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Health Care Efficiency
Health care efficiency is a comparison of delivery system outputs, such as physician visits, relative value units, or health outcomes, with inputs like cost, time, or material. Efficiency can be reported then as a ratio of outputs to inputs or a comparison to optimal productivity using stochastic frontier analysis or data envelopment analysis. An alternative approach is to look at latency times and delay times between a care order and completion of work, and stated accomplishment in relation to estimated effort. One difficulty in creating a generalized efficiency measure is comparability of outputs. For example, if hospital A discharges 100 people at an average cost of $8000, while hospital B discharges 100 at $7000, the presumption may be that B is more efficient, but hospital B may be discharging patients with poorer health that will require readmission and net higher costs to treat. Measures of efficiency Bloomberg Health-Care Efficiency Index The Bloomberg index calcula ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Relative Value Unit
Relative value units (RVUs) are a measure of value used in the United States Medicare reimbursement formula for physician services. RVUs are a part of the resource-based relative value scale (RBRVS). Background Before RVUs were used, Medicare paid for physician services using "usual, customary and reasonable" rate-setting which led to payment variability. The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. The services are classified under a nomenclature based on the Current Procedural Terminology (CPT) to which the American Medical Association holds intellectual property rights. Each service in the fee schedule is scored under the resource-based relative value scale (RBRVS) to determine a payment. Use For each service, a payment formula contains three RVUs, one for ''physician work'', one for ''practice expense'', and one for ''malpractice expense''. On average, the proportion of costs ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Patient Protection And Affordable Care Act
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After it went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage was ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medical Loss Ratio
A loss ratio is a ratio of losses to gains, used normally in a financial context. It is the opposite of the gross profit ratio (commonly known as the ''gross profit margin''). Insurance loss ratio For insurance, the loss ratio is the ratio of total losses incurred (paid and reserved) in claims plus adjustment expenses divided by the total premiums earned. For example, if an insurance company pays $60 in claims for every $100 in collected premiums, then its loss ratio is 60% with a profit ratio/gross margin of 40% or $40. Some portion of those 40 dollars must pay all operating costs (things such as overhead and payroll), and what is left is the net profit. Loss ratios for property and casualty insurance (e.g. motor car insurance) typically range from 40% to 60%. Such companies are collecting premiums more than the amount paid in claims. Conversely, insurers that consistently experience high loss ratios may be in bad financial health. They may not be collecting enough premium to p ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Commonwealth Fund
The Commonwealth Fund is a private foundation (United States), private U.S. foundation whose stated purpose is to "promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, and people of color." It is active in a number of areas related to health care and health policy. It is led by David Blumenthal, M.D. Healthcare rankings Since 2004 it has produced reports comparing healthcare systems in high income countries using survey and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization which is analyzed under five themes: access to care, the care process, administrative efficiency, equity and health-care outcomes. The United States has been assessed as worst health-care system overall among 11 high-income countries in every report, even though it spends the highest proportion o ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medicaid
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care." Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, as well as paying for half of all U.S. births ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Electronic Health Record
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. For several decades, electronic health records (EHRs) have been touted as key to increasing of quality care. Electronic health records are used for other reasons than charting for patients; today, providers are using data from patient records to improve quality outcomes through their care management programs. EHR combines all patients demographics into a large pool, and uses this information to as ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medicare (United States)
Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). In 2018, according to the 2019 Medicare Trustees Report, Medicare provided health insurance for over 59.9 million individuals—more than 52 million people aged 65 and older and about 8 million younger people. According to annual Medicare Trustees reports and research by the government's MedPAC group, Medicare covers about half of healthcare expenses of those enrolled. Enrollees almost always cover most of the remaining costs by taking additional private insurance and/or by joining a public Part C ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Dartmouth Atlas Of Health Care
The Dartmouth Institute for Health Policy and Clinical Practice (TDI) is an organization within Dartmouth College "dedicated to improving healthcare through education, research, policy reform, leadership improvement, and communication with patients and the public." It was founded in 1988 by John Wennberg as the Center for the Evaluative Clinical Sciences (CECS); a reorganization in 2007 led to TDI's current structure. The institute provides a graduate-level education program involving elements of both Dartmouth's Graduate Arts and Sciences Programs and the Geisel School of Medicine. It grants Masters in Public Health degrees as well as Master of Science and Doctor of Philosophy in Health Policy and Clinical Science degrees. The institute is located at One Medical Center Drive, WTRB, Level 5 on the Dartmouth Hitchcock Hospital campus, Lebanon, NH. The institute's largest policy product is the Dartmouth Atlas of Health Care, which documents unwarranted variation in the American healt ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Misdiagnose
A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment. Definitions The word ''error'' in medicine is used as a label for nearly all of the clinical incidents that harm patients. Medical errors are often described as human errors in healthcare. Whether the label is a medical error or human error, one definition used in medicine says that it occurs when a healthcare provider chooses an inappropriate method of care, improperly executes an appropriate method of care, or reads the wrong CT scan. It has been said that the definition should be the subject of more debate. For instance, studies of hand hygiene compliance of physicians in an ICU show that compliance varied from 19% to 85%. The deaths that result from infections caught as a result of treatment providers ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Savings Account
A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if they are not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either high-deductible health plans or standard health plans. HSA funds may be used to pay for qualified medical expenses at any time without federal tax liability or penalty. Beginning in early 2011 over-the-counter medications could not be paid with an HSA without a doctor's prescription, although that requirement was lifted as of January 1, 2020. Withdrawals for non-medical expenses are treated very similarly to ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Deductible
In an insurance policy, the deductible (in British English, the excess) is the amount paid out of pocket by the policy holder before an insurance provider will pay any expenses. In general usage, the term ''deductible'' may be used to describe one of several types of clauses that are used by insurance companies as a threshold for policy payments. Deductibles are typically used to deter the large number of claims that a consumer can be reasonably expected to bear the cost of. By restricting its coverage to events that are significant enough to incur large costs, the insurance firm expects to pay out slightly smaller amounts much less frequently, incurring much higher savings. As a result, insurance premiums are typically cheaper when they involve higher deductibles. For example, health insurance companies offer plans with high premiums and low deductibles, or plans with low premiums and high deductibles. One plan may have a premium of $1,087 a month with a $6,000 deductible, while ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Copayment
A copayment or copay (called a gap in Australian English) is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maximum, whereas coinsurance payments do. Insurance companies use copayments to share health care costs to prevent moral hazard. It may be a small portion of the actual cost of the medical service but is meant to deter people from seeking medical care that may not be necessary, e.g., an infection by the common cold. In health systems with prices below the market clearing level i ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
