Health Policy And Management Chapter 12

Front 1

Access

Back 1

the ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner

Front 2

Accessibility

Back 2

the fit between the locations of providers and patients

Front 3

Administrative costs

Back 3

the costs associated with the management of the financing, insurance, delivery, and payment functions in the health care system

Front 4

All-payer system

Back 4

a system in which centralized controls would allow cost-containment efforts to sweep through the entire health care delivery system; never attempted in the U.S

Front 5

Certificate-of-need

Back 5

state enacted statutes whose primary purpose was to control capital expenditures by health facilities

Front 6

Clinical practice guidelines

Back 6

medical practice guidelines; explicit descriptions representing preferred clinical processes for specified conditions

Front 7

Competition

Back 7

rivalry among sellers (providers of health care services) for customers; categorized as demand-side initiatives, supply-side regulation, payer-driven price competition, or utilization controls

Front 8

Cost-efficiency

Back 8

refers to a service where the benefit received is greater than the cost incurred to provide the service

Front 9

Cost shifting

Back 9

the ability of providers to make up for lost revenues in one area by increasing utilization or charging higher prices in areas free of control

Front 10

Critical pathways

Back 10

outcome-based and patient-centered case management tools that are interdisciplinary, facilitating coordination of care among multiple clinical departments and caregivers; timeline that identifies planned medical interventions along with expected patient outcomes for a specific diagnosis or class of cases

Front 11

Defensive medicine

Back 11

the prescription of additional diagnostic tests, the scheduling of return check up visits, and the maintenance of copious documentation by medical practitioners in order to protect themselves against the possibility of litigation. Many of these additional efforts are costly and may be unnecessary, thereby adding to the inefficiency in the health care system

Front 12

Disease-specific quality of life

Back 12

associated with the potential quality-of-life impacts of a specific disorder and its treatment

Front 13

Fraud

Back 13

a knowing disregard for the truth; illegal and immoral; generally occurs when billing claims or cost reports are intentionally falsified

Front 14

Health planning

Back 14

a government undertaking to align and distribute health care resources so that in the eyes of the government, it will achieve desired health outcomes for all people

Front 15

HEDIS

Back 15

health plan employer data and information set; the standard for reporting quality information on managed care health plans

Front 16

HRQL

Back 16

health related quality of life; a person’s own perception of health, ability to function, role limitations stemming from physical or emotional problems, and personal happiness during or subsequent to a disease experience

Front 17

Institution-related quality of life

Back 17

a patient’s quality of life while confined in an institution as an inpatient; classified by environmental comfort, self-governance, and caregiver attitudes.

Front 18

Outcome

Back 18

the effects or final results obtained from utilizing the structure and processes of health care delivery; bottom-line measure of the effectiveness of the health care delivery system

Front 19

Overutilization

Back 19

overuse; when the costs or risks of treatment outweigh its benefits, and yet additional care is delivered

Front 20

Peer review

Back 20

the general process of medical review of utilization and quality when it is carried out directly or under the supervision of physicians

Front 21

PROs

Back 21

peer review organizations; statewide private organizations composed of practicing physicians and other health care professionals who are paid by the federal government to review the care provided to Medicare beneficiaries.

Front 22

QIOs

Back 22

quality improvement organizations; another name for a PRO

Front 23

Quality

Back 23

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Front 24

Quality assessment

Back 24

the measurement of quality against an established standard.

Front 25

Reliability

Back 25

the extent to which the same results occur from repeated applications of a measure

Front 26

Risk management

Back 26

proactive efforts to prevent adverse events related to clinical care and facilities operations; especially focused on avoiding medical malpractice

Front 27

Small area variations

Back 27

notable differences in utilization rates for hospital admissions and surgical procedures among different communities as well as for the same specialty; usually associated with geographic areas of the country

Front 28

Top-down control

Back 28

a system of control over total health care expenditures by establishing budgets for entire sectors of the delivery system; funds distributed to providers in accordance with these global budgets

Front 29

TQM

Back 29

total quality management; an integrative management concept of continuously improving the quality of delivered goods and services through the participation of all levels and functions of the organization

Front 30

Quality assurance

Back 30

quality improvement; the process of institutionalizing quality through ongoing assessment and using the results of assessment for continuous quality improvement

Front 31

Underutilization

Back 31

under-use; when the benefits of an intervention outweigh its risks or costs, and yet it is not used

Front 32

Validity

Back 32

the extent to which a scale actually assesses what it purports to measure