Glossary
of Terms as Commonly Used in Health Care
Alpha Center: Health Policy and Planning
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Acronyms: A| B| C|
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A
acronyms
acceptability
access
accreditation
active intervention
Activities of Daily Living (ADL)
actual charge
acute care
acute disease
adjusted average per capital cost (AAPCC)
adverse selection
affiliation
Agency for Health Care Policy and Research (AHCPR)
alcoholism
allied health personnel
allowable costs
alternatives to long term institutional care
ambulatory care
ambulatory setting
amortization
ancillary services
antitrust
appropriateness
Area Health Education Center (AHEC)
association
acceptability
The level of satisfaction expressed by consumers with the availability, accessibility,
cost, quality, continuity, and degree of courtesy and consideration afforded
them by the health care system
Index
access
Often defined as the potential and actual entry of a population into the health
care system and features such as private or public insurance coverage. The probability
of entry is also dependent upon the wants, resources, and needs that patients
may bring to the care-seeking process. Actual entry into the system is described
by utilization rates and subjective evaluations of care. Ability to obtain wanted
or needed services may also be influenced by the distance one has to travel,
waiting time, total income, and whether one has a regular source of care.
Index
accreditation
A process whereby a program of study or an institution is recognized by an external
body as meeting certain predetermined standards. For facilities, accreditation
standards are usually defined in terms of physical plant, governing body, administration,
and medical and other staff. Accreditation is often carried out by organizations
created for the purpose of assuring the public of the quality of the accredited
institution or program. The State or Federal Governments can recognize accreditation
in lieu of, or as the basis for licensure or other mandatory approvals. Public
or private payment programs often require accreditation as a condition of payment
for covered services. Accreditation may either be permanent or may be given
for a specified period of time.
Index
active intervention
An active intervention is a prevention strategy which requires direct participation
of the individual him/herself to be effective (e.g, weight loss programs)
Index
Activities of Daily Living (ADL)
An index or scale which measures a patient's degree of independence in bathing,
dressing, using the toilet, eating, and moving around the house.
Index
actual charge
One of the factors determining a physician's payment for a service under Medicare;
equivalent to the billed or submitted charge.
Index
acute care
Medical treatment rendered to individuals whose illness or health problems are
of a short-term or episodic nature. Acute care facilities are those hospitals
that mainly serve persons with short-term health problems.
Index
acute disease
A disease which is characterized by a single episode of a relatively short duration
from which the patient returns to his normal or previous state of level of activity.
While acute diseases are frequently distinguished from chronic diseases, there
is no standard definition or distinction. It is worth noting that an acute episode
of a chronic disease (for example, an episode of diabetic coma in a patient
with diabetes) is often treated as an acute disease.
Index
adjusted average per capital cost (AAPCC)
The basis for HMO or CMP reimbursement under Medicare-risk contracts. The average
monthly amount recieved per enrollee is currently calculated as 95 percent of
the average costs to deliver medical care in the fee-for-service sector.
Index
adverse selection
A tendency for utilization of health services in a population group to be higher
than average. From an insurance perspective, adverse selection occurs when persons
with poorer-than-average life expectancy or health status apply for, or continue,
insurance coverage to a greater extent than do persons with average or better
health expectations.
Index
affiliation
An agreement (usually formal) between two or more otherwise independent entities
or individuals which defines how they will relate to each other. Affiliation
agreements between hospitals may specify procedures for referring or transferring
patients from one facility to another, joint faculty and/or medical staff appointments,
teaching relationships, sharing of records or services, or provision of consultation
between programs.
Index
Agency for Health
Care Policy and Research (AHCPR)
One of the newest agencies of the U.S. Public Health Service, the AHCPR was
created in 1989. The Agency's primary goal is to enhance the quality, appropriateness,
and effectiveness of health care services by conducting and sponsoring credible
and timely research. It is the Federal government's focal point for health services
research, the efforts of which are built upon the work of AHCPR's predecessor,
the National Center for Health Services Research and Health Care Technology
Assessment.
Index
alcoholism
A chronic disease manifested by intake of alcoholic beverages in exess of dietary
uses, social uses and norms of the community, and which to some extent interferes
with the drinker's health and/or his or her social or economic functioning.
The definition of alcoholism in both theory and practice is highly variable.
Some definitions require either excessive drinking or interference with the
drinker's functions rather than both; other definitions require physical signs
of drug dependence in addition to the above. There are various systems in use
for separating different types of alcoholism and grading its severity.
Index
allied health personnel
Specially trained and licensed (when necessary) health workers other than physicians,
dentists, optometrists, chiropractors, podiatrists, and nurses. The term has
no constant or agreed-upon detailed meaning; sometimes being used synonymously
with paramedical personnel, sometimes meaning all health workers who perform
tasks which must otherwise be performed by a physician, and at other times referring
to health workers who do not usually engage in independent practice.
Index
allowable costs
Items or elements of an institution's costs which are reimbursable under a payment
formula. Both Medicare and Medicaid reimburse hospitals on the basis of only
certain costs. Allowable costs may exclude, for example, luxury accomodations,
costs which are not reasonable expenditures, which are unnecessary, for the
efficient delivery of health services to persons covered under the program in
question, or depreciation on a capital expenditure which was disapproved by
a health planning agency
Index
alternatives to long term institutional care
The whole range of health, nutritional, housing, and social services designed
to keep persons out of institutions, such as skilled nursing facilities, which
provide care on a long-term basis. The goal is to provide the range of services
necessary to allow the person to continue to function in the home and community
environment. Alternatives to long term care usually focus on the aged, disabled
and retarded, and include: day care center, foster homes, or homemaker services.
Index
ambulatory care
All types of health services which are provided on an outpatient basis, in contrast
to services provided in the home or to persons who are inpatients. While many
inpatients may be ambulatory, the term ambulatory care usually implies that
the patient must travel to a location to recieve services which do not require
an overnight stay. See also ambulatory setting and outpatient.
Index
ambulatory setting
A type of institutional organized health setting in which health services are
provided on an outpatient basis. Ambulatory care settings may be either mobile
(when the facility is capable of being moved to different locations) or fixed
(when the person seeking care must travel to a fixed service site).
Index
amortization
The act or process of retiring a debt, usually by equal payments at regular
intervals over a specific period of time.
Index
ancillary services
Supplemental services, including laboratory, radiology, physical therapy, and
inhalation therapy, that are provided in conjunction with medical or hospital
care.
Index
antitrust
A legal term encompassing a variety of efforts on the part of the government
to assure that sellers do not conspire to restrain trade or fix prices for their
goods or services in the market.
Index
appropriateness
Appropriate health care is care for which the expected health benefit exceeds
the expected negative consequences by a wide enough margin to justify treatment.
Index
Area Health Education Center (AHEC)
An organization or organized system of health and educational institutions whose
purpose is to improve the supply, distribution, quality, use and efficiency
of health care personnel in specific medically underserved areas. An AHEC's
objectives are to educate and train the health personnel specifically needed
by the underserved areas and to decentralize health workforce education, thereby
increasing supply and linking the health and educational institutions in scarcity
areas.
Index
association
A term signifying the relationship between two or more events or variables.
Events are said to be associated when they occur more frequently together than
one would expect by chance. Association does not necessarily imply a casual
relationship. Statistical significance testing enables a researcher to determine
the likelihood of observing the sample relationship by chance if in fact no
association exists in the population that was sampled. The terms "association"
and "relationship" are often used interchangeably.
Index
AAMC | Association of American Medical Colleges; Association of American Medical Clinics |
AAPCC | Adjusted Average Per Capita Cost |
AAPS | Association of American Physicians and Surgeons |
ADA | American Dietetic Association; American Dental Association |
ADL | Activities of Daily Living |
AFDC | Aid to Families with Dependent Children |
AGPA | American Group Practice Association |
ACHPR | Agency for Health Care Policy and Research |
AHEC | Area Health Education Center |
ANA | American Nurses Association |
AHA | American Hospital Association |
ANHA | American Nursing Homes Association |
AOA | American Optometric Association; American Osteopathic Association |
APA | Administrative Procedures Act |
APHA | American Pharmaceutical Association |
APHA | American Public Health Association; American Protestant Hospital Association |
ASTHO | Association of State and Territorial Health Officials |
B
acronym
bad debts
Blue Cross Plan
Blue Shield Plan
board certified
bad debts
Income lost to a provider because of failure of patients to pay amounts owed.
Bad debts may sometimes be recovered by increasing charges to paying patients.
Some cost-based reimbursement programs reimburse certain bad debts. The impact
of the loss of revenue from bad debts may be partially offset for proprietary
institutions by the fact that income tax is not payable on income not recieved.
Index
Blue Cross Plan
A nonprofit, tax exempt insurance plan providing coverage for hospital care
and related services. The individual plans should be distinguished from their
national association, the Blue Cross Association. Historically, the plans were
largely the creation of the hospital industry and designed to provide hospitals
with a stable source of revenue, although formal association between Blue Cross
and the American Hospital Association ended in 1972. A Blue Cross plan must
be a nonprofit community service organization with a governing body whose membership
includes a majority of public representatives.
Index
Blue Shield Plan
A nonprofit, tax exempt insurance plan which provides coverage for physicians'
services. Blue Shield coverage is sometimes sold in conjunction with Blue Cross
coverage, although this is not always the case.
Index
board certified
Status granted a medical specialist who completes a required course of training
and experience (residency) and passes an examination in his or her specialty.
Individuals who have met all requirements except examination are referred to
as "board eligible."
