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32 Cards in this Set

  • Front
  • Back
the ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner
the fit between the locations of providers and patients
Administrative costs
the costs associated with the management of the financing, insurance, delivery, and payment functions in the health care system
All-payer system
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
state enacted statutes whose primary purpose was to control capital expenditures by health facilities
Clinical practice guidelines
medical practice guidelines; explicit descriptions representing preferred clinical processes for specified conditions
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
refers to a service where the benefit received is greater than the cost incurred to provide the service
Cost shifting
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
Critical pathways
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
Defensive medicine
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
Disease-specific quality of life
associated with the potential quality-of-life impacts of a specific disorder and its treatment
a knowing disregard for the truth; illegal and immoral; generally occurs when billing claims or cost reports are intentionally falsified
Health planning
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
health plan employer data and information set; the standard for reporting quality information on managed care health plans
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
Institution-related quality of life
a patient’s quality of life while confined in an institution as an inpatient; classified by environmental comfort, self-governance, and caregiver attitudes.
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
overuse; when the costs or risks of treatment outweigh its benefits, and yet additional care is delivered
Peer review
the general process of medical review of utilization and quality when it is carried out directly or under the supervision of physicians
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.
quality improvement organizations; another name for a PRO
the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Quality assessment
the measurement of quality against an established standard.
the extent to which the same results occur from repeated applications of a measure
Risk management
proactive efforts to prevent adverse events related to clinical care and facilities operations; especially focused on avoiding medical malpractice
Small area variations
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
Top-down control
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
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
Quality assurance
quality improvement; the process of institutionalizing quality through ongoing assessment and using the results of assessment for continuous quality improvement
under-use; when the benefits of an intervention outweigh its risks or costs, and yet it is not used
the extent to which a scale actually assesses what it purports to measure