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.State Government: The level of governmental organization and function below that of the national or country-wide government.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.State Health Planning and Development Agencies: Agencies established under PL93-641 to coordinate, conduct, and implement state health planning activities. Two primary responsibilities are the preparation of an annual State Health Plan and giving assistance to the Statewide Health Coordinating Council.Public Health Administration: Management of public health organizations or agencies.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.United StatesHealth 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.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.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.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.Health Systems Agencies: Health planning and resources development agencies which function in each health service area of the United States (PL 93-641).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 Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.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 Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.Public Health Practice: The activities and endeavors of the public health services in a community on any level.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 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 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.Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.Health Planning: Planning for needed health and/or welfare services and facilities.Government Agencies: Administrative units of government responsible for policy making and management of governmental activities.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)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)Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.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.Centers for Disease Control and Prevention (U.S.): An agency of the UNITED STATES PUBLIC HEALTH SERVICE that conducts and supports programs for the prevention and control of disease and provides consultation and assistance to health departments and other countries.Population Surveillance: Ongoing scrutiny of a population (general population, study population, target population, etc.), generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy.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.Civil Defense: Preventive emergency measures and programs designed to protect the individual or community in times of hostile attack.Epidemiology: Field of medicine concerned with the determination of causes, incidence, and characteristic behavior of disease outbreaks affecting human populations. It includes the interrelationships of host, agent, and environment as related to the distribution and control of disease.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)Health Services: Services for the diagnosis and treatment of disease and the maintenance of health.Disaster Planning: Procedures outlined for the care of casualties and the maintenance of services in disasters.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.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.Attitude to Health: Public attitudes toward health, disease, and the medical care system.Politics: Activities concerned with governmental policies, functions, etc.Interinstitutional Relations: The interactions between representatives of institutions, agencies, or organizations.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 Priorities: Preferentially rated health-related activities or functions to be used in establishing health planning goals. This may refer specifically to PL93-641.MassachusettsHealth Planning Technical Assistance: The provision of expert assistance in developing health planning programs, plans as technical materials, etc., as requested by Health Systems Agencies or other health planning organizations.Preventive Health Services: Services designed for HEALTH PROMOTION and prevention of disease.Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.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.Societies, Hospital: Societies having institutional membership limited to hospitals and other health care institutions.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.Disease Notification: Notification or reporting by a physician or other health care provider of the occurrence of specified contagious diseases such as tuberculosis and HIV infections to designated public health agencies. The United States system of reporting notifiable diseases evolved from the Quarantine Act of 1878, which authorized the US Public Health Service to collect morbidity data on cholera, smallpox, and yellow fever; each state in the US has its own list of notifiable diseases and depends largely on reporting by the individual health care provider. (From Segen, Dictionary of Modern Medicine, 1992)Chronology as Topic: The temporal sequence of events that have occurred.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)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.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.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.Schools, Public Health: Educational institutions for individuals specializing in the field of public health.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.CaliforniaLocal Government: Smallest political subdivisions within a country at which general governmental functions are carried-out.Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.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.TexasEmployer Health Costs: That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.WashingtonPatient 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.Patient Acceptance of Health Care: The seeking and acceptance by patients of health service.Public Health Informatics: The systematic application of information and computer sciences to public health practice, research, and learning.Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.OregonFinancing, Government: Federal, state, or local government organized methods of financial assistance.Rate Setting and Review: A method of examining and setting levels of payments.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)Blue Cross Blue Shield Insurance Plans: Prepaid health and hospital insurance plan.Disease Outbreaks: Sudden increase in the incidence of a disease. The concept includes EPIDEMICS and PANDEMICS.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.New JerseyMedicare 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.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.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.MinnesotaOccupational Health: The promotion and maintenance of physical and mental health in the work environment.KansasTravel: Aspects of health and disease related to travel.WisconsinHealth Plan Implementation: Those actions designed to carry out recommendations pertaining to health plans or programs.Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.IllinoisHealth 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.NevadaSocioeconomic 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.Chronic Disease: Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)New YorkWorld 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.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.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)Information Dissemination: The circulation or wide dispersal of information.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.Capacity Building: Organizational development including enhancement of management structures, processes and procedures, within organizations and among different organizations and sectors to meet present and future needs.Value-Based Purchasing: Purchasers are provided information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. The focus is on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. (from http://www.ahrq.gov/qual/meyerrpt.htm accessed 11/25/2011)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.North CarolinaMass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease.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)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.Decision Making, Organizational: The process by which decisions are made in an institution or other organization.Health 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.United States Health Resources and Services Administration: A component of the PUBLIC HEALTH SERVICE that provides leadership related to the delivery of health services and the requirements for and distribution of health resources, including manpower training.Contract Services: Outside services provided to an institution under a formal financial agreement.VermontHealth 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 StatesModels, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.Infant, Newborn: An infant during the first month after birth.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.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.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.BrazilDisease 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)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.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.ConnecticutProvider-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.