Index
BCA
Blue Cross Association
Index
C
acronyms
capital
capital costs
capital depreciation
capital expenditure
capital expenditure review
capitation
carve out
case management
case-mix
catastrophic health insurance
catchment area
causality
Centers for Disease Control and Prevention (CDC)
Certificate of Need (CON)
certification
CHAMPUS (Civilian Health and Medical Program of the Uniformed
Services)
charity care
chronic care
clinic
coinsurance
community-based care
community health center
Community Mental Health Center
community rating
community rating by class (class rating)
competition
Competitive Medical Plan
comprehensive health planning (CHP)
confidence interval
consumer
continuing medical education (CME)
contractual allowance
contribution margin
coordination of benefits
cost
cost-benefit analysis
cost center
cost containment
cost of goods sold
cost-effectiveness analysis
cost-shifting
covered services
credentialing
current cost
Current Procedural Terminology, fourth edition (CPT-4)
customary charge
Customary, Prevailing and Reasonable (CPR)
capital
Fixed or durable non-labor inputs or factors used in the production of goods
and services, the value of such factors, or the money specifically allocated
for their aquisition or development. Capital costs include, for example, the
buildings, beds and equipment used in the provision of hospital services. Capital
assets are usually thought of as permanent and durable as distinguished from
consumables such as supplies.
Index
capital costs
Expenditures for land, facilities, and major equipment. They are distinguished
from operating costs, which include such items as labor, supplies and administrative
expenses.
Index
capital depreciation
The decline in value of capital assets (assets of a permanent or fixed nature,
e.g., goods and plant) with use over time. The rate and amount of depreciation
is calculated by a variety of different methods (e.g., straight line, sumof
the digits, declining balance) which often give quite different results. Third-party
reimbursement for health services usually includes an amount intended to be
equivalent to the capital depreciation in any given period experienced by the
provider of a service.
Index
capital expenditure
An expenditure for the aquisition, replacement, modernization, or expansion
of facilities which, under generally accepted accounting principles, is not
properly chargeable as an expense of operation and maintainance.
Index
capital expenditure review
A review of proposed capital expenditures of hospitals and/or other health facilities
to determine the need for, and appropriateness of, the proposed capital expenditures.
The review is done by a designated regulatory agency and has a sanction attached
which prevents or discourages unneeded expenditures.
Index
capitation
A method of payment for health services in which an individual or institutional
provider is paid a fixed amount for each person served, without regard to the
actual number or nature of services provided to each person in a set period
of time. Capitation is the characteristic payment method in certain health maintainance
organizations. It also refers to a method of Federal support of health professional
schools. Under these authorizations, each eligable school recieves a fixed payment,
called a "capitation grant" from the Federal Government for each student
enrolled.
Index
carve out
Regarding health insurance, an arrangement whereby an employer eliminates coverage
for a specific category of services (e.g., vision care, mental health/psychological
services and prescription drugs) and contracts with a separate set of providers
for those services according to a predetermined fee schedule or capitation arrangement.
Carve out may also refer to a method of coordinating dual coverage for an individual.
Index
case management
The monitoring and coordination of treatment rendered to patients with specific
diagnosis or requiring high-cost or extensive services.
Index
case-mix
A measure of the mix of cases being treated by a particular health care provider
that is intended to reflect the patients' different needs for rescources. Case
mix is generally established by estimating the relative frequency of various
types of patients seen by the provider in question during a given time period
and may be measured by factors such as diagnosis, severity of illness, utilization
of services, and provider characteristics.
Index
catastrophic health insurance
Heath insurance which provides protection against the high cost of treating
severe or lengthy illnesses or disability. Generally such policies cover all,
or a specified percentage of, medical expenses above an amount that is the responsability
of another insurance policy up to a maximum limit of liability.
Index
catchment area
A geographic area defined and served by a health program or institution such
as a hospital or community mental health center, which is delineated on the
basis of such factors as population distribution, natural geographic boundaries,
and transportation accessibility. By definition all residents of the area needing
the services of the program are usually eligible for them, although eligibility
may also depend on additional criteria.
Index
causality
Relating causes to the effect they produce. Most of epidemiology concerns causality,
and several types of causes can be distinguished. A cause is termed "necessary"
when a particular variable must always precede an effect. The effect need not
be the sole result of the one variable. A cause is termed "sufficient"
when a particular variable inevitably initiates or produces an effect. Any given
cause may be necessary, sufficient, neither, or both.
Index
Centers for Disease Control
and Prevention (CDC)
The Centers for Disease Control and Prevention, based in Atlanta, Georgia, is
the Federal agency charged with protecting the nations' public health by providing
direction in the prevention and control of communicable and other diseases and
responding to public health emergencies. CDC is the U.S. Public Health Service
agency that led efforts to prevent such diseases as malaria, polio, smallpox,
toxic shock syndrome, Legionnaire's disease and, more recently, acquired immunodeficiency
syndrome (AIDS) and tuberculosis. CDC's responsibilities as the nation's prevention
agency have expanded over the years and will continue to evolve as the agency
addresses contemporary threats to health, such as injury, environmental and
occupational hazards, behavioral risks, and chronic diseases.
Index
Certificate of Need (CON)
A certificate issued by a governmental body to an individual or organization
proposing to construct or modify a health facility, aquire major new medical
equipment, modify a health facility, or offer a new or different health service.
Such issuance recognizes that a facility or service, when available, will meet
the needs of those for whom it is intended. CON is intended to control expansion
of facilities and services by preventing excessive or duplicative development
of facilities and services.
Index
certification
The process by which a governmental or nongovernmental agency or association
evaluates and recognizes an individual, institution, or educational program
as meeting predetermined standards. One so recognized is said to be "certified."
It is essentially synonymous with accreditation, except that certification is
usually applied to individuals, and accreditation to institutions. Certification
programs are generally nongovernmental and do not exclude the uncertified from
practice as do licensure programs.
Index
CHAMPUS (Civilian Health and Medical Program of the Uniformed
Services)
A Department of Defense program supporting private sector care for military
dependents.
Index
charity care
Generally refers to physician and hospital services provided to persons who
are unable to pay for the cost of services, especially those who are low-income,
uninsured and underinsured. A high proportion of the costs of charity care is
derived from services for children and pregnant women(e.g., neonatal intensive
care).
Index
chronic care
Care and treatment rendered to individuals whose health problems are of a long-term
and continuing nature. Rehabilitation facilities, nursing homes, and mental
hospitals may be considered chronic care facilities.
Index
chronic disease
A disease which has one or more of the following characteristics: is permanant,
leaves residual disability; is caused by nonreversible pathological alternation,
requires special training of the patient for rehabilitation, or may be expected
to require a long period of supervision, observation, or care.
Index
clinic
A facility, or part of one, devoted to diagnosis and treatment of outpatients.
"Clinic" is irregularly defined. It may either include or exclude
physicians' offices; may be limited to describing facilities which serve poor
or public patients; and may be limited to facilities in which graduate or undergraduate
medical education is done.
Index
coinsurance
A cost-sharing requirement under a health insurance policy. It provides that
the insured party will assume a portion of the costs of covered services. The
health insurance policy provides that the insurer will reimburse a specified
percentage of all, or certain specified, covered medical expenses in excess
of any deductable amounts payable by the insured. The insured is then liable
for the remainder of the costs until their maximum liability is reached.
Index
community-based care
The blend of health and social services provided to an individual or family
in their place of residence for the purpose of promoting, maintaining, or restoring
health or minimizing the effects of illness and disability.
Index
community health center
An ambulatory health care program (defined under section 330 of the Public Health
Service Act) usually serving a catchment area which has scarce or nonexistent
health services or a population with special health needs; sometimes known as
a "neighborhood health center." Community health centers attempt to
coordinate Federal, State and local rescources in a single organization capable
of delivering both health and related social services to a defined population.
While such a center may not directly provide all types of health care, it usually
takes responsibility to arrange all medical services needed by its patient population.
Index
Community Mental Health Center (CMHC)
An entity which provides comprehensive mental health services (principally ambulatory),
primarily to individuals residing or employed in a defined catchment area.
Index
community rating
A method of calculating health plan premiums using the average cost of actual
or anticipated health services for all subscribers within a specific geographic
area. The premium does not vary for different groups or subgroups of subscribers
on the basis of their specific claims experience.
Index
Community rating by class (class rating)
For federally qualified HMOs, the Community Rating by Class (CRC)-- adjustment
of community- rated premiums on the basis of such factors as age, sex, family
size, marital status and industry classification. These health plan premiums
reflect the experience of all enrollees of a given class within a specific geographic
area, rather than the experience of any one employer group.
Index
competition
A characteristic of market economics in which buyers choose from among alternative
goods and services made available in the market by two or more sellers. In a
classic competitive market, there are many buyers and many sellers.
Index
Competitive Medical Plan (CMP)
A state-licensed entity, other than a federally qualified HMO, that signs a
Medicare Risk Contract and agrees to assume financial risk for providing care
to Medicare eligables on a prospective, prepaid basis.
Index
comprehensive health planning (CHP)
Health planning that encompasses all personal factors and community programs
which impact on people's health.
Index
confidence interval
A range within which an estimate is deemed to be close to the actual value being
measured. In statistical measurements, estimates cannot be said to be exact
measures, but rather are defined in terms of their probability of matching the
value of the thing being measured.
Index
consumer
One who may recieve or is receiving health services. While all people at times
consume health services, a consumer, as the term is used in health legislation
and programs, is usually someone who is not associated in any direct or indirect
way with the provision of health services.
Index
continuing medical education (CME)
Formal education obtained by a health professional after completing his or her
degree and full- time postgraduate training. For physicians, some States require
CME (usually 50 hours per year) for continued licensure, as do some specialty
boards for certification.
Index
contractual allowance
The difference between what hospitals bill and what they receive in payment
from third party payers, most commonly government programs; also known as contractual
adjustment.
Index
contribution margin
Revenue from sales less all variable expenses.
Index
coordination of benefits (COB)
Procedures used by insurers to avoid duplicate payment for losses insured under
more than one insurance policy. A coordination of benefits, or "nonduplication,"
clause in either policy prevents double payment by making one insurer the primary
payer, and assuring that not more than 100 percent of the cost is covered. Standard
rules determine which of two or more plans, each having COB provisions, pays
its benefits in full and which becomes the supplementary payer on a claim.
