OCR Text |
Show 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. medically indigent Persons who cannot afford needed health care because of insufficient income and/or lack of adequate health insurance. medical savings account (MSA) An account in which individuals can accumulate contributions to pay for medical care or insurance. Some states give tax-preferred status to MSA contributions, but such contributions are still subject to federal income taxation. MSAs differ from medical reimbursement accounts, sometimes called flexible benefits or Section 115 accounts, in that they need not be associated with an employer. MSAs are not currently recognized in federal statute. 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). 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. medigap policy A private health insurance policy offered to Medicare beneficiaries to cover expenses not paid by Medicare. Medigap policies are strictly regulated by federal rules. Also known as Medicare supplemental insurance. 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. mortality Death. Used to describe the relation of deaths to population in which they occur. The mortality rate (death rate) expresses the number of deaths in a 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 for cancer in white males in relation to the white male population during a given year). open enrollment A method for assuring that insurance plans, especially prepaid plans, do not exclusively select good risks. Under an open enrollment requirement plan must accept all who apply during a specific period each year. 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 the many other factors that influence patients' health and satisfaction. 138 |