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Peach State Health Plan Gastroenterologists in Allenspark, CO: Book Appointments Online - ZocDocCO that take Peach State Health Plan, See Reviews and Book Online Instantly. It's free! All appointment times are guaranteed by ... Gastroenterologists and other providers in Allenspark, CO, 80510 , Peach State Health Plan - Medicaid ... Zocdoc › Find a Gastroenterologist › Colorado › Denver Gastroenterologists › Allenspark Gastroenterologists › Peach State ...
Minnesota State Health Plan Among Most Generous « WCCO | CBS MinnesotaA new report from the Pew Charitable Trusts says Minnesota state employees get 94 percent of their health care costs covered by ... roughly equivalent to platinum plans sold on the state's health insurance exchange, MNsure. And it's better than the plans most ... Filed Under: Health Plan, Jim Monroe, Minnesota Association of Professional Employees, Pew Charitable Trusts, State Employees ... The Pew report also said Minnesota's state health plan spending increased 2 percent from 2011-13 - the same percentage as the ...
Peach State Health Plan Psychiatrists in Escondido, CA (92027): Book Appointments Online - ZocDocCA 92027 that take Peach State Health Plan, See Reviews and Book Online Instantly. It's free! All appointment times are ... Zocdoc › Find a Psychiatrist › California › San Diego Psychiatrists › 92027 Psychiatrists › Peach State Health Plan ... Psychiatrists and other providers in Escondido, CA 92027, 92027 , Peach State Health Plan - Medicaid ... "He is a very compassionate , great psychiatrist works with you to come up with a good game plan for you . I would highly ...
Home State Health Plan Travel Medicine Specialists: Book Online By Insurance, Reviews & ZIPTravel Medicine Specialists that take Home State Health Plan, See Reviews and Book Online Instantly. It's free! All appointment ... Travel Medicine Specialists and other providers in Wichita, KS , Home State Health Plan - Home State Health Plan ...
Wyoming State Health Plan Will Cover the Pill | Wyoming Public MediaWyoming was one of only two states in the nation that didn't offer state employees some kind of contraceptive coverage. ... Wyoming State Health Plan Will Cover the Pill TweetShareGoogle+Email ... Hayes says the state spends about 12 million dollars total on the state's prescription drug coverage plan for employees. Birth ... Ralph Hayes, who manages the state's group insurance plan, says the topic came up before, but both the state's conservative ...
Important information about the state employee health plan... By Stephanie Harvey. Check out the "Need to Know Information" on ... Kansas State University. search. Search K-State web, people, directories. Browse A-Z ... Kansas State University. 128 Dole Hall. 1525 Mid-Campus Drive North. Manhattan, KS 66506. 785-532-2535. email@example.com ... Health insurance confirmation statements available online. *Important information about the state employee health plan ...
k-state.edu/today/announcement.php?id=1639&category=human_resources-benefits-training&referredBy=K-State Today Archive
Diamond State Health Plan - Plus - Delaware Health and Social Services - State of DelawareFor questions regarding Diamond State Health Plan - Plus (DSHP - Plus), please email Dhss_dmma_dshp_plus@state.de.us ... Diamond State Health Plan - Plus (DSHP - Plus). The Division of Medicaid and Medical Assistance (DMMA) in partnership with the ... Diamond State Health Plan Plus 1115 Demonstration Waiver Amendment. Public notice of DMMA's intent to submit a waiver amendment ... State Service Center. Substance Abuse. Mental Health. Visually Impaired. Councils and Committees. Health Information & ...
