change is a central objective in public health interventions,WHO 2002: World Health Report 2002 - Reducing Risks, Promoting Healthy Life Accessed Feb 2015 http://www.who.National Collaborating Centre for Mental Health: The National Collaborating Centre for Mental Health (NCCMH) is one of several centres of the National Institute for Health and Care Excellence (NICE) tasked with developing guidance on the appropriate treatment and care of people with specific conditions within the National Health Service (NHS) in England and Wales. It was established in 2001.Oncology benefit managementList of waterfalls in Oregon: There are at least 238 waterfalls in the U.S.Blue Cross and Blue Shield of Kansas City: Blue Cross and Blue Shield of Kansas City (Blue KC) is an independent licensee of the Blue Cross Blue Shield Association and a not-for-profit health insurance provider with more than one million members. Founded in 1938, Blue Cross and Blue Shield of Kansas City offers a wide variety of healthcare, dental, life insurance and Medicare coverage.Salim Batla: Salim Batla, an investment manager turned risk manager is the founder of Implied Risk Calibration Theory. Implied Risk Calibration is a theory that attempts to mathematically explain the correlation between managing financial risks and the incremental risks that arise from such management.Iranian National Formulary: The Iranian National Formulary (INF) has more than 2,300 molecules registered at the Iran's Ministry of Health, including various strengths and dosage forms. The standards regarding pharmaceutical products in Iran are determined and modified by the Pharmacopeia Council.Great Lakes Environmental Research Laboratory: right|300px|thumb|Great Lakes Environmental Research Laboratory logo.WHO collaborating centres in occupational health: The WHO collaborating centres in occupational health constitute a network of institutions put in place by the World Health Organization to extend availability of occupational health coverage in both developed and undeveloped countries.Network of WHO Collaborating Centres in occupational health.Comprehensive Rural Health Project: The Comprehensive Rural Health Project (CRHP) is a non profit, non-governmental organization located in Jamkhed, Ahmednagar District in the state of Maharashtra, India. The organization works with rural communities to provide community-based primary healthcare and improve the general standard of living through a variety of community-led development programs, including Women's Self-Help Groups, Farmers' Clubs, Adolescent Programs and Sanitation and Watershed Development Programs.Implementation research: Implementation research is the scientific study of methods to promote the uptake of research findings. Often research projects focus on small scale pilot studies or laboratory based experiments, and assume that findings can be generalised to roll out into a practice based domain with few changes.Aging (scheduling): In Operating systems, Aging is a scheduling technique used to avoid starvation. Fixed priority scheduling is a scheduling discipline, in which tasks queued for utilizing a system resource are assigned a priority each.Poundage quota: A poundage quota, also called a marketing quota, is a quantitative limit on the amount of a commodity that can be marketed under the provisions of a permanent law. Once a common feature of price support programs, this supply control mechanism ended with the quota buyouts for peanuts in 2002 and tobacco in 2004.Women's Health Initiative: The Women's Health Initiative (WHI) was initiated by the U.S.Private healthcareSensory Processing Disorder Foundation: The Sensory Processing Disorder Foundation (formerly known as the KID Foundation) is a registered 501(c)3, nonprofit organization dedicated to research in 1979, education and advocacy for Sensory Processing Disorder. The Foundation was founded in 1979 by Dr.European Immunization Week: European Immunization Week (EIW) is an annual regional initiative, coordinated by the World Health Organization Regional Office for Europe (WHO/Europe), to promote immunization against vaccine-preventable diseases. EIW activities are carried out by participating WHO/Europe member states.State health agency: A state health agency (SHA), or state department of health, is a department or agency of the state governments of the United States focused on public health. The state secretary of health is a constitutional or at times a statutory official in several states of the United States.Healthy community design: Healthy community design is planning and designing communities that make it easier for people to live healthy lives. Healthy community design offers important benefits:Open Fuel Standard Coalition: The Open Fuel Standard Coalition is a bipartisan group in the United States actively working for passage of H.R.Resource leak: In computer science, a resource leak is a particular type of resource consumption by a computer program where the program does not release resources it has acquired. This condition is normally the result of a bug in a program.Themis Medicare

(1/30) Prepaid capitation versus fee-for-service reimbursement in a Medicaid population.