Index
cost
Expenses incurred in the provision of services or goods. Many different kinds
of costs are defined and used (see allowable, indirect, and operating costs).
Charges, the price of a service or amount billed an individual or third party,
may or may not be equal to service costs.
Index
cost-benefit analysis
An analytic method in which a program's cost is compared to the program's benefits
for a period of time, expressed in dollars, as an aid in determining the best
investment of rescources. For example, the cost of establishing an immunization
service might be compared with the total cost of medical care and lost productivity
which will be eliminated as a result of more persons being immunized. Cost-benefit
analysis can also be applied to specific medical tests and treatments.
Index
cost center
An accounting device whereby all related costs attributable to some "financial
center" within an institution, such as a department or program are segregated
for accounting or reimbursement purposes.
Index
cost containment
A set of steps to control or reduce inefficiencies in the consumption, allocation,
or production of health care services which contribute to higher than necessary
costs. Ineffciencies in consumption can occur when health services are inappropriately
utilized; ineffciencies in allocation exist when health services could be delivered
in less costly settings without loss of quality; and ineffciencies in production
exist when the cost of producing health services could be reduced by using a
different combination of rescources.
Index
cost of goods sold
Inventoriable costs that are expensed because the units are sold; equals beginning
inventory plus cost of goods purchased or manufactured minus ending inventory.
Index
cost-effectiveness analysis
A method of comparing alternative ways for achieving a specific set of results.
Alternatives are compared on the basis of the ratio of the cost of each alternative
to its estimated future effect on objectives which need not be measured in financial
terms.
Index
cost-shifting
The condition which occurs when health care providers are not reimbursed or
not fully reimbursed for providing health care so charges to those who pay must
be increased. Typically results from providing health care to the medically
indigent or the Medicare patients.
Index
covered services
Health care services covered by an insurance plan.
Index
credentialing
The recognition of professional or technical competence. the credentialing process
may include registration, certification, licensure, professional association
membership, or the award of a degree in the field. Certification and licensure
affect the supply of health personnel by controlling entry into practice and
influence the stability of the labor force by affecting geographic distribution,
mobility, and retention of workers. Credentialing also determines the quality
of personnel by providing standards for evaluating competence and by defining
the scope of functions and how personnel may be used.
Index
current cost
Cost stated in terms of current values (of productive capacity) rather than
in terms of aquisition cost.
Index
Current Procedural Terminology, fourth edition (CPT-4)
A manual that assigns five digit codes to medical services and procedures to
standardize claims processing and data analysis.
Index
customary charge
One of the factors determining a physician's payment for a service under Medicare.
Calculated as the physician's median charge for that service over a prior 12-month
period.
Index
Customary, Prevailing, and Reasonable (CPR)
Current method of paying physicians under Medicare. Payment for a service is
limited to the lowest of (1) the physician's billed charge for the service,
(2) the physician's customary charge for the service, or (3) the prevailing
charge for that service in the community. Similar to the Usual, Customary, and
Reasonable system used by private insurers.
Index
CAP | Community Action Program |
CAT | Computerized Axial Tomography |
CBO | Congressional Budget Office |
CCHP | Consumer Choice Health Plan |
CCU | Coronary Care Unit |
CDC | Centers for Disease Control and Prevention |
CHAMPUS | Civillian Health and Medical Program of the Uniformed Services |
CHC | Community Health Center |
CMHC | Community Mental Health Center |
CME | Continuing Medical Education |
CMP | Competitive Medical Plan |
COB | Coordination of Benefits |
COG | Council of Governments |
CON | Certificate of Need |
COTH | Council of Teaching Hospitals |
CPA | Certified Public Accounts |
CPHA | Commission on Professional and Hospital Activities |
CPI | Consumer Price Index |
CPR | Customary, Prevailing, and Reasonable |
CPT-4 | Current Procedural Technology, Fourth Edition |
CRVS | California Relative Value Studies |
CT | Computer Tomographic (scanners) |
D
acronyms
debt service
deductible
default
defined benefit
defined contribution
deinstitutionalization
demand
dental health services
developmental disability (DD)
Diagnosis Related Groups (DRGs)
direct cost
disability
disease
drug abuse
debt service
Required payments for interest on and retirement of a debt; the amount needed,
supplied, or accrued for meeting such payments during any given accounting period;
a budget or operating statement heading for such items.
Index
deductible
The amount of loss or expense that must be incurred by an insured or otherwise
covered individual before an insurer will assume any liability for all or part
of the remaining cost of covered services. Deductibles may be either fixed-dollar
amounts or the value of specified services (such as two days of hospital care
or one physician visit). Deductibles are usually tied to some reference period
over which they must be incurred, e.g, $100 per calendar year, benefit period,
or spell of illness.
Index
default
Failure to pay debt service when due.
Index
defined benefit
Funding mechanisms for pension plans that can also be applied to health benefits.
Typical pension approaches include: (1) pegging benefits to a percentage of
an employee's average compensation over his entire service or over a particular
number of years; (2) calculation of a flat monthly payment; (3) setting benefits
based upon a definite amount for each year of service or as a flat dollar amount
for each year of service, either as a percentage of compensation for each year
of service or as a flat dollar amount for each year of service.
Index
defined contribution
Funding mechanism for pension plans that can also be applied to health benefits
based on a specific dollar contribution, without defining services to be provided.
Index
deinstitutionalization
Policy which calls for the provision of supportive care and treatment for medically
and socially dependent individuals in the community rather than in an institutional
setting.
Index
demand
In health economics, the amount of a good or service consumers are willing and
able to buy at varying prices, given constant income and other factors. Demand
should be distinguished from utilization (the amount of services actually used)
and need (which has a normative connotation and relates to the amount of goods
or services which should be consumed based on professional value judgments).
Index
dental health services
All services designed or intended to promote, maintain, or restore dental health
including educational, preventive, and theraputic services.
Index
developmental disability (DD)
A severe, chronic disability which is attributable to a mental or physical impairment
or combination of mental and physical impairments; is manifested before the
person attains age 22; is likely to continue indefinitely; results in substantial
functional limitations in three or more of the following areas of major life
activity self-care, receptive and expressive language, learning, mobility, self-direction,
capacity of independent living, economic self-sufficiency; and reflects the
person's needs for a combination and sequence of special, interdisciplinary,
or generic care treatments of services which are of lifelong or extended duration
and are individually planned and coordinated.
Index
Diagnosis Related Groups (DRGs)
Groupings of diagnostic categories drawn from the International Classification
of Diseases and modified by the presence of a surgical procedure, patient age,
presence or absence of significant comorbidities or complications, and other
relevant criteria. DRGs are the case-mix measure used in Medicare's prospective
payment system.
Index
direct cost
A cost which is identifiable directly with a particular activity, service, or
product of the program experience the costs. These costs do not include the
allocation of costs to a cost center which are not specifically attributable
to that cost center.
Index
disability
Any limitation of physical, mental, or social activity of an individual as compared
with other individuals of similar age, sex, and occupation. Frequently refers
to limitation of a person's usual or major activities, most commonly vocational.
there are varying types (functional, vocational, learning), degrees (partial,
total), and durations (temporary, permanent) of disability. Public programs
often provide benefits for specific disabilities, such as total and permanent.
Index
disease
May be defined as a failure of the adaptive mechanisms of an organism to counteract
adequately, normally, or appropriately to stimuli and stresses to which it is
subjected, resulting in a disturbance in the function or structure of some part
of the organism. This definition emphasizes that disease is multifactorial and
may be prevented or treated by changing any or a combination of factors. Disease
is a very elusive and difficult concept to define, being largely socially defined.
Thus, criminality and drug dependence are presently seen by some as diseases,
when they were previously considered to be moral or legal problems.
Index
drug abuse
Persistent or sporadic drug use inconsistent with or unrelated to acceptable
medical or cultural practice. The definition of drug abuse is highly variable,
sometimes also requiring excessive use of a drug, unnecessary use (thus incorporating
recreational use), dependence, or illegal use.
Index
DD | Develomental Disability |
DDS | Doctor of Dental Surgery |
DEA | Drug Enforcement Administration |
DMD | Doctor of Dental Medicine |
DO | Doctor of Osteopathy |
DRG | Diagnosis-Related Group |
DVM | Doctor of Veterinary Medicine |
E
acronyms
Early and Periodic Screening, Diagnosis, and Treatment Program
(EPSDT)
effectiveness
efficacy
efficiency
emergency medical services (EMS)
Employee Retirement Income Security Act (ERISA)
epidemic
epidemiology
etiology
evaluation
exclusive provider arrangement (EPA)
expenditure target (ET)
experience rating
exposure
Early and Periodic Screening, Diagnosis, and Treatment
Program (EPSDT)
A program mandated by law as part of the Medicaid program. The law requires
that all states have in effect a program for eligable children under 21 to ascertain
their physical or mental defects and to provide such health care treatments
and other measures to correct or ameliorate defects and chronic conditions discovered.
The State programs also have active outreach components to inform eligible persons
of the benefits available to them, to provide screening, and if necessary, to
assist in obtaining appropriate treatment.
Index
effectiveness
A particular application of efficacy, i.e., it reflects the performance of an
intervention under ordinary conditions by the average practitioner for the typical
patient.
Index
efficacy
The probabilty of benefit to individuals in a defined population from a medical
technology applied to a given medical problem under ideal conditions of use.
Index
efficiency
"Productive" effciency describes the performance of a service or delivery
of medical care of a given quality with the least expenditure of rescources.
"Allocative" efficiency concerns not only whether care is provided
as cheaply as possible given its cost and quality, but also whether the costs
expended for the additional care are worth the benefits to be gained.
Index
emergency medical services (EMS)
Services utilized in responding to the percieved individual need for immediate
treatment for medical, physiological, or psychological illness or injury.
Index
Employee Retirement
Income Security Act (ERISA)
A Federal act, past in 1974, that established new standards and reporting/disclosure
requirements for the employer-funded pension and health benefit programs. To
date, self-funded health benefit plans operating under ERISA have been held
to be exempt from State insurance laws.
