| Show community Similar to the Usual Customary and Reasonable system used by private insurers defined benefit Funding mechanisms for pension plans that can be applied to health benefits Typical pension approaches include pegging benefits topercentage of an employeeaverage compensation over his her entire service or overparticular number of years calculation offlat monthly payment setting benefits based upondefinitive amount for each year of service either aspercentage of compensation for each year of service or asflat dollar amount for each year of service defined contribution Funding mechanism for pension plans that can also be applied to health benefits based onspecific 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 sefting populations Epidemiology utilizes biology clinical medicine and statistics ineffort to understand the etiology causes of iliness and or disease The ultimate goal of the epidemiologist is not merely to identify underlying causes of disease but to apply findings to disease prevention and health promotion expenditure target ET mechanism to adjust fee updates or the fees themselves based on how actual expenditures in an area compare totarget for those expenditures experience ratingmethod of adjusting health plan premiums based on the historical utilization data and distinguishing characteristics ofspecific subscriber group gatekeeper The primary care practitioner in managed care organizations who determines whether the presenting patient needs to seespecialist or requires other non routine services The goal is to guide the patient to appropriate services while avoiding unnecessary and costly referrals to specialists Diagnosis Related Groups DRGs Groupings of diagnostic categories drawn from the International Classification of Diseases and modified by the presence ofsurgical procedure patient age presence or absence of significant comorbidties or complications and other relevant criteria DRGs are the case-mix measure used in Medicareperspective payment system global budgetingmethod of hospital cost containment in which participating hospitals must shareprospectively 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 underuniversal health insurance system epidemiology The study of patterns of determinants and global feetotal charge forspecfic set of services such as obstetrical services that encompass prenatal delivery and post-natal-care antecedents of disease in human Digital image 2005 Marriott Library University of Utah Al rights reserved |
