Author: Glossary

A Medicare term referring to nursing and to other rehabilitation services provided to Medicare beneficiaries under conditions set up by the Medicare program.  

A method of health care financing in which there is only one source of money for paying health care providers. The Canadian-style system is the prime example of a single-payer plan, but not all elements of the Canadian program need be included for a plan to be “single-payer”; in fact, the single-payer could be an…

An organization, external to the hospital, set up to provide shared services, such as group purchasing. Such an organization may or may not have been set up by the organizations receiving the services, and may or may not be under their joint control.  

A growing process in medical care in which physician and patient collaborate in making the decisions as to diagnostic efforts to be made to determine the causes of the patient’s problem(s) and the treatments to be used. This sharing of responsibility in SDM results in replacing the authoritarian role traditionally given to the physician with…

A mathematical score which expresses the severity of illness of a patient according to one of several severity measurement methods. The goal is to use such scores in a formula for determining payment for care, and in quantifying the quality of care.  

The gravity of a patient’s condition. Patients with the same diagnosis often vary from being mildly ill to being extremely ill, or even dying. Under the prospective payment system (PPS), every patient with the same diagnosis (actually, every patient within a given diagnosis related group (DRG), of which there are only 468) is given the…

An agreement made by the parties to end a dispute or lawsuit before (or during) the hearing or trial, without a formal adjudication (decision by the arbitrator, judge, jury, or other decisionmaker) of the merits of the dispute. The term “settlement” is also sometimes used to refer to the specific terms of the agreement (such…

The geographic area served by a hospital or other facility or, perhaps more accurately, the area from which the institution or organization draws its patients or clients. A “service area” is sometimes referred to as a “catchment area.” The catchment areas of organizations with like services may overlap.  

An alliance of health maintenance organizations (HMOs) which offers enrollment in the SPN, and thus in its constituent HMOs. Medicare prepays part or all the cost of enrollment in an SPN as it does in an HMO under certain circumstances.  

A patient who pays either all or part of the hospital bill from his or her own resources, as opposed to third-party payment (payment by an insurance company, Medicare, or Blue Cross/Blue Shield (BC/BS)), for example).