Index
epidemic
A group of cases of a specific disease or illness clearly in excess of what
one would normally expect in a particular geographic area. There is no absolute
criterion for using the term epidemic; as standards and expectations change,
so might the definition of an epidemic, e.g., an epidemic of violence.
Index
epidemiology
The study of the patterns of determinants and antecedents of disease in human
populations. Epidemiology utilizes biology, clinical medicine, and statistics
in an effort to understand the etiology (causes) of illness and/or disease.
The ultimate goal of the epidemiologist is not merely to identify underlying
causes of a diseas but to apply findings to disease prevention and health promotion.
Index
etiology
Cause. A term used by epidemiologists.
Index
evaluation
In health services research, a systematic analysis of the degree to which a
program or initiative has achieved, or is capable of achieving, its goals and
objectives. In medicine, an analysis of a patient's condition.
Index
exclusive provider arrangement (EPA)
An indemnity or service plan that provides benefits only if care is rendered
by the institutional and professional providers with which it contracts (with
some exceptions for emergency and out of area services).
Index
expenditure target (ET)
A mechanism to adjust fee updates (or the fees themselves) based on how actual
expenditures in an area compare to a target for those expenditures.
Index
experience rating
A method of adjusting health plan premiums based on the historical utilization
data and distinguishing characteristics of a specific subscriber group.
Index
exposure
A general term used to describe contact with a risk factor. An exposure can
be a physical agent (e.g., radiation) or a behavior (i.e., excessive drinking).
Index
ECF | Extended Care Facility |
EMS | Emergency Medical Services |
EPA | Exclusive Provider Arrangement |
EPSDT | Early and Periodic Screening, Diagnosis, and Treatment Program |
ER | Emergency Room |
ERISA | Employee Retirement Income Security Act |
ESRD | End Stage Renal Disease |
ET | Expenditure Target |
F
acronyms
family practice
favorable selection
fee-for-service
fee schedule
fiduciary
financial feasibility
foreign medical graduate (FMG)
family practice
A form of specialty practice in which physicians provide continuing comprehensive
primary care within the context of the family unit.
Index
favorable selection
A tendency for utilization of health services in a population group to be lower
than expected or estimated.
Index
fee-for-service
Method of billing for health services under which a physician or other practitioner
charges separately for each patient encounter or service rendered; it is the
method of billing used by the majority of U.S. country's physicians. Under a
fee-for-service payment system, expenditures increase if the fees themselves
increase, if more units of service are provided, or if more expensive services
are substituted for less expensive ones. This system contrasts with salary,
per capita, or other prepayment systems, where the payment to the physician
is not changed with the number of services actually used.
Index
fee schedule
An exhaustive list of physician services in which each entry is associated with
a specific monetary amount that represents the approved payment level for a
given insurance plan.
Index
fiduciary
Relating to, or founded upon, a trust of confidence. A fiduciary relationship
exists where an individual or organization has an explicit or implicit obligation
to act in behalf of another person's or organization's interests in matters
which affect the other person or organization. A physician has such a relation
with his patient, and a hospital trustee has one with a hospital.
Index
financial feasibility
The projected ability of a provider to pay the capital and operating costs associated
with the delivery of a proposed health care service.
Index
foreign medical graduate (FMG)
A physician who graduated from a medical school outside the United States, usually
Canada. U.S. citizens who go to medical school abroad are classified as foreign
medical graduates (sometimes distinguished as USFMGs), just as foreign-born
persons who are not trained in a medical school in this country. U.S. citizens
represent only a small portion of the FMG group.
Index
FAH | Federation of American Hospitals |
FDA | Food and Drug Administration |
FEHBP | Federal Employees Health Benefits Program |
FICA | Federal Insurance Contributions Act |
FMG | Foreign Medical Graduate |
FNP | Family Nurse Practitioner |
FTC | Federal Trade Commission |
FY | Fiscal Year |
G
acronyms
general practice
global budgeting
global fee
goal
gross margin
group practice
general practice
A form of practice in which physicians without specialty training provide a
wide range of primary health care services to patients.
Index
global budgeting
A method of hospital cost containment in which participating hospitals must
share a prospectively set budget. Method for allocating funds among hospitals
may vary but the key is that the participating hospitals agree to an aggregate
cap on revenues that they will recieve each year. Global budgeting may also
be mandated under a universal health insurance system.
Index
global fee
A total charge for a specific set of services, such as obstetrical services
that encompass prenatal, delivery and post-natal care.
Index
goal
A statement of expectations of desired, attainable levels of health status and/or
health system performance.
Index
gross margin
Net sales minus goods sold; the difference between sales revenues and manufacturing
costs as an intermediate step in the computation of operating profits or net
income.
Index
group practice
A formal association of three or more physicians or other health professionals
providing health services. Income from the practice is pooled and redistributed
to the members of the group according to some prearranged plan (often, but not
necessarily, through partnership). Groups vary a great deal in size, composition,
and financial arrangements.
Index
GHAA | Group Health Association of America |
GP | General Practitioner |
H
acronyms
handicapped
health
Health Care Financing Administration
health education
health facilities
health insurance
health maintenance organization (HMO)
Health Manpower Shortage Area (HMSA)
health personnel
health planning
health promotion
Health Rescources and Services Administration (HRSA)
health service area
health status
Health Systems Agency (HSA)
Hill-Burton
holism
home health care
hospice
hospital
handicapped
As defined by section 504 of the Rehabilitation Act of 1973, any person who
has a physical or mental impairment which substantially limits one or more major
life activity, has a record of such impairment, or is regarded as having such
an impairment.
Index
health
The state of complete physical, mental, and social well-being and not merely
the absence of disease or infirmity. It is recognized, however, that health
has many dimensions (anotomical, physiological, and mental) and is largely culturally
defined. The relative importance of various disabilities will differ depending
upon the cultural milieu and the role of the affected individual in that culture.
Most attempts at measurement have been assessed in terms of morbidity and mortality.
Index
Health Care Financing
Administration (HCFA)
The Government agency within the Department of Health and Human Services which
directs the Medicare and Medicaid programs (Titles XVIII and XIX of the Social
Security Act) and conducts research to support those programs.
Index
health education
Any combination of learning opportunities designed to facilitate voluntary adaptions
of behavior (in individuals, groups, or communities) conducive to health.
Index
health facilities
Collectively, all physical plants used in the provision of health services;
usually limited to facilities which were built for the purpose of providing
health care, such as hospitals and nursing homes. They do not included an office
building which includes a physician's office. Health facility classifications
include: hospitals (both general and specialty), long-term care facilities,
kidney dialysis treatment centers, and ambulatory surgical facilities.
Index
health insurance
Financial protection against the medical care costs arising fromm disease or
accidental bodily injury. Such insurance usually covers all or part of the medical
costs of treating the disease or injury. Insurance may be obtained on either
an individual or group basis.
Index
health maintenance organization (HMO)
An entity with four essential attributes: (1) An organized system providing
health care in a geographic area, which accepts the responsibility to provide
or otherwise assure the delivery of; (2) an agreed-upon set of basic and supplemental
health maintenance and treatment services to (3) a voluntarily enrolled group
of persons; and (4) for which services the entity is reimbursed through a predetermined
fixed, periodic prepayment made by, or on behalf of, each person or family unit
enrolled. The payment is fixed without regard to the amounts of actual services
provided to an individual enrollee. Individual practice associations involving
groups or independent physicians can be included under the definition.
Index
Health Manpower Shortage Area (HMSA)
An area or group which the U.S. Department of Health and Human Services designates
as having an inadequate supply of health care providers. HMSAs can include:
(1) an urban or rural geographic area, (2) a population group for which access
barriers can be demonstrated to prevent members of the group from using local
providers, or (3) medium and maximum-security correctional institutions and
public or non-profit private residential facilities.
Index
health personnel
Collectively, all persons 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. Facilities and health personnel are the principal health rescources
used in providing health services.
Index
health planning
Planning concerned with improving health, whether undertaken comprehensively
for a whole community or for a particular population, type of health service,
institution, or health program. The components of health planning include: data
assembly and analysis, goal determination, action recommendation, and implementation
strategy.
Index
health promotion
Any combination of health education and related organizational, political and
economic interventions designed to facilitate behavioral and environmental adaptions
that will improve or protect health.
Index
Health Resources
and Services Administration (HRSA)
One of the eight agencies of the U.S. Public Health Service, HRSA has responsibility
for addressing resource issues relating to acess, equity and quality of health
care, particularly to the disadvantaged and underserved. HRSA provides leadership
to assure the support and delivery of primary health care services, particularly
in underserved areas, and the development of qualified primary care health professionals
and facilities to meet the health needs of the nation. HRSA focuses on support
of states and communities in their efforts to plan, organize, and deliver primary
health care, as well as strengthen the overall public health system.
Index
health service area
Geographic area designated on the basis of such factors as geography, political
boundaries, population, and health resources, for the effective planning and
development of health services.
Index
health status
The state of health of a specified individual, group or population. It may be
measured by obtaining proxies such as people's subjective assessments of their
health; by one or more indicators of mortality and morbidity in the population,
such as longevity or maternal and infant mortality; or by using the incidence
or prevelence of major diseases (communicable, chronic, or nutritional). Conceptually,
health status is the proper outcome measure for the effectiveness of a specific
population's medical care system, although attempts to relate effects of available
medical care to variations in health status have proved difficult.
Index
Health Systems Agency (HSA)
A health planning agency created under the National Health Planning and Rescources
Development Act of 1974. HSAs were usually nonprofit private organizations and
served defined health service areas as designated by the states.
Index
Hill-Burton
Coined from the names of the principal sponsors of the Public Law 79-725 (the
Hospital Survey and Construction Act of 1946); this program provided Federal
support for the construction and modernization of hospitals and other health
facilities. Hospitals that have recieved Hill-Burton funds incur and obligation
to provide a certain amount of charity care.
