Author: Glossary

Selection of a provider by a managed care plan enrollee at the time (and each time) the care is needed. The entire plan may be designed as point-of-service, or the option may be offered to enrollees, usually for a higher premium and/or copay amount. Most managed care plans require the enrollee to use only in-plan…

A system which provides alternatives. The U.S. is described as favoring pluralism, as illustrated by the fact that medical care, for example, can be obtained from solo practitioners or group practices or prepaid health plans.  

An educational visit to an unfamiliar environment. The term is being used in health care for a visit to a community in order to begin to learn about its population, organizations, resources, problems, needs, and interests.  

A consumer health care organization founded in 1978 as a nonprofit corporation. Its philosophy is based on consumer access to health and medical information, involvement of family and friends, and encouraging consumers to become active participants in improving, maintaining, and restoring their health. Planetree was created to humanize, personalize and de-mystify the health care system…

Finding, soliciting, and attracting physicians to a particular hospital or area. Hospitals devote resources to the search, and provide incentives, for physicians in specialties which are needed by the hospital and community. Such incentives may include relocation reimbursement and either initial employment of the physician or provision of a loan (with favorable terms) to enable…

A basic change in the way physicians were paid for services for Medicare patients, mandated by the Omnibus Budget Reconciliation Act of 1989 (OBRA 89), effective 1 January 1992. Prior to that date, payment had been based on customary, prevailing, reasonable charges (CPR). Replacing that method, the new method was based on a resource-based relative…

A legal entity formed by a hospital and a group of physicians. The PHO serves as a negotiating and contracting unit to obtain managed care contracts directly with employers. The physicians usually maintain their own practices, and contract with the PHO to provide services.  

The study of the use and effects of drugs in a given population. Investigators using the methods of this discipline provide information used by, among others, agencies concerned with the regulation of medicines. The application of the science of epidemiology to the study of the effects of drugs, desired and undesired, and uses of drugs…

The study of the cost-effectiveness of health-related interventions. The name has appeared because the initial attention is being given to drugs, but it appears that these evaluations will also include other health services, such as medical and surgical techniques and procedures, both diagnostic and therapeutic, and the use of technological tools. About 300 articles were…

Usually, services which are provided simply because the recipient wants them, rather than because they are essential to her medical or other care. Examples include beauty parlor services, catered meals, and the like. Such services are not included in the benefits of a health care plan.