Term
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Definition
| The ability of persons needing health services to obtain appropriate care in a timely manner. Can you get medical care when you need it? If yes, you have access to medical care. Access is not the same as health insurance coverate, although insurance coverage is a strong predictor of access for primary care services. |
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Term
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Definition
| Costs that are incidental to the delivery of health services. These costs are not only associated with the billing and collection of claims for services delivered but also include numerous other costs, such as time and effort incurred by employers for the selection of insurance carriers, costs incurred by insurance and managed care organizations to market their products, and time and effort involved in the negotiation of rates. |
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Term
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Definition
| Billing of the leftover sum by the provider to the patient after insurance has only partially paid the charge initially billed. |
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Term
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Definition
| Excessive medical tests and procedures performed as a protection against malpractice lawsuits, otherwise regarded as unnecessary. |
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Term
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Definition
| The quantity of health care demanded by consumers based solely on the price of those services. Enabling services, such as transportation or translation services, facilitate access when an individual already has health insurance coverage. |
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Term
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Definition
| A person enrolled in a health plan, especially in a managed care plan |
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Term
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Definition
| Characterized by the unencumbered operation of the forces of supply and demand when numerous buyers and sellers freely interact in a competitive market. |
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Term
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Definition
| Allocation of pre-established total expenditures for a health care system or subsystem. |
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Term
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Definition
| In the US context, expansion of health insurance to cover the uninsured. |
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Term
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Definition
| The contractual arrangement between the MCO and the enrollee, including the collective array of covered health services that the enrollee is entitled to. |
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Term
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Definition
| A system of health care delivery that (1) seeks to achieve efficiencies by integrating the four functions of health care delivery, (2) employs mechanisms to control (manage) utilization of medical services, and (3) determines the price at which the services are purchased and, consequently, how much the providers get paid. |
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Term
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Definition
| A joint federal-state program of health insurance for the poor. |
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Term
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Definition
| A federal program of health insurance for the elderly, certain disabled individuals, and people with end-stage renal disease. |
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Term
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Definition
| Consumer behavior that leads to a higher utilization of health care services because people are covered by insurance |
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Term
| national health insurance |
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Definition
| A tax-supported national health care program in which services are financed by the government but are rendered by private providers (Canada, for example) |
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Term
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Definition
| A taxpayer supported national health care program in which teh government finances and also controls the service infrastructure (for example, Great Britain) |
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Term
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Definition
| Need for health services (in contrast to demand for health services) is based on individual judgment. The patient makes the primary determination of the need for health care and, under most circumstances, initiates contact with the system. The physician may make a professional judgment and determine need for referral to higher-level services |
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Term
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Definition
| Bundling of fees for an entire package of related services |
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Term
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Definition
| Practitioners who general function in an adjunct capacity. The patient does not receive direct services from them. They bill for their services separately, and the patients often wonder why they have been billed. Examples include anesthesiologists, radiologists, and pathologists. |
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Term
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Definition
| Refers to the common practice by employers that require their employees to pay a portion of the health insurance cost. |
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Term
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Definition
| Basic and routine health care provided in an office or clinic by a provider (physician, nurse, or other health care professional) who takes responsibility for coordinating all aspects of a patient's health care needs. An approach to health care delivery that is the patient's first contact with the health care delivery system and the first element of a continuing health care process. |
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Term
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Definition
| Any entity that delivers health care services and can either independently bill for those services or is tax supported. Common examples of providers include physicians, dentists, optometrists, and therapists in private practices; hospitals; diagnostic and imaging clinic; and suppliers of medical equipment (e.g. wheelchairs, walkers, ostomy supplies, oxygen). |
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Term
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Definition
| Artificial creation of demand by providers that enables them to deliver unneeded services to boost their incomes. |
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Term
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Definition
| The four key functions necessary for health care delivery: financing, insurance, delivery, and payment |
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Term
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Definition
| The amount insurers pay to a provider. The payment may only be a portion of the actual charge. |
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Term
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Definition
| A national health care program in which the financing and insurance functions are taken over by the federal government. |
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Term
| socialized health insurance |
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Definition
| Health care is financed through government-mandated contributions by employers and employees. Health care is delivered by private providers (for example, Germany, Israel, and Japan) |