Oregon Health Authority : Oregon Health Plan : Oregon Health Plan : State of OregonOregon Health Plan for healthcare providers and OHP members. ... Oregon Health Plan arrow_drop_down *Oregon Health Plan Home. * ... The state remains committed to ensuring all Oregonians have access to high-quality, affordable health care. OHA is committed to ... Questions about the Oregon Health Plan? To learn more about your new benefits, your welcome packet, and what to do if you have ... Oregon Health Authority Contact Us. Find us on Facebook. Follow us on Twitter ...
Directory of Connecticut public health plans :: State PublicationsDirectory of Connecticut public health plans Subject - LCSH Health planning--Connecticut--Abstracts.; Public health ... initiated the Connecticut Health Planning Database Project... The Directory of Connecticut Public Health Plans represents Phase ... It contains key information from the database about plans issued by the Connecticut Department of Public Health; lists of ... http://www.ct.gov/dph/lib/dph/state_health_planning/dphplans/plan_directory_dph_012010.pdf ...
State Occupational Safety and Health Plans | Vermont State Plan | Occupational Safety and Health AdministrationState Occupational Safety and Health Plans , Vermont State Plan ... Vermont State Plan. Vermont State Plan. Vermont. Overview. * ... The Vermont State Plan applies to private sector workplaces in the state with the exception of: *Offshore maritime employment, ... The State Plan covers state and local government workers. VOSHA does not cover federal government employers, including USPS. ... State Plan Certification: March 4, 1977 (42 FR 12428). *Operational Status Agreement : May 12, 1975 (40 FR 20627), amended on ...
State Occupational Safety and Health Plans | Virginia State Plan | Occupational Safety and Health AdministrationState Occupational Safety and Health Plans , Virginia State Plan ... Virginia State Plan. Virginia State Plan. [Virginia]. Overview ... The Virginia State Plan also applies to state and local government workers, including maritime state and local government ... The Virginia State Plan applies to private sector workplaces in the state with the exception of: *Maritime employment, ... State Plan Standards and Regulations. VOSH has adopted the majority of OSHA standards that would relate to private sector and ...
Kansas opens state workers' health plan to same-sex spouses | BonnerSprings.com... health plan to gay and lesbian spouses.. The state employees' health plan covers about 104,000 people. Belfry says the state ... Topeka The health insurance plan for Kansas state government workers is allowing married gay and lesbian couples to obtain ... Kansas Department of Health and Environment spokeswoman Sara Belfry says the health plan began accepting coverage applications ... Belfry says the legal review led the department to open the state employees' ...
Section 6 - VI. State Plans | Occupational Safety and Health AdministrationState Plans. The 25 states and territories with their own OSHA-approved occupational safety and health plans must adopt a ... Occupational Safety and Health Administration. 200 Constitution Ave., NW, Washington, DC 20210. 800-321-6742 (OSHA). TTY. www. ... Occupational Safety and Health Administration. 200 Constitution Ave., NW, Washington, DC 20210. 800-321-6742 (OSHA). TTY. www. ... These 25 States and territories are: Alaska, Arizona, California, Connecticut (for state and local government employees only), ...