Index
holism
Refers to the integration of mind, body, and spirit of a person and emphasizes
the importance of perceiving the individual (regarding physical symptoms) in
a "whole" sense. Holism teaches the the health care system must extend
its focus beyond solely the physical aspects of disease and particular organ
in question, to concern itself with the whole person and the interrelationships
between the emotional, social, spiritual, as well as physical implications of
disease and health.
Index
home health care
Health services rendered in the home to the aged, disabled, sick or convalescent
individuals who do not need institutional care. The services may be provided
by a visiting nurse association (VNA), home health agency, county public health
department, hospital, or other organized community group and may be specialized
or comprehensive. The most common types of home health care are the following--
nursing services; speech, physical, occupational and rehabilitation therapy;
homemaker services; and social services.
Index
hospice
A program which provides palliative and supportive care for terminally ill patients
and their families, either directly or on a consulting basis with the patient's
physician or another community agency. Originally a medieval name for a way
station for crusaders where they could be replenished, refreshed, and cared
for, hospice is used here for an organized program of care for people going
through life's "last station." The whole family is considered the
unit of care, and care extends through their period of mourning.
Index
hospital
An institution whose primary funcition is to provide inpatient diagnostic and
theraputic services for a variety of medical conditions, both surgical and nonsurgical.
In addition, most hospitals provide some outpatient services, particularly emergency
care. Hospitals may be classified by length of stay (short-term or long-term),
as teaching or nonteaching, by major type of service (psychiatric, tuberculosis,
general, and other specialties, such as maternity, pediatric, or ear, nose and
throat), and by type of ownership or control (Federal, State, or local government;
for-profit and nonprofit). The hospital system is dominated by the short-term,
general, nonprofit community hospital, often called a voluntary hospital.
Index
HCFA | Health Care Financing Administration |
(D)HHS | Department of Health and Human Services |
HIAA | Health Insurance Association of America |
HMO | Health Maintenance Organization |
HMSA | Health Manpower Shortage Area |
HRSA | Health Rescources and Services Administration |
HSA | Health Systems Agency |
I
acronyms
incidence
indemnity
independent practice association (IPA)
indigent care
indirect cost
inpatient
institutional health services
instrumental activities of daily living (IADL)
interest
intermediate care facility (ICF)
intervention or intervention strategy
inventory
incidence
In epidemiology, the number of cases of disease, infection, or some other event
having their onset during a prescribed period of time in relation to the unit
of population in which they occur. Incidence measures morbidity or other events
as they happen over a period of time. Examples include the number of accidents
occurring in a manufactuing plant during a year in relation to the number of
employees in the plant, or the number of cases of mumps occurring in a school
during a month in relation to the number of pupils enrolled in the school. It
usually refers only to the number of new cases, particularly of chronic diseases.
Index
indemnity
Health insurance benefits provided in the form of cash payments rather than
services. An indemnity insurance contract usually defines the maximum amounts
which will be paid for the covered services.
Index
independent practice association (IPA)
An organized form of prepaid medical practice in which participating physicians
remain in their independent office settings, seeing both enrollees of the IPA
and private-pay patients. Participating physicians may be reimbursed by the
IPA on a fee-for-service basis or a capitation basis.
Index
indigent care
Health services provided to the poor or those unable to pay. Since many indigent
patients are not eligible for Federal or State programs, the costs which are
covered by Medicaid are generally recorded separately from indigent care costs.
Index
indirect cost
A cost which cannot be indentified directly with a particular activity, service,
or product of the entity incurring the cost. Indirect costs are usually apportioned
among an entity's services in proportion to each service's share of direct costs.
Index
inpatient
A person who has been admitted at least overnight to a hospital or other health
facility (which is therefore responsible for his or her room and board) for
the purpose of receiving diagnostic treatment or other health services.
Index
institutional health services
Health services delivered on an inpatient basis in hospitals, nursing homes,
or other inpatient institutions. The term may also refer to services delivered
on an outpatient basis by departments or other organizational units of, or sponsored
by, such institutions.
Index
instrumental activities of daily living (IADL)
An index or scale which measures a patient's degree of independence in aspects
of cognitive and social functioning including shopping, cooking, doing housework,
managing money, and using the telephone.
Index
interest
The cost incurred for borrowing funds. Interest is usually expressed as a percentage
of a total loan.
Index
intermediate care facility (ICF)
An institution which is licensed under State law to provide on a regular basis,
health-related care and services to individuals who do not require the degree
of care or treatment which a hospital or skilled nursing facility is designed
to provide. Public institutions for care of the mentally retarded or people
with related conditions are also included in the definition. The distinction
between "health-related care and services" and "room and board"
has often proven difficult to make but is important because ICFs are subject
to quite different regulations and coverage requirements than institutions which
do not provide health-related care and services.
Index
intervention or intervention strategy
A generic term used in public health to describe a program or policy designed
to have an impact on an illness or disease. Hence a mandatory seat belt law
is an intervention designed to reduce automobile-related fatalities.
Index
inventory
A detailed description of quantities and locations of different kinds of facilities,
major equipment, and personnel which are available in a geographic area and
the amount, type and distribution of services these resources can support.
Index
IADL | Instrumental Activities of Daily Living |
ICDA | International Classification of Diseases, Adapted |
ICF | Intermediate Care Facility |
ICU | Intensive Care Unit |
ICU/MR | Intermediate Car Facility for the Mentally Retarded |
IOM | Institute of Medicine of the National Academy of Sciences |
IPA | Independent Practice Association |
J
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
A national, private, nonprofit organization whose purpose is to encourage the
attainment of uniformly high standards of institutional medical care. Established
guidelines for the operation of hospitals and other health facilities and conducts
survey and accreditation programs.
Index
L
acronyms
license/licensure
life safety code
long-term care
license/licensure
A permission granted to an individual or organization by a competent authority,
usually public to engage lawfully in a practice, occupation, or activity. Licensure
is the process by which the license is granted. It is usually granted on the
basis of examination and/or proof of education rather than on measures of performance.
A license is usually permanent but may be conditioned on annual payment of a
fee, proof of continuing education, or proof of competence.
Index
life safety code
A fire safety code prepared by the National Fire Protection Association. The
provisions of this code relating to hospitals and nursing facilities must (except
in instances where a waiver is granted) be met by facilities certified for participation
under Medicare and Medicaid. The code is based on optimum (non minimum) standards.
Index
long-term care
A set of health care, personal care and social services required by persons
who have lost, or never acquired, some degree of functional capacity (e.g.,
the cronically ill, aged, disabled or retarded) in an institution or at home,
on a long-term basis. The term is often used more narrowly to refer only to
long-term institutional care such as that provided in nursing homes, homes for
the retarded, and mental hospitals. Ambulatory services such as home health
care, which can also be provided on a long-term basis, are seen as alternatives
to long-term institutional care.
Index
LOS | Length of Stay |
LPN | Licensed Practical Nurse |
LSC | Life Safety Code |
LVN | Licensed Vocational Nurse |
M
acronyms
magnetic resonance imaging (MRI)
malpractice
managed care
margin
maximum allowable actual charge (MAAC)
Medicaid (Title XIX)
Medicaid notch
medical audit
medically indigent
medically underserved population
Medicare (Title XVII)
medicare risk contract
mental health
mental health services
mental illness
merit good
modernization
morbidity
mortality
magnetic resonance imaging (MRI)
This relatively new form of diagnostic radiology is a method of imaging body
tissues that uses the response or resonance of the nuclei of the atoms of one
of the bodily elements, typically hydrogen or phosphorus, to externally applied
magnetic fields.
Index
malpractice
Professional misconduct or failure to apply ordinary skill in the performance
of a professional act. A practitioner is liable for damages or injuries caused
by malpractice. For some professions like medicine, malpractice insurance can
cover the cost of defending suits instituted against the professional and/or
any damages assessed by the court, usually up to a maximum limit. To prove malpractice
requires that a patient demonstrate some injury and that the injury be caused
by negligence.
Index
managed care
Any form of health plan that initiates selective contracting to channel patients
to a limited number of providers and that requires utilization review to control
unnecessary use of health services.
Index
margin
Revenue less specified expenses.
Index
maximum allowable actual charge (MAAC)
A limitation on billed charges for Medicare services provided by nonparticipating
physicians. For physicians with charges exceeding 115 percent of the prevailing
charge for nonparticipating physicians, MAACs limit increases in actual charges
to 1 percent a year. For physicians whose charges are less than 115 percent
of the prevailing, MAACs limit actual charge increases so they may not exceed
115 percent.
Index
Medicaid
(Title XIX)
A Federally aided, State-operated and administered program which provides medical
benefits for certain indigent or low-income persons in need of health and medical
care. The program, authorized by Title XIX of the Social Security Act, is basically
for the poor. It does not cover all of the poor, however, but only persons who
meet specified eligibility criteria. Subject to broad Federal guidelines, States
determine the benefits covered, program eligibility, rates of payment for providers,
and methods of administering the program.
Index
Medicaid notch
The reduction in real income that occurs when increased earnings removes a person
from not only public cash-assistance programs, and from Medicaid
Index
medical audit
Detailed retrospective review and evaluation of selected medical records by
qualified professional staff. Medical audits are used in some hospitals, group
practices, and occasionally in private performance by comparing it with accepted
criteria, standards, and current professional judgement. A medical audit is
usually concerned with the care of a given illness and is undertaken to identify
deficiencies in that care in anticipation of educational programs to improve
it.
Index
medically indigent
People who cannot afford needed health care because of insufficient income and/or
lack of adequate health insurance.
Index
medically underserved population
A population group experiencing a shortage of personal health services. A medically
underserved population may or may not reside in a particular medically underserved
area or be defined by its place of residence. Thus, migrants, American Indians,
or the inmates of a prison or mental hospital may constitute such a population.
The term is defined and used to give priority for Federal assistance (e.g.,
the National Health Service Corps).
