| OCR Text |
Show passive intervention Health promotion and disease prevention initiatives which do not require the direct involvement of the individual (e.g., fluoridation programs) are termed "passive." Most often these types of initiatives are Government sponsored. peer review Generally, the evaluation by practicing physicians or other professionals of the effectiveness and efficiency of services ordered or performed by other member, of the profession (peers). Frequently, peer review refers to the activities of the Professional Review Organizations, and also to review of research by other researchers. point of service A health insurance benefits program in which subscribers can select between different delivery systems (i.e., HMO, PPO and fee-for-service) when in need of health care services, rather than making the selection between delivery systems at time of open enrollment at place of employment. Typically the costs associated with receiving care from HMO providers are less than when care is rendered by PPO or non-contracting providers. portability Requirement that health plans guarantee continuous coverage without waiting periods for persons moving between plans. consisting of hospital and physician providers. The PPO provides health care services to purchasers usually at discounted rates in return for expedited claims payment and a somewhat predictable market share. In this model, consumers have a choice of using PPO or non-PPO providers; however, financial incentives are built in to benefit structures to encourage utilization of PPO providers. prevalence The number of cases of disease, infected persons, or persons with some other attribute, present at a particular time and in relation to the size of the population from which drawn. It can be a measurement of morbidity at a moment in time, e.g. the number of cases of hemophilia in the country as of the first of the year. primary care Basic or general health care focused on the point at which a patient ideally first seeks assistance from medical care system. Primary care is considered comprehensive when the primary provider takes responsibility for the overall coordination of the care of the patient's health problems, be they biological, behavioral, or social. The appropriate use of consultants and community resources is an important part of effective primary care. Such care is generally provided by physicians but is increasingly provided by other personnel such as nurse practitioners or physician assistants. practice guidelines, parameters Standards used to guide providers based on accepted clinical treatment protocols for typical cases. Preferred Provider Organization (PPO) Formally organized entity generally prospective payment Any method of paying hospitals or other health programs in which amounts or rates of payment established in advance for a defined period (usually a year). Institutions are paid these amounts regardless of the costs they actually incur. These systems of: payment are designed to introduce a degree of constraint on charge or costs increases 139 |