Choice of Health Plans to Vary Sharply By StateUnder President Obama's health care law, it is becoming clear that the millions of people purchasing policies in the exchanges ... Health & Human Services Choice of Health Plans to Vary Sharply By State Under President Obama's health care law, it is becoming ... FINANCE HEALTH INFRASTRUCTURE MANAGEMENT POLITICS PUBLIC SAFETY URBAN EDUCATION DATA PUBLIC OFFICIALS OF THE YEAR WOMEN IN ... MORE FROM Health & Human Services. New Movie Spotlights the 'Hidden Homeless' and Already Has Oscar Buzz. It's rare to see a ...
House approves state-run mental health service plan for Iowa's poor (audio)You are here: Home / Health & Medicine / House approves state-run mental health service plan for Iowa's poor (audio) ... House approves state-run mental health service plan for Iowa's poor (audio). April 24, 2012. By O. Kay Henderson ... said a state-managed system will be fairer to Iowans who cannot afford to get mental health treatment on their own. ... Filed Under: Health & Medicine, News, Politics & Government Tagged With: Democratic Party, Legislature, Republican Party, Taxes ...
Section 8 - VIII. State Plan States | Occupational Safety and Health AdministrationState Plan States The 25 states and territories with their own OSHA-approved occupational safety and health plans must adopt a ... Occupational Safety and Health Administration. 200 Constitution Ave., NW, Washington, DC 20210. 800-321-6742 (OSHA). TTY. www. ... Occupational Safety and Health Administration. 200 Constitution Ave., NW, Washington, DC 20210. 800-321-6742 (OSHA). TTY. www. ... Until such time as a state standard is promulgated, Federal OSHA will provide interim enforcement assistance, as appropriate, ...
HR pop quiz: How can a health plan lose grandfathered status? | BenefitsPRO... which of the following changes would cause a health care plan to lose its grandfathered status? ... HR pop quiz: How can a health plan lose grandfathered status?. Aug 22, 2011 , By ... which of the following changes would cause a health care plan to lose its grandfathered status? ... decreasing in the choices above) co-insurance charges are changes that would cause a plan to lose its grandfathered status. ...
Blue Ribbon Task Force on the State Health Plan for Teachers and State Employees : report to the 2011 session of the General...Force on the State Health Plan for Teachers and State Employees examined issues related to governance of the State Health Plan ... Force on the State Health Plan for Teachers and State Employees examined issues related to governance of the State Health Plan ... State Health Plan present challenges in finding a logical organizational fit of the State Health Plan within an existing State ... State Health Plan present challenges in finding a logical organizational fit of the State Health Plan within an existing State ...
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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.Combined Development Agency: The Combined Development Agency (CDA) was a defense purchasing authority established in 1948 by the governments of the United States and the United Kingdom. Its role was to ensure adequate supplies of uranium for the respective countries weapons development programmes.List of Parliamentary constituencies in Kent: The ceremonial county of Kent,DenplanPublic Health Act: Public Health Act is a stock short title used in the United Kingdom for legislation relating to public health.Rock 'n' Roll (Status Quo song)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.Self-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.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.Global Health Delivery ProjectLifestyle 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.Companies OfficePious fraud: Pious fraud (Latin: pia fraus) is used to describe fraud in religion or medicine. A pious fraud can be counterfeiting a miracle or falsely attributing a sacred text to a biblical figure due to the belief that the "end justifies the means", in this case the end of increasing faith by whatever means available.The Complete Stevie Wonder: The Complete Stevie Wonder is a digital compilation featuring the work of Stevie Wonder. Released a week before the physical release of A Time to Love, the set comprises almost all of Wonder's officially released material, including single mixes, extended versions, remixes, and Workout Stevie Workout, a 1963 album which was shelved and replaced by With A Song In My Heart.Proportional reporting ratio: The proportional reporting ratio (PRR) is a statistic that is used to summarize the extent to which a particular adverse event is reported for individuals taking a specific drug, compared to the frequency at which the same adverse event is reported for patients taking some other drug (or who are taking any drug in a specified class of drugs). The PRR will typically be calculated using a surveillance database in which reports of adverse events from a variety of drugs are recorded.Beef aging: Beef aging is a process of preparing beef for consumption, mainly by breaking down the connective tissue.Federal Civil Defense Administration: The Federal Civil Defense Administration (FCDA) was organized by President Harry S. Truman on 1 December 1950 through Executive Order 