Utilization of health resources by 37,444 Medicaid recipients enrolled in a capitated health maintenance organization was compared with that of 227,242 Medicaid recipients enrolled in a traditional fee-for-service system over a 1-year period (1983-1984) in the state of Kentucky. Primary care providers in the capitated program had financial incentives to reduce downstream costs like specialist referral, emergency room use, and hospitalizations. The average number of physician visits was similar for both groups (4.47/year in the capitated program; 5.09/year in the fee-for-service system). However, the average number of prescriptions (1.9 versus 4.9 per year), average number of hospital admissions per recipient (0.11 versus 0.22 per year), and average number of hospital days per 1,000 recipients (461 versus 909 per year) were 5% to 60% lower in the capitated group than in the fee-for-service group. The Citicare capitated program resulted in a dramatic reduction in healthcare resource utilization compared with the concurrent fee-for-service system for statewide Medicaid recipients.  (+info)

(2/30) The relation of household income to mammography utilization in a prepaid health care system.

Managed care organizations should be expected to provide equivalent access to preventive and screening services to all members. We studied mammography in 1,667 women members of one HMO who had an overall utilization rate of 84.9%. Significant correlates of mammography utilization included age, estimated household income, and division of the managed care organization in which the member was enrolled. Each $10,000 increment of income increased mammography rates by 2.5 percentage points (95% confidence interval [CI], 1.4% to 3.6%), independent of age and division. Our findings suggest that coverage for mammography services is not sufficient to ensure equivalent use of screening across income groups.  (+info)

(3/30) Medicaid program; Medicaid managed care. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule with comment period amends the Medicaid regulations to implement provisions of the Balanced Budget Act of 1997 (BBA) that allow the States greater flexibility by permitting them to amend their State plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without obtaining waivers if beneficiary choice is provided; establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services; eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing. In addition, this final rule expands on regulatory beneficiary protections provided to enrollees of prepaid health plans (PHPs) by requiring that PHPs comply with specified BBA requirements that would not otherwise apply to PHPs.  (+info)

(4/30) The Bambui Health and Aging Study (BHAS): private health plan and medical care utilization by older adults.

The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor) and use of medications by older adults. All residents in Bambui town (Minas Gerais, Brazil) aged >/= 60 years (n = 1,742) were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements). After adjustments for worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%), an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%). Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively). Further investigations are needed to verify whether our results can be generalized to other communities of the country.  (+info)

(5/30) Medicaid program; Medicaid managed care. Withdrawal of final rule with comment period.

This document withdraws all provisions of the final rule with comment period on Medicaid managed care that we published in the Federal Register on January 19, 2001 (66 FR 6228) with an initial effective date of April 19, 2001. This January 19, 2001 final rule, which has never taken effect, would have combined Medicaid managed care regulations in a new part 438, implemented Medicaid managed care requirements of the Balanced Budget Act of 1997 (Pub. L. 105-33), and imposed new requirements on entities currently regulated as "prepaid health plans'' (PHPs). The regulations set forth in the final rule being withdrawn have been superseded by regulations promulgated in a subsequent rulemaking initiated on August 20, 2001 (66 FR 43613). In addition, this document addresses comments received in response to an interim final rule with comment period that we published on August 17, 2001 in the Federal Register (66 FR 43090) that further delayed, until August 16, 2002, the effective date of the January 19, 2001 final rule with comment period.  (+info)

(6/30) Medicaid program; Medicaid managed care: new provisions. Final rule.

This final rule amends the Medicaid regulations to implement provisions of the Balanced Budget Act of 1997 (BBA) that allow the States greater flexibility by permitting them to amend their State plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without obtaining waivers if beneficiary choice is provided; establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services; and eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as, the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing.  (+info)

(7/30) Sampling patients within physician practices and health plans: multistage cluster samples in health services research.

OBJECTIVE: To better inform study design decisions when sampling patients within health plans and physician practices with multiple analysis goals. STUDY SETTING: Chronic eye care patients within six health plans across the United States. STUDY DESIGN: We developed a simulation-based approach for designing multistage samples. We created a range of candidate designs, evaluated them with respect to multiple sampling goals, investigated their tradeoffs, and identified the design that is the best compromise among all goals. This approach recognizes that most data collection efforts have multiple competing goals. DATA COLLECTION: We constructed a sample frame from all diabetic patients in six health plans with evidence of chronic eye disease (glaucoma and retinopathy). PRINCIPAL FINDINGS: Simulations of different study designs can uncover efficiency gains as well as inform potential tradeoffs among study goals. Simulations enable us to quantify these efficiency gains and to draw tradeoff curves. CONCLUSIONS: When designing a complex multistage sample it is desirable to explore the tradeoffs between competing sampling goals via simulation. Simulations enable us to investigate a larger number of candidate designs and are therefore likely to identify more efficient designs.  (+info)

(8/30) Use of e-Health services between 1999 and 2002: a growing digital divide.