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Term
| standards of participation |
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Definition
| Minimum quality standards established by government regulatory agencies to certify providers for delivery of services to Medicare and Medicaid patients |
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Term
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Definition
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Term
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Definition
| An intermediary between patients and providers. Third parties carry out the functions of insurance and payment for health care delivery |
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Term
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Definition
| People who are without health insurance coverage |
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Term
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Definition
| Health insurance coverage for all citizens |
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Term
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Definition
| extent to which health care services are actually used |
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Term
| Activities of daily living |
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Definition
| The most commonly used measure of disability. ADLs determine whether an individual needs assistance to perform basic activities, such as eating, bathing, dressing, toileting, and getting into or out of a bed or chair. |
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Term
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Definition
| Short-term, intense medical care for an illness or injury usually requiring hospitalization. |
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Term
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Definition
| One of the factors of the epidemiology triangle, must be present in order for an infectious disease to occur. In other words, an infectious disease cannot occur without an agent. |
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Term
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Definition
| Encompasses the use of chemical, biological, and nuclear agents to cause harm to relatively large civilian populations. |
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Term
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Definition
| Refers to individuals who acquire a certain disease or condition |
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Term
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Definition
A medical condition that persists over time. Chronic diseases may lead to a permanent medical condition that is nonreversible and/or leaves residual disability.
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Term
| community health assessment |
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Definition
| A method used for conducting broad assessments of populations at a local or state level. |
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Term
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Definition
| Measures referring to the total population; they are not specific to any age groups or disease categories. |
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Term
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Definition
| Refers to barriers to obtaining health care faced by individuals who do not have sufficient income to pay for services or purchase health insurance |
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Term
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Definition
| Means migration out of a defined geographic area |
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Term
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Definition
| One of the factors of the epidemiology triangle, is external to the host. It includes the physical, social, cultural, and exonomic aspects of the environment. |
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Term
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Definition
| The field that focuses on the environmental determants of health |
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Term
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Definition
| An outbreak of an infectious disease that spreads rapidly and affects many individuals within a population. |
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Term
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Definition
| The capacity of a population to reproduce |
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Term
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Definition
| Refers to the treatment of illnesses and the maintenance of health |
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Term
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Definition
| Factors that contribute to the general well-being of individuals and population |
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Term
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Definition
| Refers to the evaluation of risk factors and their health consequences for individuals. Health risk appraisal is an important aspect of health promotion and disease prevention because it can be instrumental in developing avenues for motivating individuals to alter their behaviors to more healthful patterns. |
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Term
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Definition
| Emphasizes the well-being of every aspect of what makes a person whole and complete |
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Term
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Definition
| A philosophy of health care that emphasizes the well-being of every aspect of a person, including the physical, mental, social, and spiritual aspects of health |
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Term
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Definition
| One of the factors of the epidemiology trinagle, is an organism, generally a human, who receives the agent. The host is the organism that becomes sick. |
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Term
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Definition
| Illness or injury caused by the process of medical care. |
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Term
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Definition
| Means migration to a defined geographic area. |
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Term
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Definition
| The number of new cases of a disease in a defined population within a specified period. |
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Term
| instrumental activities of daily living |
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Definition
| A person's ability to perform household and social tasks, such as home maintenance, cooking, shopping, and management money. |
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Term
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Definition
| Actuarial determination of how long, on average, a person of a given age is likely to live |
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Term
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Definition
| A distributional principle according to which health care is most equitably distributed through the market forces of supply and demand rather than government interventions |
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Term
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Definition
| Delivery of health care that places its primary emphasis on the treatment of disease and relief of symptoms instead of prevention of disease and promotion of optimum health |
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Term
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Definition
| Refers to the geographic movement of populations between defined geographic units, and involves a permanent change of residence |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
|
Definition
See supply side rationing.