10186, and became an official government agency via the Federal Civil Defense Act of 1950 on 12 January 1951.ESCAIDEDrugstore.comHalfdan T. MahlerStrategic National Stockpile: The Strategic National Stockpile (SNS) is the United States' national repository of antibiotics, vaccines, chemical antidotes, antitoxins, and other critical medical equipment and supplies. In the event of a national emergency involving bioterrorism or a natural pandemic, the SNS has the capability to supplement and re-supply local health authorities that may be overwhelmed by the crisis, with response time as little as 12 hours.Munich 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.Opinion polling in the Philippine presidential election, 2010: Opinion polling (popularly known as surveys in the Philippines) for the 2010 Philippine presidential election is managed by two major polling firms: Social Weather Stations and Pulse Asia, and several minor polling firms. The polling firms conducted surveys both prior and after the deadline for filing of certificates of candidacies on December 1, 2009.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.Massachusetts Tobacco Cessation and Prevention Program: The Massachusetts Tobacco Cessation and Prevention Program (MTCP) is an anti-tobacco program run by the Massachusetts Department of Public Health with the goal of decreasing tobacco prevalence in the state of Massachusetts. MTCP has four main components: preventing youth smoking, assisting current smokers with quitting, protecting against second hand smoke, and eliminating tobacco related disparities.Conservation technical assistanceBehavior: 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.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.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.Notifiable disease: A notifiable disease is any disease that is required by law to be reported to government authorities. The collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks.Sunday Bloody SundayULTRA (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.Jiann-Ping Hsu College of Public Health: The Jiann-Ping Hsu College of Public Health is one of the eight colleges of Georgia Southern University, located in Statesboro, Georgia, in the United States.San Diego County, California Probation: The San Diego County Probation Department is the body in San Diego County, California responsible for supervising convicted offenders in the community, either who are on probation, such as at the conclusion of their sentences, or while on community supervision orders.Local government areas of Scotland: Local government areas covering the whole of Scotland were first defined by the Local Government (Scotland) Act 1889. As currently defined, they are a result, for the most part, of the Local Government etc (Scotland) Act 1994.Chronic care: Chronic care refers to medical care which addresses pre-existing or long term illness, as opposed to acute care which is concerned with short term or severe illness of brief duration. Chronic medical conditions include asthma, diabetes, emphysema, chronic bronchitis, congestive heart disease, cirrhosis of the liver, hypertension and depression.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.University of Texas Health Science Center at HoustonEnvironmental issues in Puget Sound: Puget Sound is a deep inlet of the Pacific Ocean in Washington, extending south from the Strait of Juan de Fuca through Admiralty Inlet. It was explored and named by Captain George Vancouver for his aide, Peter Puget, in 1792.Essence (Electronic Surveillance System for the Early Notification of Community-based Epidemics): Essence is the United States Department of Defense's Electronic Surveillance System for the Early Notification of Community-based Epidemics. Essence's goal is to monitor health data as it becomes available and discover epidemics and similar health concerns before they move out of control.Oncology benefit managementList of waterfalls in Oregon: There are at least 238 waterfalls in the U.S.Themis MedicareBlue 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.National Outbreak Reporting System: ==The National Outbreak Reporting System (NORS)==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.
(1/437) Challenges in securing access to care for children.
Congressional approval of Title XXI of the Social Security Act, which created the State Children's Health Insurance Program (CHIP), is a significant public effort to expand health insurance to children. Experience with the Medicaid program suggests that eligibility does not guarantee children's enrollment or their access to needed services. This paper develops an analytic framework and presents potential indicators to evaluate CHIP's performance and its impact on access, defined broadly to include access to health insurance and access to health services. It also presents options for moving beyond minimal monitoring to an evaluation strategy that would help to improve program outcomes. The policy considerations associated with such a strategy are also discussed. (+info)
(2/437) 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)
(3/437) "Carving out" conditions from global capitation rates: protecting high-cost patients, physicians, and health plans in a managed care environment.