OBJECTIVE: To evaluate the patterns of e-Health use over a four-year period and the characteristics of users. DESIGN: Longitudinal, population-based study (1999-2002) of members of a prepaid integrated delivery system. Available e-Health services included ordering prescription drug refills, scheduling appointments, and asking medical questions. MEASUREMENTS: Rates of known access to e-Health services, and of e-Health use each quarter. RESULTS: The number of members with known e-Health access increased from 51,336 (1.6%) in 1999 to 324,522 (9.3%), in 2002. The percentage of households in which at least one person in the household had access increased from 2.7% to 14.1%. Among the subjects with known access, the percentage of subjects that used e-Health at least once increased from 25.7% in 1999 to 36.2% in 2002. In the multivariate analysis, subjects who had a low expected clinical need, were nonwhite, or lived in low socioeconomic status (SES) neighborhoods were less likely to have used e-Health services in 2002. Disparities by race/ethnicity and SES persisted after controlling for access to e-Health and widened over time. CONCLUSION: Access to and use of e-Health services are growing rapidly. Use of these services appears to be greatest among persons with more medical need. The majority of subjects, however, do not use any e-Health services. More research is needed to determine potential reasons for disparities in e-Health use by race/ethnicity and SES as well as the implications of these disparities on clinical outcomes.  (+info)


  • This proposed rule would address application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children's Health Insurance Programs. (
  • PHPs could be commercial managed care networks or organizations comprising private health care providers. (
  • Behavioral health organizations - When the division of behavioral health and recovery administers regional behavioral health services. (
  • Behavioral health organizations - How to request an exemption of a minimum standard. (
  • Behavioral health organizations - Payment for behavioral health services. (
  • Behavioral health organizations - Public awareness of behavioral health services. (
  • Behavioral health organizations - Governing body responsible for oversight. (
  • Behavioral health organizations - Advisory board membership. (
  • Behavioral health organizations - Voluntary inpatient services and involuntary evaluation and treatment services. (
  • Behavioral health organizations - Administration of the Mental Health and Substance Use Disorders Involuntary Treatment Acts. (
  • Behavioral health organizations - Quality review teams. (
  • Behavioral health organizations - Standards for contractors and subcontractors. (
  • Behavioral health organizations - Operating as a behavioral health agency. (
  • Today, health maintenance organizations are more common and considered far less radical. (
  • FHP is capitalizing on the fact that more people belong to health maintenance organizations in Southern California than anywhere else in the country. (


  • You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2333-P, P.O. Box 8016, Baltimore, MD 21244-8016. (
  • For delivery in Washington, DC-Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue SW. (
  • For delivery in Baltimore, MD-Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. (
  • RALEIGH - A Senate panel has passed legislation to accelerate mental health Medicaid reform and free up nearly $1 billion in frozen assets to provide more behavioral health services. (
  • Up to five PHPs would serve Medicaid and NC Health Choice recipients statewide. (
  • In 2006, Medicaid represented 40% of federal expenditures on health services. (
  • Capitation payments and premiums include premiums paid to Medicaid managed care plans, pre-paid health plans, other health plan premiums, and premiums for Medicare Part A and Part B. (


  • Behavioral health organization managed care plan - Utilization management. (
  • These improvements will provide Uniformed Service members and families with numerous quality of life benefits that will improve participation in the plan, significantly reduce enrollment errors and positively effect utilization of this important dental plan. (

providing care

  • The bill would hold providers accountable by developing health metrics to measure how successful they are in providing care to patients with problems resulting from mental illness, substance abuse, and intellectual or developmental disabilities. (


  • The bill would also require the payment of direct grants to designated and nondesignated public hospitals in support of health care expenditures funded by the quality assurance fee for the first program period. (


  • Acute care includes fee-for-service spending for inpatient and outpatient hospital care, physician and other medical professional services, prescription drugs, dental care, laboratory and imaging tests, mental hospital services, and case management costs, as well as coinsurance payments for beneficiaries in managed care plans. (
  • February 26, 1952 Federal Security Administrator Oscar Ewing proposed a substitute health insurance measure limited to the payment, through the Social Security system, of hospital coats for retired beneficiaries and their dependents as a step toward a larger goal. (


  • Area seniors who opt for FHP's plan, one of only a few Medicare-alternative HMOs in the country, go to FHP for all their medical services, with the Medicare benefits going to the HMO company, rather than to the individual. (
  • By contrast, the senior plan through FHP has no deductibles and pays 100% of Medicare-covered costs. (
  • FHP officials said the average Medicare beneficiary can save up to $750 a year in out-of-pocket health care expenses under their plan. (