Genrally carried out by a government to limit the availability of health care services, particularly expensive technology
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Term
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Definition
| Include all the people in the same community or population group who are susceptible to acquiring a disease or a negative health condition. |
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Term
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Definition
| The number of cases of a given disease in a given population at a certain point in time. |
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Term
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Definition
| In a strict epidemiological sense, it refers to prevention of disease, for example, health education, immunization, and environmental control measures |
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Term
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Definition
| A wide variety of activities undertaken by state and local governments to ensure conditions that promote optimum health for society as a whole. |
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Term
|
Definition
(1) Quality of life refers to factors considered important by patients, such as environmental comfort, security, interpersonal relations, personal preferences, and autonomy in making decisions when institutionalized.
(2) It also includes overall satisfaction with life during and following a person's encounter with the health care delivery system. |
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Term
|
Definition
| An environmental element, personal habit, or living condition that increases the likelihood of developing a particular disease or negative health condition in the future. |
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Term
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Definition
| Efforts to detect disease in early stages to provide a more effective treatment, for example screening. |
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Term
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Definition
| Evaluated in terms of the number of social contacts or social activities a person engages in within a specified period of time. Examples are visits with friends and relatives, and attendance at social events, such as conferences, picnics, or other outings. |
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Term
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Definition
| A distribution principle according to which health care is most equitably distributed by a government-run national health care program. |
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Term
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Definition
| Refer to social contacts that can be relied upon for support, such as family, relatives, friends, neighbors, and members of a religious congregation. They are indicative of adequacy of social relationships. |
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Term
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Definition
| Technically complex services that are beyond traditional skilled nursing care. |
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Term
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Definition
| Also called "planned rationing" that is generally carried out be a government to limit the availability of health care services, particularly expensive technology |
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Term
|
Definition
| The ability of a health care facility or system to expand its operations to safely treat an abnormally large influx of patients. |
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Term
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Definition
| Interventions that would prevent complications from chronic conditions and prevent further illness, injury, or disability. |
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Term
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Definition
| Extent to which health care services are actually used. |
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Term
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Definition
| Also a poorhouse, was an unspecialized institution existing during the 18th and mid-19th centuries that mainly served general welfare functions, essentially providing shelter to the homeless, the insane, the elderly, orphans, and the sick who had no family to care for them. |
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Term
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Definition
| Billing of the leftover sum by the provider to the patient after insurance has only paritally paid the charge initially billed. |
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Term
|
Definition
| A reimbursement mechanism under which the provider is paid a set monthly fee per enrollee (sometimes referred to as per member paer month or PMPM rate) regardless of whether or not an enrollee sees the provider and regardless of how often an enrollee sees the provider. |
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Term
cost-shifting
(cross-subsidizing) |
|
Definition
| In general, shifting of costs from one entity to another as a way of making up losses in one area by charging more in other areas. For example, when care is provided to the uninsured, the provider makes up the cost for those services by charging more to the insured. |
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Term
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Definition
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Term
|
Definition
| Refers to the general acceptance of professional judgment as valid. Physicians' cultural authority is reflected in the reliance placed on their evaluation of signs and symptoms, diagnosis of disease, and suggested prognosis. |
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Term
|
Definition
| A legal requirement for employers to help pay for their employees' health insurance. |
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Term
|
Definition
| Payment of separate fees to the providers for each separate service, such as examination, administering a test, and hospitalization. |
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Term
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Definition
The use of primary care physicians to coordinate health care services needed by an enrollee in a managed care plan.