Index
Medicare
(Title XVIII)
A U.S. health insurance program for people aged 65 and over, for persons eligible
for social security disability payments for two years or longer, and for certain
workers and their dependents who need kidney transplantation or dialysis. Monies
from payroll taxes and premiums from beneficiaries are deposited in special
trust funds for use in meeting the expenses incurred by the insured. It consists
of two separate but coordinated programs: hospital insurance (Part A) and supplementary
medical insurance (Part B).
Index
medicare risk contract
An agreement by an HMO or competitive medical plan to accept a fixed dollar
reimbursement per Medicare enrollee, derived from costs in the fee-for-service
sector, for delivery of a full range of prepaid health services.
Index
mental health
The capacity in an individual to function effectively in society. Mental health
is a concept influenced by biological, environmental, emotional, and cultural
factors and is highly variable in definition, depending on time and place. It
is often defined in practice as the absence of any identifiable or significant
mental disorder and sometimes improperly used as a synonym for mental illness.
Index
mental health services
Comprehensive mental health services, as defined under some State laws and Federal
statutes include: inpatient care, outpatient care, day care, and other partical
hospitalization and emergency services; specialized services for the mental
health of children; specialized services for the mental health of the elderly;
consultation and education services; assistance to courts and other public agencies
in screening catchment area residents; follow-up care for catchment area residents
discharged from mental health facilities or who would require inpatient care
without such halfway house services; and specialize programs for the prevention,
treatment and rehabilitation of alcohol and drug offenders.
Index
mental illness
All forms of illness in which psychological, emotional, or behavioral disturbances
are the dominating feature. The term is relative and variable in different cultures,
schools of thought, and definitions. It includes a wide range of types and severities.
Index
merit good
A good or service which is societally sanctioned and deemed worthy of use or
consumption by the general population. Often, a merit good is publicly provided
or subsidized in order to assure widespread availability. Primary education
is an example of a merit good which is made compulsory by the Government.
Index
modernization
Remodeling, renovation, or sometimes, replacement of health facilities and equipment
to bring them up to current construction standards, into compliance with fire
and safety codes, or to meet contemporary health delivery needs.
Index
morbidity
The extent of illness, injury, or disability in a defined population. It is
usually expressed in general or specific rates of incidence or prevalence.
Index
mortality
Death. Used to describe the relation of deaths to the population in which they
occur. The mortality rate (death rate) expresses the number of deaths in a unit
of population within a prescribed time and may be expressed as crude death rates
(e.g., total deaths in relation to total population during a year) or as death
rates specific for diseases and, sometimes, for age, sex, or other attributes
(e.g., number of deaths from cancer in white males in relation to the white
male population during a given year).
Index
MAAC | Maximum Allowable Actual Charge |
MAF | Medical Assistance Facility |
MAP | Medical Audit Program |
MCAT | Medical College Admission Test |
MCH | Maternal and Child Health Program |
MEDLARS | Medical Literature and Analysis Retrieval System |
MMIS | Medicaid Management Information System |
MR | Mentally Retarded |
MRI | Magnetic Resonance Imaging |
MSA | Metropolitan Statistical Areas |
N
acronyms
natural history of disease
need
neighborhood health center
nurse
nurse practitioner
nursing home
natural history of disease
This term refers to the fact that virtually all illnesses and diseases have
certain predictable and regular patterns associated with them, i.e., a natural
history. Understanding something of a natural history of a disease is a necessity
if an effective intervention program is to be implemented.
Index
need
In health services, need has a normative connotation (i.e., the amount of a
good or service which should be consumed). Because of the technical nature of
medical care this value judgement is generally made by the health professional,
rather than the consumer of these services. In health planning, need is the
appropriate amount of health facilities and services required for a given area.
Index
neighborhood health center
An ambulatory health care program usually serving a catchment area which has
scarce or nonexistent health services or a population with special health needs
and is often know as a community health center. Neighborhood health centers
attempt to coordinate Federal, State, and local rescources in a single organization
capable of delivering both health care and related social services to a defined
population.
Index
nurse
An individual trained to care for the sick, aged, or injured. A nurse can be
defined as a professional qualified by education and authorized by law to practice
nursing. There are many different types, specialties, and grades of nurses.
Index
nurse practitioner
A registered nurse qualified and specially trained to provide primary care,
including primary health care in homes and in ambulatory care facilities, long-term
care facilities, and other health care institutions. Nurse practitioners generally
function under the supervision of a physician but not necessarily in his or
her presence. They are usually salaried rather than reimbursed on a fee-for-service
basis, although the supervising physician may recieve fee-for-service reimbursement
for their services.
Index
nursing home
Includes a wide range of institutions which provide various levels of maintainance
and personal or nursing care to people who are unable to care for themselves
and who have health problems which range from minimal to very serious. The term
includes free-standing institutions, or identifiable components of other health
facilities which provide nursing care and related services, personal services,
and residential care. Nursing homes include skilled nursing facilities and extended
care facilities but not boarding homes.
Index
NACo | National Association of Counties |
NCHS | National Center for Health Statistics |
NCHSR/HCTA | National Center for Health Services Research/Health Care Technology Assessment |
NGA | National Governor's Association |
NHSC | National Health Service Corps |
NICU | Neonatal Intensive Care Unit |
NIH | National Institutes of Health |
NIMH | National Institute of Mental Health |
NIOSH | National Institute of Occupational Safety and Health |
NLM | National Library of Medicine |
NP | Nurse Practitioner |
NPRM | Notice of Proposed Rulemaking |
O
acronyms
occupancy rate
occupational health services
open enrollment
operating cost
operating margin
outcomes research
outlier
outpatient
overhead
occupancy rate
A measure of inpatient health facility use, determined by dividing available
bed days by patient days. It measures the average percentage of a hospital's
beds occupied and may be institution-wide or specific for one department or
service.
Index
occupational health services
Health services concerned with the physical, mental, and social well-being of
an individual in relation to his or her working environment and with the adjustment
of individuals to their work. The term applies to more than the safety of the
workplace and includes health and job satisfaction. In the U.S., the principal
Federal statute concerned with occupational health is the Occupational Safety
and Health Act administered by the Occupational Safety and Health Administration
(OSHA) and the National Institute of Occupational Safety and Health (NIOSH).
Index
open enrollment
A method for assuring that insurance plans, especially prepaid plans, do not
exclusively select good risks. Under an open enrollment requirement, a plan
must accept all who apply during a specific period each year.
Index
operating cost
In the health field, the financial requirements necessary to operate an activity
which provides health services. These costs normally include the costs of personnel,
materials, overhead, depreciation, and interest.
Index
operating margin
Revenues from sales minus current cost of goods sold. A measure of operating
efficiency that is independent of the cost flow assumption for inventory. Sometimes
called "current (gross) margin".
Index
outcomes research
Research on measures of changes in patient outcomes, that is, patient health
status and satisfaction, resulting from specific medical and health interventions.
Attributing changes in outcomes to medical care requires distinguishing the
effects of care from the effects of many other factors that influence patients'
health and satisfaction.
Index
outlier
A hospital admission requiring either substantially more expense or a much longer
stay than average. Under DRG reimbursement, outliers are given exceptional treatment
(subject to peer review organization review).
Index
outpatient
A patient who is receiving ambulatory care at a hospital or other facility without
being admitted to the facility. Usually, it does not mean people receiving services
from a physician's office or other program which also does not provide inpatient
care.
Index
overhead
The general costs of operating an entity which are allocated to all the revenue
producing operations of the entity but which are not directly attributable to
a single activity. For a hospital, these costs normally include maintenance
of plant, occupancy costs, housekeeping, administration, and others.
Index
OAA | Old Age Assistance |
OASDHI | Old Age Survivors, Disability, and Health Insurance Program |
OMB | Office of Management and Budget |
OPD | Outpatient Department |
P
passive intervention
patient origin study
peer review
physician assistant (PA)
Physician Payment Review Commission (PPRC)
planning
point of service
policy
poverty area
preadmission certification
precision
preferred provider arrangement (PPA)
Preferred Provider Organization (PPO)
prepayment
prevailing charge
prevalence
preventive medicine
primary care
primary prevention
probability (P value)
prospective payment
Prospective Payment Assessment Commission (ProPAC)
provider
public good
public health
passive intervention
Health promotion and disease prevention initiatives which do not require the
direct involvement of the individual (e.g., fluoridation programs) are termed
"passive". Most often these types of initiatives are Government sponsored.
Index
patient origin study
A study, generally undertaken by an individual health program or health planning
agency, to determine the geographic distribution of the residences of the patients
served by one or more health programs. Such studies help define catchment and
medical trade areas and are useful in locating and planning the development
of new services.
Index
peer review
Generally, the evaluation by practicing physicians or other professionals of the
effectiveness and efficiency of services ordered or performed by other members of the
profession (peers). Frequently, peer review refers to the activities of the Professional
Review Organizations, and also to review of research by other researchers.
Index
physician assistant (PA)
Also known as a physician extender, a PA is a specially trained and licensed or otherwise
credentialed individual who performs tasks, which might otherwise be performed by a
physician, under the direction of a supervising physician.
Index
Physician Payment Review
Commission (PPRC)
In 1986, the Congress created the Physician Payment Review Commission to advise it on
reforms of the methods used to pay physicians under the Medicare program. The Commission
has conducted analyses of physician payment issues and worked closely with the Congress to
bring about comprehensive reforms in Medicare physician payment policy. Its
recommendations formed the basis of 1989 legislation that created the RBRVS, a
rescource-based fee schedule limiting the amount physicians may charge patients.
Index
planning
The conscious design of a desired future state (described in a plan by its goals
and objectives); including; description of, and selection among, alternative
means of achieving the goals and objectives; the conduct of the activities necessary
to the design process (such as data gathering and analysis); and the activities
necessary to assure that the plan is achieved.
