OCR Text |
Show D 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/her 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, either as a percentage of compensation for each year of service or as a flat dollar amount for each year of service. defined contribution Funding mechanism for pension plans that can also be applied to health benefits based on a specific dollar contribution, without defining the services to be provided. 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. 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. 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. evidence-based decision making In a health policy context, evidence-based decision-making is the application of the best available scientific evidence to policy decisions about specific medical treatments or changes in the delivery system. The goals of evidence-based decision-making are to improve the quality of care, increase the efficiency of care delivery, and improve the allocation of health care resources. evidence-based medicine Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This approach must balance the best external evidence with the desires of the patient and the clinical expertise of health care providers. 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. experience rating A method of adjusting health plan premiums based on the historical utilization data and distinguishing characteristics of a specific subscriber group. G gatekeeper The primary care practitioner in managed care organizations who determines whether the presenting patient needs to see a specialist or requires other non-routine services. The goal is to guide the patient to appropriate services while avoiding unnecessary and costly referrals to specialists. 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 receive each year. Global budgeting may also be mandated under a universal health insurance system. Utah's Health: An Annual Review Volume VIII 143 |