The purposes of this study were (1) to develop a method for identifying individuals with high-cost medical conditions, (2) to determine the percentage of healthcare spending they represent, and (3) to explore policy implications of "carving out" their care from managed care capitation. Annual payments over a 2-year period to enrollees of three health plans--a traditional managed care organization, and a state Medicaid program--were determined by using a cross-sectional analysis of insurance claims data. The main outcome measures were the number of enrollees with total annual payments in excess of $25,000 and the contribution of these high-cost enrollees to each health plan's total costs. Forty-one groups of diagnosis and procedure codes representing a combination of acute and chronic conditions were included on the list of carve-out conditions. Pulmonary insufficiency and respiratory failure together accounted for the largest number of high-cost individuals in each health plan. Solid organ and bone marrow transplants, AIDS, and most malignancies that required high-dose chemotherapy were also important. The carve-out list identified more than one third of high-cost individuals enrolled in the Medicaid program, approximately 20% of high-cost managed care enrollees, and 10% of high-cost fee-for-service enrollees. These data confirm that it is possible to identify high-cost individuals in health plans by using a carve-out list. Carving out high-cost patients from capitation risk arrangements may protect patients, physicians, and managed care organizations. (+info)
(4/437) The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island.
OBJECTIVES: The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island. METHODS: Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates. RESULTS: Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3). After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). CONCLUSIONS: Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care. (+info)
(5/437) A conflict of strategies: Medicaid managed care and Medicaid maximization.
OBJECTIVE: To examine the influence of state strategies aimed at increasing federal Medicaid matching dollars on the design of states' Medicaid managed care programs. STUDY DESIGN: Data obtained from the 1996-1997 case studies of 13 states to examine how states have adapted the design of their Medicaid managed care programs in part because of maximization strategies, to accommodate the many roles and responsibilities that Medicaid has assumed over the years. PRINCIPAL FINDINGS: Our study showed that as states made the shift to managed care, some found that the responsibilities undertaken in part through maximization strategies proved to be in conflict with their Medicaid managed care initiatives. Among other things, the study revealed that most states included provisions that preserved the health care safety net, such as adapting the managed care benefit package and promoting the participation of safety net providers in managed care programs. In addition, most of the study states continued to pay special subsidies to safety net providers, including hospitals and clinics. CONCLUSIONS: States have made real progress in moving a large number of Medicaid beneficiaries into managed care. At the same time, many states have specially crafted their managed care programs to accommodate safety net providers and existing funding mechanisms. By making these adaptations states, in the long run, may compromise the central goals of managed care: controlling costs and improving Medicaid beneficiaries' access to and quality of care. (+info)
(6/437) Medical records and privacy: empirical effects of legislation.
OBJECTIVE: To determine the effects of state legislation requiring patient informed consent prior to medical record abstraction by external researchers for a specific study. DATA SOURCES/STUDY SETTING: Informed consent responses obtained from November 1997 through April 1998 from members of a Minnesota-based IPA model health plan. STUDY DESIGN: Descriptive case study of consent to gain access to medical records for a pharmaco-epidemiologic study of seizures associated with use of a pain medication that was conducted as part of the FDA's post-marketing safety surveillance program to evaluate adverse events associated with approved drugs. DATA COLLECTION: The informed consent process approved by an institutional review board consisted of three phases: (1) a letter from the health plan's medical director requesting participation, (2) a second mailing to nonrespondents, and (3) a follow-up telephone call to nonrespondents. PRINCIPAL FINDINGS: Of 140 Minnesota health plan members asked to participate in the medical records study, 52 percent (73) responded and 19 percent (26) returned a signed consent form authorizing access to their records for the study. For 132 study subjects enrolled in five other health plans in states where study-specific consent was not required, health care providers granted access to patient medical records for 93 percent (123) of the members. CONCLUSION: Legislation requiring patient informed consent to gain access to medical records for a specific research study was associated with low participation and increased time to complete that observational study. Efforts to protect patient privacy may come into conflict with the ability to produce timely and valid research to safeguard and improve public health. (+info)
(7/437) Access to care for the uninsured: is access to a physician enough?