Index
point of service
A health insurance benefits program in which subscribers can select betweeen
different delivery systems (i.e., HMO, PPO and fee-for-service) when in need
of medical services, rather than making the selection between delivery systems
at time of open enrollment at place of employment. Typically, the costs associated
with recieving care from HMO providers are less than when care is rendered by
PPO or noncontracting providers.
Index
policy
A course of action adopted and pursued by a government, party, statesman, or
other individual or organization; any course of action adopted as proper, advantageous,
or expedient. The term is sometimes used less actively to describe any stated
position on matters at issue, i.e., an organization's policy statement on national
health insurance. Policies bear the same relationship to rules (regulations)
as rules do to law, except that unlike regulations, they do not have the force
of law.
Index
poverty area
An urban or rural geographic area with a high proportion of low income families.
Normally, average income is used to define a poverty area, but other indicators,
such as housing conditions, illegitimate birth rates, and incidence of juvenile
delinquency, are sometimes added to define geographic areas with poverty conditions.
Index
preadmission certification
A process under which admission to a health institution is reviewed in advance
to determine need and appropriateness and to authorize a length of stay consistent
with norms for evaluation.
Index
precision
In statistics, the quality of being sharply defined or stated. One measure of
precision is the number of distinguishable alternatives from which a measurement
was selected, sometimes indicated by the number of significant digits in the
measurement. Precision can be contrasted with accuracy, which is the degree
of conformity of a measure to a standard or true value. Often, however, this
contrast is not relevant, because the true value is not known.
Index
preferred provider arrangement (PPA)
Selective contracting with a limited number of health care providers, often
at reduced or pre-negotiated rates of payment.
Index
Preferred Provider Organization (PPO)
Formally organized entity generally consisting of hospital and physician providers.
The PPO provides health care services to purchasers usually at discounted rates
in return for expediated claims payment and a somewhat predictable market share.
In this model, consumers have a choice of using PPO or non-PPO providers; however,
financial incentives are built in to benefit structures to encourage utilization
of PPO providers.
Index
prepayment
Usually refers to any payment to a provider for anticipated services (such as
an expectant mother paying in advance for maternity care). Sometimes prepayment
is distinguished from insurance as referring to payment to organizations which,
unlike an insurance company, take responsibility for arranging for, and providing,
needed services as well as paying for them (such as health maintenance organizations,
prepaid group practices, and medical foundations).
Index
prevailing charge
One of the factors determining a physician's payment for a service under Medicare,
set as a percentile of customary charges of all physicians in the locality.
Index
prevalence
The number of cases of disease, infected persons, or persons with some other
attribute, present at a particular time and in relation to the size of the population
from which drawn. It can be a measurement of morbidity at a moment in time,
e.g., the number of cases of hemophilia in the country as of the first of the
year.
Index
preventive medicine
Care which has the aim of preventing disease or its consequences. It includes
health care programs aimed at warding off illnesses (e.g., immunizations), early
detection of disease (e.g., Pap smears), and inhibiting further deterioration
of the body (e.g. exercise or prophylactic surgery). Preventive medicine developed
following discovery of bacterial diseases and was concerned in its early history
with specific medical control measures taken against the agents of infectious
diseases. Preventive medicine is also concerned with general preventive measures
aimed at improving the healthfulness of the environment. In particular, the
promotion of health through altering behavior, especially using health education,
is gaining prominence as a component of preventive care.
Index
primary care
Basic or general health care focused on the point at which a patient ideally
first seeks assistance from the medical care system. Primary care is considered
comprehensive when the primary provider takes responsibility for the overall
coordination of the care of the patient's health problems, be they biological,
behavioral, or social. The appropriate use of consultants and community rescources
is an important part of effective primary care. Such care is generally provided
by physicians but is increasingly provided by other personnel such as nurse
practitioners or physician assistants.
Index
primary prevention
The prevention of an illness or disease before any symptoms manifest themselves.
Index
probability (P value)
The likelihood that an event will occur. When looking at differences between
data samples, statistical techniques are used to determine if the differences
are likely to reflect real differences in the whole group from which the sample
is drawn or if they are simply the result of random variation in the samples.
For example, a probability (or P value) of one percent indicates that the differences
observed would have occured by chance in one out of a hundred samples drawn
from the same data.
Index
prospective payment
Any method of paying hospitals or other health programs in which amounts or
rates of payment are established in advance for a defined period (usually a
year). Institutions are paid these amounts regardless of the costs they actually
incur. These systems of payment are designed to introduce a degree of constraint
on charge or cost increases by setting limits on amounts paid during a future
period. In some cases, such systems provide incentives for improved efficiency
by sharing savings with institutions that perform at lower than anticipated
costs. Prospective payment contrasts with the method of payment originally used
under Medicare and Medicaid (as well as other insurance programs) where institutions
were reimbursed for actual expenses incurred.
Index
Prospective
Payment Assessment Commission (ProPAC)
In 1983, the Congress created the Prospective Payment Assessment Commission
to advise the secretary of the Department of Health and Human Services on Medicare's
diagnosis related group-based prospective payment system. Its members
are appointed by the director of the Office of Technology Assessment. The commission's
main responsibilties include recommending an appropriate annual percentage change
in DRG payments; recommending needed changes in the DRG classification system
and individual DRG weights; collecting and evaluating data on medical practices,
patterns, and technology; and reporting on its activities.
Index
provider
Hospital or licensed health care professional or group of hospitals or health
care professionals that provide health care services to patients. May also refer
to medical supply firms and vendors of durable medical equipment.
Index
public good
A good or service whose benefits may be provided to a group at no more cost
than required to provide it for one person. The benefits of the good are indivisible
and individuals cannot be excluded. For example, a public health measure that
eradicates smallpox protects all, not just those paying for the vaccination.
Index
public health
The science dealing with the protection and improvement of community health
by organized community effort. Public health activities are generally those
which are less amenable to being undertaken by individuals or which are less
effective when undertaken on an individual basis and do not typically include
direct personal health services. Public health activities include: immunizations;
sanitation; preventive medicine, quarantine and other disease control activities;
occupational health and safety programs; assurance of the healthfulness of air,
water, and food; health education; epidemiology, and others.
Index
Q
quality of care
Can be defined as a measure of the degree to which delivered health services
meet established professional standards and judgements of value to the consumer.
Quality may also be seen as the degree to which actions taken or not taken maximize
the probability of beneficial health outcomes, given the existing state of medical
service and art. Quality is frequently described as having three dimensions:
quality of input rescources (certification and/or training of providers); quality
of the process of services delivery (the use of appropriate procedures for a
given condition); and quality of outcome of service use (actual improvement
in condition or reduction of harmful effects).
Index
R
rate
rate review
regression analysis
rehabilitation
reimbursement
reinsurance
relative risk
relative value scale (RVS)
relative value studies (also California Relative Value Studies)
retrospective reimbursement
risk or risk factor
rate
A measure of the intensity of the occurence of an event. For example, the mortality
rate equals the number who die in one year divided by the number at risk of
dying. Rates are usually expressed using a standard denominator such as 1,000
or 100,000 persons.
Index
rate review
Review by a Government or private agency of a hospital's budget and financial
data, performed for the purpose of determining the reasonableness of the hospital
rates and evaluating proposed rate increases.
Index
regression analysis
Given data on a dependent variable and an independent variable, regression analysis
involves finding the "best" mathematical model (within some restricted
form) to describe the dependent variable as a function of the independent variable
or to predict the dependent from the independent variable. Multiple regression
analysis considers a dependent variable as a function of more than one independent
variable.
Index
rehabilitation
The combined and coordinated use of medical, social, educational, and vocational
measures for training or retraining individuals disabled by disease or injury
to the highest possible level of functional ability. Several different types
of rehabilitation are distinguished: vocational, social, psychological, medical,
and educational.
Index
reimbursement
The process by which health care providers receive payment for their services.
Because of the nature of the health care environment, providers are often reimbursed
by third parties who insure and represent patients.
Index
reinsurance
The resale of insurance products to a secondary market thereby spreading the
costs associated with underwriting.
Index
relative risk
The rate of disease in one group exposed to a particular factor (e.g., a toxic
spill) divided by the rate in another group which is not exposed. A relative
risk of one (1) indicates that the two groups have the same rate of disease.
Index
relative value scale (RVS)
A list of all physician services containing a cardinal ranking of those services
with respect to some conception of value, such that the difference between the
numerical rankings for any two services is a measure of the difference in value
between those services. Two common measures of value used in relative value
scales are rescources used and charges.
Index
relative value studies (also California Relative Value
Studies)
Coded listing of professional services with unit values to indicate relative
complexity as measured by time, skill and overhead costs. Third party payers
often assign a dollar value to units to calculate provider reimbursement.
Index
retrospective reimbursement
Payment made after-the-fact for services rendered on the basis of costs incurred
by the facility. See also prospective payment.
Index
risk or risk factor
Risk is a term used by epidemiologists to quantify the likelihood that something
will occur. A risk factor is something which either increases or decreases an
individual's risk of developing a disease. However, it does not mean that, if
exposed, an individual will definately contract a particular disease.
Index
S
acronym
screening
secondary care
secondary opinions
secondary prevention
self-funding of health benefits
service period
severity of illness
shadow pricing
shared services
skilled nursing facility (SNF)
sole community hospital (SCH)
solo practice
specialist
spend down
standard error
standards
Substance Abuse and Mental Health Service Administration (SAMHSA)
supply
survey
symptomatic
screening
The use of the quick procedures to differentiate apparently well persons who
have a disease or a high risk of disease from those who probably do not have
the disease. It is used to identify high risk individuals for more definitive
study or follow-up. Multiple screening (or multiphasic screening) is the combination
of a battery of screening tests for various diseases performed by technicians
under medical direction and applied to large groups of apparently well persons.
Index
secondary care
Services provided by medical specialists who generally do not have first contact
with patients (e.g., cardiologists, urologists, dermatologists). In the U.S.,
however, there has been a trend toward self-referral by patients for these services,
rather than referral by primary care providers. This is quite different from
the practice in England, for example, where all patients must first seek care
from primary care providers and are then referred to secondary and/or tertiary
providers, as needed.