  • Carlos Zarabozo, a policy specialist with the Health Care Financing Administration in San Francisco, said FHP has a large senior enrollment, "which is a measure of success. (


  • FHP contracts directly with the federal Health Care Financing Administration to provide comprehensive care, so there is a minimum of paper work for members. (

managed care plan

  • Behavioral health organization managed care plan - Minimum standards. (
  • Behavioral health organization managed care plan - Choice of primary provider. (
  • Behavioral health organization managed care plan - Behavioral health screening for children. (


  • This bill would authorize the Director of Health Care Services to maximize federal financial participation to provide access to services provided by hospitals that are not reimbursed by certified public expenditure, as specified, by authorizing the use of intergovernmental transfers to fund the nonfederal share of supplemental payments as permitted under federal law. (


  • The Commission was to determine the Nation's total health requirements, both immediate and long term, and to recommend courses of action to meet those needs. (


  • Hussein Declares Holy War on Foes : Reaction: The Iraqi leader orders his pilots and air defense units to fire on U.S. and allied planes in the future. (
  • Lightweight option of only bringing the chapters required to school Key Concepts in VCE Health & Human Development Units 1&2, 3rd Edition has been updated and revised to address the new VCAA study design which will be implemented for Health & Human Development in 2014. (


  • FHP, which originally stood for Family Health Plan, grew 35% in membership last year and now has 180,000 members in Southern California, Utah and Guam. (
  • 3) Existing law requires that the California Medical Assistance Commission be dissolved after June 30, 2012, and requires that, upon dissolution of the commission, all powers, duties, and responsibilities of the commission be transferred to the Director of Health Care Services. (


  • Sen. Ralph Hise, R-Mitchell, a co-chairman of the Senate Health Care Committee, presented an amended version of House Bill 403 that he said would speed the integration of mental health services and physical health care. (
  • Hise called it "a Herculean task" for the state Department of Health and Human Services to implement the reforms in a two-year period. (
  • He wasn't willing to wait the six years the House version of the bill allows to reform the system, improve services, and achieve improved health outcomes. (
  • 1) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. (


  • Twenty-six years ago, colleagues called Dr. Robert Gumbiner a communist because his group practice in Long Beach offered patients a prepaid health care plan for $14 a month. (


  • Such integrated care would deliver better results for less money by using Prepaid Health Plans, Hise said. (


  • This final rule revises the comprehensive CHAMPUS regulation pertaining to the Expanded Active Duty Dependents Benefit Plan, or more commonly referred to as the TRICARE Family Member Dental Plan (TFMDP). (


  • The response to our senior program has been remarkable because we have eliminated the fear of medical bankruptcy," Dr. Raymond Pingle, regional vice president of senior plans, said in a recent interview. (


  • Although the Kaiser Foundation Health Plan had been started in the 1940s, prepaid health plans still were considered "revolutionary" when Gumbiner's group opened shop. (
  • 3) Subsection (2)(c) does not apply to nonrenewal or discontinuation of group health insurance offered in connection with a group health plan in the small group market or large group market, as those terms are defined in [section (


  • January 1, 1950 A new plan for collecting taxes due under the Federal Insurance Contributions Act and under the income tax withholding provisions of the Internal Revenue Code became effective. (
  • The Act also struck section 1076b (Selected Reserve dental insurance), or Chapter 55 of title 10, United States Code, since the affected population and the authority for that particular dental insurance plan has been incorporated in 10 U.S.C. 1076 a. (


  • The original House bill created the six-year transition plan. (


  • Although its general HMO program has been growing steadily, every time FHP opens a senior health center, it quickly attracts new members. (


  • May 31, 1950 President Truman submitted to the Congress Reorganization Plan No. 27 of 1950, providing for the establishment of a new Department of Health, Education, and Security. (
  • July 10, 1950 The House adopted a resolution killing President Truman's Reorganization Plan No. 27, which proposed to elevate the Federal Security Agency into a Cabinet-level Department of Health, Education, and Security. (


  • Trillium Health serves Pitt and surrounding counties. (


  • December 29, 1951 President Truman created, by executive order, the President's Commission on the Health Needs of the Nation. (


  • FHP is also considering plans for a senior housing project and nursing care facilities on its 11-acre site near the San Diego Freeway. (

utilized a new

  • The plan provided for consolidating the two collections and utilized a new form--Form 941-replacing Forms SS-LA, the Social Security reporting form and Form W-1 which had been used for reporting income taxes withheld from wages. (