OBJECTIVES: This study examined a private-sector, statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. METHODS: A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). RESULTS: The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason for not receiving mammography, and 38% had not filled prescribed medicines in the previous year. CONCLUSIONS: Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services. (+info)
(8/437) Medicaid managed care payment rates in 1998.
This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate data for Medicaid's Aid to Families with Dependent Children (AFDC)/Temporary Assistance for Needy Families (TANF) and poverty-related populations and made adjustments to make the data comparable across states. The results show a slightly more than twofold variation in capitation rates among states, caused primarily by fee-for-service spending levels and demographics. There is a very low correlation between the variation in Medicaid capitation rates among states and the variations in Medicare's adjusted average per capita cost. The data are not sufficient to answer questions about the adequacy of rates but should help to further policy discussions and research. (+info)
Department of Healt
- United States Department of Health and Human Services. (umich.edu)
- The Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) administers the block grant. (blogspot.com)
- These core services are often divided into four categories: infrastructure-building, population-based, enabling, and direct health care. (blogspot.com)
- Manolakas says he cannot afford his workers' rising health care premiums. (americanprogress.org)
- This decline in health care benefits is almost entirely due to the shrinking number of small businesses that can afford to offer benefits, especially among the smallest employers. (americanprogress.org)
- Conservatives have suggested that the solution is further deregulating the health care market and shifting the burden for buying insurance to individuals. (americanprogress.org)
- But a business with only five employees is in a very different situation because not all people are equally likely to need health care. (americanprogress.org)
- Insurers use a process called "underwriting" to determine how high the health care costs of an individual business' employees are likely to be. (americanprogress.org)
- Public Use Tape 16 is the second public use data release from the NMES Health Insurance Plans Survey (HIPS). (umich.edu)
- The purpose of the HIPS was to verify information reported by respondents to two components of the NMES, the Household Survey and the Survey of American Indians and Alaska Natives (SAIAN), about their health insurance coverage. (umich.edu)
- These link files permit identification of the records in the Private Health Insurance Benefit Database (Parts 3-17 of this collection) that describe the specific benefits held by the policyholders. (umich.edu)
- If rising health insurance premiums are giving employers a cold, they are giving small businesses the flu. (americanprogress.org)
- Since President George W. Bush took office, the number of businesses that offer health insurance to their workers has declined 8 percent, from 69 percent in 2000 to 63 percent in 2008. (americanprogress.org)
- Small business owners and their employees account for the largest share of the uninsured population-an estimated 27 million of the 47 million Americans without health insurance . (americanprogress.org)
- Why do small businesses face a greater struggle to provide health insurance than other employers? (americanprogress.org)
- Your health insurance premium subsidizes the costs when someone else gets sick, and other people's premiums, in turn, subsidize your costs when you get sick. (americanprogress.org)
- Many of the expenses of administering health insurance-fees to insurance brokers and underwriting costs-are fixed, while others are actually higher for small businesses. (americanprogress.org)
- The Maternal and Child Health Bureau of HRSA also receives funding for other maternal and child health programs authorized under both Title V of the Social Security Act and the Public Health Service Act, including maternal and infant home visiting and autism services. (blogspot.com)
- MCH Services Block Grant funds are distributed for the purpose of funding core public health services provided by maternal and child health agencies. (blogspot.com)
- The National Medical Expenditure Survey (NMES) series provides information on health expenditures by or on behalf of families and individuals, the financing of these expenditures, and each person's use of services. (umich.edu)
- The program provides grants to states and territories to enable them to coordinate programs, develop systems, and provide a broad range of direct health services. (blogspot.com)