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Term
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Definition
| Various forms of cross-border economic activities driven by gloval exchange of information, production of goods and services more economically in developing countries, and increased interdependence of mature and emerging world economics. |
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Term
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Definition
| A program in which elegibility depends on income. |
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Term
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Definition
| Travel abroad to receive elective, non-emergency medical care. |
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Term
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Definition
| Concerted activities of physicians, mainly to protect their own interests, through such associations as the AMA. |
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Term
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Definition
| Provides coverage for hospital care and limited nursing home care. |
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Term
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Definition
| Government-subsidized voluntary insurance for physician services and outpatient services. |
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Term
|
Definition
| Operated by local governments during the 18th and mid-19th centuries to quarantine people who contracted a contagious disease chuch as cholera, smallpox, or typhoid. The primary function of a pesthouse was to protect the community from the spread of contagious disease; medical care was only secondary. |
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Term
|
Definition
| A type of employer mandate in which employers must choose to provide health insurance to employees ("play") or pay a penalty. |
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Term
prepaid plan
(capitation) |
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Definition
| A contractual arrangement under which a provider must provide all needed services to a group of members (or enrollees) in exchange for a fixed monthly fee paid in advance to the provider on a per-member basis. |
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Term
|
Definition
| Or more precisely, Title XVIII (18) of the social security amendment of 1965 refers to the Medicare program. |
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Term
|
Definition
| Or more precisely, Title XIX (19) of the Social Security Amendment of 1965 refers to the Medicaid program. |
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Term
| voluntary health insurance |
|
Definition
| Private health insurance (in contrast to government-sponsored compulsory health insurance). |
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Term
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Definition
| A general name for nurses who have education and clinical experience beyond that required of an RN. APNs include four areas of specialization in nursing: clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), nurse practitioners (NPs), and certified nurse midwives (CNMs). |
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Term
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Definition
| A broad category that includes services and professionals in many health-related technical areas. Allied health professionals include technicians, assistants, therapists, and technologists. |
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Term
| allied health professional |
|
Definition
| Someone who has received a certificate; associate's bachelor's, or master's degree; doctoral level preparation; or post-baccalaureate training in a science related to health care and has responsibility for the delivery of health or related service. |
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Term
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Definition
| A philosophy of medicine that views medical treatment as active intervention to counteract the effects of disease through medical and surgical procedures that produce effects opposite those of the disease. |
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Term
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Definition
| RNs with additional training from a nurse-midwifery program in areas such as maternal and fetal procedures, maternity and child nursing, and patient assessment. CNMs deliver babies, provide family planning education, and manage gynecological and obstetric care. They can substitute for obstetricians/gynecologists in prenatal and postnatal care. |
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Term
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Definition
| A licensed practitioner who has completed the Doctor of Chiropractic (DC) degree. Chiropractors must be licensed to practice. Requirements for licensure include completion of an accredited program that awards a DC degree and an examination by the state chiropractic board. |
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Term
|
Definition
| Presence of more than one health problem in an individual |
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Term
|
Definition
| Usually work for dentists in the preparation, examination, and treatment of patients. |
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Term
|
Definition
| Work under the supervision of dentists and provide preventative dental care, including cleaning teeth and educating patients on proper dental care. |
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Term
|
Definition
| A professional who diagnoses and treats dental problems related to the teeth, gums, and tissues of the mouth |
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Term
|
Definition
| A physician in family practice, general internal medicine, or general pediatrics |
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Term
|
Definition
| A physician who specializes in the care of hospitalized patients. |
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Term
| licensed practical nurses |
|
Definition
| Called licensed vocational nurses in some states. Nurses who have completed a state-approved program in practical nursing and a national written examination. They often work under the supervision of RNs to provide patient care. |
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Term
|
Definition