Index
secondary opinions
In cases involving nonemergency or elective surgical procedures, the practice
of seeking judgment of another physician in order to eliminate unnecessary surgery
and contain the cost of medical care.
Index
secondary prevention
Early diagnosis, treatment and follow-up. Secondary prevention activities start
with the assumption that illness is already present and that primary prevention
was not successful and the goal is to diminish the impact of disease or illness
through early detection, diagnosis and treatment. For example, blood pressure
screening, treatment, and follow-up programs.
Index
self-funding of health benefits
An employer or group of employers sets aside funds to cover the cost of health
benefits for their employees. Benefits may be administered by the employer(s)
or handled through an administrative service only agreement with an insurance
carrier or third-party administrator. Under self-funding, it is generally possible
to purchase stop-loss insurance that covers expenditures above a certain aggregate
claim level and/or covers catastrophic illness or injury when individual claims
reach a certain dollar threshold.
Index
service period
Period of employment that may be required before an employee is eligible to
participate in an employer-sponsored health plan, most commonly one to three
months.
Index
severity of illness
A risk prediction system to correlate the "seriousness" of a disease
in a particular patient with the statistically "expected" outcome
(e.g., mortality, morbidity, efficiency of care). Most effectively, severity
is measured at or soon after admission, before therapy is initiated, giving
a measure of pretreatment risk.
Index
shadow pricing
Within a given employer group, pricing of premiums by HMO(s) based upon the
cost of indemnity insurance coverage, rather than strict adherence to community
rating or experience rating criteria.
Index
shared services
The coordinated, or otherwise explicitly agreed upon, sharing of responsibility
for provision of medical or nonmedical services on the part of two or more otherwise
independent hospitals or other health programs. The sharing of medical services
might include an agreement that one hospital provide all pediatric care needed
in a community and no obstetrical services while another provide obstetrics
and no pediatrics. Examples of shared nonmedical services would include joint
laundry or dietary services for two or more nursing homes.
Index
skilled nursing facility (SNF)
A nursing care facility participating in the Medicaid and Medicare programs
which meets specified requirements for services, staffing and safety.
Index
sole community hospital (SCH)
A hospital which (1) is more than 50 miles from any similar hospital, (2) is
25 to 50 miles from a similar hospital and isolated from it at least one month
a year as by snow, or is the exclusive provider of services to at least 75 percent
of its service area populations, (3) is 15 to 25 miles from any similar hospital
and is isolated from it at least one month a year, or (4) has been designated
as SCH under previous rules. The Medicare DRG program makes special optional
payment provisions for SCHs, most of which are rural, including providing that
their rates are set permanently so that 75 percent of their payment is hospital-specific
and only 25 percent is based on regional DRG rates.
Index
solo practice
Lawful practice of a health occupation as a self-employed individual. Solo practice
is by definition private practice but is not necessarily general practice or
fee-for-service practice (solo practitioners may be paid by capitation, although
fee-for-service is more common). Solo practice is common among physicians, dentists,
podiatrists, optometrists, and pharmacists.
Index
specialist
A physician, dentist, or other health professional who is specially trained
in a certain branch of medicine or dentistry related to specific other services
or procedures (e.g., surgery, radiology, pathology); certain age categories
of patients (e.g., pediatrics, geriatrics); certain body systems (e.g., dermatology,
orthopedics, cardiology); or certain types of diseases (e.g., allergy, psychiatry,
peridontics). Specialists usually have advanced education and training related
to their specialties.
Index
spend down
The amount of expenditures for health care services, relative to income, that
qualifies an individual for Medicaid in States that cover categorically eligible,
medically indigent individuals. Eligibility is determined on a case-by-case
basis.
Index
standard error
In statistics, the standard error is defined as the standard deviation of an
estimate. That is, multiple measurements of a given value will generally group
around the mean (or average) value in a normal distribution. The shape of this
distribution is known as the standard error.
Index
standards
Generally, a measure set by a competent authority as the rule for measuring
quantity or quality. Conformity with standards is usually a condition of licensure,
accreditation, and sometimes, payment for services. Standards may be defined
most often in relation to: the actual or predicted effects of care; the performance
or credentials of professional personnel; and the physical plant, governance
and administration of facilities and programs.
Index
Substance Abuse and
Mental Health Services Administration (SAMHSA)
The mission of SAMHSA is to provide, through the U.S. Public Health Service,
a national focus for the Federal effort to promote effective strategies for
the prevention and treatment of addictive and mental disorders. SAMHSA is primarily
a grant-making organization, promoting knowledge and scientific state-of-the-art
practice. SAMHSA strives to reduce barriers to high quality, effective programs
and services for individuals who suffer from, or are at risk for, these disorders,
as well as for their families and communities.
Index
supply
In health economics, the quantity of services provided or personnel in a given
area.
Index
survey
An investigation in which information is systematically collected. A population
survey may be conducted by face-to-face inquiry, by self-completed questionnaires,
by telephone, by postal service, or in some other way. Each method has its advantages
and disadvantages. The generalizability of results depends upon the extent to
which those surveyed are representative of the entire population.
Index
symptomatic
Someone who has symptoms of a disease or illness is symptomatic. Someone who
has smoked all their life and has a heavy cough is said to be symptomatic. A
heavy lifelong smoker who has not yet developed symptoms is said to be pre-symptomatic.
Index
SAMHSA
Substance Abuse and Mental Health Services Administration
Index
T
technology assessment
tertiary care
tertiary prevention
third-party payer
Title XVII (Medicare)
Title XIX (Medicaid)
type I error
type II error
technology assessment
A comprehensive form of policy research that examines the technical, economic,
and social consequences of technological applications. It is especially concerned
with unintended, indirect, or delayed social impacts. In health policy, the
term has come to mean any form of policy analysis concerned with medical technology,
especially the evaluation of efficacy and safety.
Index
tertiary care
Services provided by highly specialized providers (e.g. neurologists, neurosurgeons,
thoracic surgeons, intensive care units). Such services frequently require highly
sophisticated equipment and support facilities. The development of these services
has largely been a function of diagnostic and theraputic advances attained through
basicand clinical biomedical research.
Index
tertiary prevention
Prevention activities which focus on the individual after a disease or illness
has manifested itself. The goal is to reduce long-term effects and help individuals
better cope with symptoms.
Index
third-party payer
Any organization, public or private, that pays or insures health or medical
expenses on behalf of beneficiaries or recipients. An individual pays a premium
for such coverage in all private and in some public programs; the payer organization
then pays bills on the individual's behalf. Such payments are called third-party
payments and are distinguished by the separation among the individual receiving
the service (the first party), the individual or institution providing it (the
second party), and the organization paying for it (third party).
Index
Title
XVIII (Medicare)
The title of the Social Security Act which contains the principal legislative
authority for the Medicare program and therefore a common name for the program.
Index
Title
XIX (Medicaid)
The title of the Social Security Act which contains the principal legislative
authority for the Medicaid program and therefore a common name for the program.
Index
type I error
Also known as "false positive" or "alpha error." An incorrect
judgement or conclusion that occurs when an association is found between variables
where, in fact, no association exists. In an experiment, for example, if the
experimental procedure does not really have any effect, chance or random error
may cause the researcher to conclude that the experimental procedure did have
an effect.
Index
type II error
Also known as "false negative" or "beta error." An incorrect
judgement or conclusion that occurs when no association is found between variables
where in fact, an association does exist. In a medical screening, for example,
a negative test result may occur by chance in a subject who posesses the attribute
for which the test is conducted.
Index
U
uncompensated care
underinsured
uninsured
usual, customary and reasonable (UCR) fees
utilization
utilization review
uncompensated care
Service provided by physicians and hospitals for which no payment is received
from the patient or from third-party payers. Some costs for these services may
be covered through cost-shifting. Not all uncompensated care results from charity
care. It also includes bad debts from persons who are not classified as charity
cases but who are unable or unwilling to pay their bill.
Index
underinsured
People with public or private insurance policies that do not cover all necessary
medical services, resulting in out-of pocket expenses that exceed their ability
to pay.
Index
uninsured
People who lack public or private health insurance.
Index
usual, customary and reasonable (UCR) fees
The use of fee screens to determine the lowest value of physician reimbursement
based on: (1) the physician's usual charge for a given procedure, (2) the amount
customarily charged for the service by other physicians in the area (often defined
as a specific percentile of all charges in the community), and (3) the reasonable
cost of services for a given patient after medical review of the case.
Index
utilization
Use; commonly examined in terms of patterns or rates of use of a single service
or type of service, e.g., hospital care, physician visits, prescription drugs.
Use is also expressed in rates per unit of population at risk for a given period.
Index
utilization review
Evaluation of the necessary, appropriateness, and efficiency of the use of medical
services, procedures, and facilities. In a hospital, this includes review of
the appropriateness of admissions, services ordered and provided, length of
a stay, and discharge practices, both on a concurrent and retrospective basis.
Utilization review can be done by a peer review group, or a public agency.
Index
V
vital statistics
Statistics relating to births (natality), deaths (mortality), marriages, health
and disease (morbidity). Vital statistics for the United States are published
by the National Center for Health Statistics.
Index
W
wellness
A dynamic state of physical, mental, and social well being; a way of life which
equips the individual to realize the full potential of his or her capabilities
and to overcome and compensate for weakness; a lifestyle which recognizes the
importance of nutrition, physical fitness, stress reduction, and self-responsibility.
Wellness has been viewed as the result of four key factors over which an individual
has varying degrees of control: human biology, environment, health care organization
(system), and lifestyle.
Index
working capital
The sum of an institution's short-term or current assets including cash, marketable
(short-term) securities, accounts receivable, and inventories. Net working capital
is defined as the exess of total current assets over total current liabilities.
Index
This glossary has been compiled and periodically updated and edited by the Alpha
Center. Major sources of original definitions include: