Show case management The monitoring and coordination of treatment rendered to patients with specific diagnosis or requiring high-cost or extensive services capable of delivering both health and related social services todefined population While suchcenter may not directly provide all types of health care it usually takes responsibility to arrange all health care service needed by its patient case-mixmeasure of the mix of cases being treated byparticular health care provider that is intended to reflect the patients different needs for resources Case mix is generally established by estimating the relative frequency of various types of patients seen by the provider in question duringgiven time period and may be measured by factors such as diagnosis severity of illness utilization of services and provider characteristics population community rating method of calculating health plan premiums using the average cost of actual or anticipated health services for all subscribers withinspecific geographic area The premium does not vary for different groups or subgroups of subscribers on the basis of their specific claims experience cost-benefit analysis catastrophic health insurance An analytic method in whichprogram Health insurance which provides protection cost is compared to the programbenefits against the high cost of treating severe or lengthy illnesses or disability Generally such policies cover all orspecified percentage of medical expenses above an amount that is the responsibility of another insurance policy up tomaximum limit of liability forperiod of time expressed in dollars as an aid in determining the best investment of resources For example the cost of establishing an immunization service might be compared with the total cost of medical care and lost productivity which will be eliminated asresult of more persons being immunized Cost-benefit analysis can disease which has one or more of the also be applied to specific medical tests and treatments leaves residual disability is caused by cost-shifting chronic disease following characteristics is permanent nonreversible pathological alternation requires special training of the patient for rehabilitation or may be expected to requirelong period of supervision observation or care The condition that occurs when health care providers are not reimbursed or not fully reimbursed for providing health care so charges to those who pay must be increased Typically results from providing health care to the medically indigent or the community health center Medicare patients under Section 330 of the Public Health customary prevailing and reasonable area which has scarce or nonexistent health Current method of paying physicians under Medicare Payment forservice is limited to An ambulatory health care program defined Service Act usually servingcatchment services orpopulation with special health needs sometimes known as neighborhood health center Community health centers attempt to coordinate Federal State and local resources insingle organization CPR the lowest of the physicianbilled charge for the service the physician customary charge for the service or the prevailing charge for that service in the Digital image 2005 Marriott Library University of Utah Al rights reserved |