| An imbalance (i.e., surplus in some but shortage in others) of the distribution of health professionals, such as physicians, needed to maintain the health status of a given population at an optimum level. Geographic maldistribution refers to the surplus in some regions (e.g., metropolotin areas) but shortage in other regions (e.g., rural and inner city areas) of needed health professionals. Specialty maldistribution refers to the surplus in some specialties (e.g., physician specialists) but shortage in others (e.g., primary care). |
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Term
| nonphysician practitioners |
|
Definition
| Clinical professionals who practice in many areas similar to those in which physicians practice but who do not have an MD or a DO degree. NPPs are sometimes called midlevel practitioners because they receive less advanced training than physicians but more training than RNs. |
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Term
|
Definition
| Individuals who have completed a program of study leading to competence as RNs in an expanded role. NP specialties include pediatric, family, adult, psychiatric, and geriatric programs. The primary function of NPs is to promote wellness and good health through patient educaiton. Their traditional nursing role has expanded to include taking patients' comprehensive health histories, assessing health status, performing physical examinations, and formulating and managing a care regimen for acutely and chronically ill patients. |
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Term
|
Definition
| help people of allages improve their ability to perform tasks in their daily living and working environments. They work with individuals who have conditions taht are mentally, physically, develoopmentally, or emotionally disabling. |
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Term
|
Definition
| A professional who possesses a Doctor of Optometry degree and has passed a written and clinical state board examination. An optometrist provides vision care--examination, diagnosis, and correction of vision disorders. |
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Term
|
Definition
| A medical philosophy based on the holistic approach to treatment. It uses the traditional methods of medical practice, which include pharmaceuticals, laboratory tests, X-ray diagnostics, and surgery, and supplements them by advocating treatment that involves correction of hte position of the joints or tissues and emphasizes diet and environment as factors that might destroy natural resistance. |
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Term
|
Definition
| A mode of pharmacy practice in which the pharmacist takes an active role on behalf of patients, which includes giving information on drugs and advice on their potential misuse and assisting prescribers in appropriate drug choices. In doing so, the pharmacist assumes direct responsibility collaboratively with other health care professionals and with patients to achieve the desired therapeutic outcomes. |
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Term
|
Definition
| A professional who has graduated from an accredited pharmacy program that awards a Bachelor of Pharmacy or Doctor of Pharmacy degree and has successfully completed a state board examiniation and a supervised internship. |
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Term
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Definition
| Provide care for patients with movement dysfunction |
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Term
|
Definition
| Professionals who work in a dependent relationship with a supervising physician to provide comprehensive medical care to patients. The major servcies provided by PAs include evaluation, monitoring, diagnostics, therapeutics, counseling, and referral. |
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Term
|
Definition
| Non physician practitioners |
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Term
|
Definition
| Professionals who treat patients with foot diseases or deformities. |
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Term
|
Definition
| Basic and routine health care provided in an office or clinic by a provider (physician, nurse, or other health care professional) who takes responsibility for coordinating all aspects of a patient's health care needs. An approach to health care delivery that is the patient's first contact with the health care delivery system and the first element of a continuing health care process. |
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Term
|
Definition
| Mental health professionals who must be licensed or certified to practice. Psychologists may specialize in such areas as clinical, counseling, developmental, educational, engineering, personnel, experimental, industrial, psychometric, rehabilitation, school and social psychology |
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Term
|
Definition
| Nurses who have completed an associate's degree (ADN), a diploma program, or a bachelor's degree (BSN) and are licensed to practice. |
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Term
|
Definition
| Graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital |
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Term
|
Definition
| A physician who specializes in specific health care problems, for example, anesthesiologists, cardiologists, and oncologists. |
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Term
|
Definition
| Tends to be limited to illness episodes, the organ system, or the disease process involved. Specialty care, if needed, generally follows primary care. |
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Term
| administrative information systems |
|
Definition
| Designed to assist in carrying out financial and administrative support activities such as payroll, patient accounting, materials management, and office automation |
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Term
|
Definition
| Use of store-and-forward technology that allows the users to review the information at a later time |
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Term
|
Definition
| Biological products that include a wide range of products such as vaccines, blood and blood components, allergenics, somatic cells, gene therapy, tissues, and recombinant therapeutic proteins |
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Term
| clinical information systems |
|
Definition
| Involve the organized processing, storage, and retrieval of information to suppott patient care processes |
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Term
|
Definition
| A research study, generally based on random assignments, designed to study the effectiveness of a new drug, device, or treatment |
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Term
|
Definition
| Used to evaluate benefits in relation to costs when both are expressed in dollar terms. Hence, cost benefit analysis is subject to a more rigorous quantitative analysis compared to cost-effectiveness analysis |
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Term
| cost-effectiveness analysis |
|
Definition
| A step beyond the determination of efficacy. Whereas efficacy is concerned only with the benefit to be derived from the use of technology, cost-effectiveness evaluates the additional (marginal) benefits to be derived in relation to the additional (marginal) costs to be incurred |
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Term
cost efficiency
(efficiency) |
|
Definition
| A service is cost efficient when the benefit received is greater than the cost incurred to provide the survice. |
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Term
|
Definition
| Analysis that includes the use of quality-adjusted life years |
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Term
|
Definition
| Computer-based information and analytical tools to support managerial decision making in health care organizations |
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Term
|
Definition
| Health benefits of a medical intervention |
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Term
|
Definition
| Health benefits of a medical intervention |
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Term
|
Definition
| Health care information and services offered over the Internet by professionals and nonprofessionals alike |
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Term
| electronic health records |
|
Definition
| Information technology applications that enable the processing of any electronically stored information pertaining to individual patients for the purpose of delivering health care services |
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Term
|
Definition
| Any type of professional therapeutic interaction that makes use of the Internet to connect qualified mental health professionals and their clients |
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Term
|
Definition
| Medical care that produces relatively little or no benefit for the patient because of diminishing marginal returns |
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Term
|
Definition
| The application of information science to improve the health care services. Health informatics requires the use of information technology but goes beyond IT by emphasizing the improvement of health care delivery |
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Term
| health information organization |
|
Definition
| An independent organization that brings together health care stakeholders within a defined geograpic area and governs electronic information exchange among these stakeholders with the objective of improving the delivery of health care in the community. |
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Term
| health technology assessment |
|
Definition
| Any process of examining and reporting properties of a medical technology used in health care, such as safety, effectiveness, feasibility, and indications for use, cost, and cost effectiveness, as well as social, economic, and ethical consequences, whetherr intended or unintended. |
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Term
|
Definition
| Technology used for teh transformation of data into useful information. IT involves determining data needs, gathering appropriate data, storing and analyzing the data, and reporting the information generated in a user-friendly format |
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Term
|
Definition
| Practical application of the scientific body of knowledge for the purpose of improving health and creating efficiencies in the delivery of health care. |
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Term
|
Definition
| Short for "mobile health," which is the use of wireless communication devices to support public health and clinical practice. |
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Term
|
Definition
| A new area, still in its infancy, which involves the application of nanotechnology is a cutting-edge advancement within science and engineering. It is not a single field, but an intense collaboration between disciplines to manipulate materials on the atomic and molecular level (one nanometer is one-billionth of a meter) |
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Term
|
Definition
| Certain ne3w drug therapies for conditions that affect fewer than 200,000 people in the United States |
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|
Term
quality-adjusted life year
(QALY) |
|
Definition
| The value of 1 year of high-quality life, used as a measure of health benefit |
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Term
|
Definition
| Physicians order services from laboratories or other medical facilities in which they have a direct financial interest, usually without disclosing this conflict of interest to the patient |
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Term
|
Definition
| A credit card-like device with an embedded computer chip and memory to hold personal medical information that can be accessed and updated at a hospital or physician's office |
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Term
|
Definition
| Technology in which telecommunications occur in real time |
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Term
|
Definition
| Implies the use of technology without cost considerations, especially when the benefits to be derived from the use of technology are small compared to the costs |
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Term
|
Definition
| Although in general the terms telemedicine and telehealth can be used interchangeably, in a stricter sense, telehealth encompasses education, research, and administrative uses, as well as clinical applications that involve nurses, psychologists, administrators, and other nonphysicians |
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Term
|
Definition
| Use of telecommunications technology that enables physicians to conduct two-way, interactive video consultations or transmit digital images, such as X-rays and MRIs to other sites |
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Term
|
Definition
| Means greater benefits or higher quality at the same or lower price levels (costs) |
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Term
|
Definition
| Online, clinical encounters between a patient and physician. |
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|
Term
| 4 components of health services delivery system |
|
Definition
- financing
- insurance
- delivery
- payment
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|
