Author: Glossary

A strategy for purchasing health care in a manner which, it is proposed, would obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven (Stanford University), and has been promulgated by the Jackson Hole Group. In health care practice, the requirement…

An organization providing managed care. A managed care plan has a defined group of providers and an identified group of enrollees to be served. Forward-looking plans develop explicit standards of care to be required of its providers, and are concerned not only with treatment and amelioration of disease, but also with prevention. The plan may…

A term applied to a variety of organizations which contract to provide management services for the reduction and control of health care costs to corporations, insurers, and third party administrators. MCOs employ such methods as making decisions as to what care is to be given individual patients and where it will be provided, negotiating contracts…

A term used in the prospective payment system (PPS). All patients are ultimately classified into one of the 468 Diagnosis Related Groups (DRGs) (categories). On the way to that classification, each patient first falls into one of 23 MDCs on the basis of his principal diagnosis; the patient is then further classified according to age,…

An electronic system similar to that used in clothing stores to detect removal of a magnetically tagged garment past a sensor at the exit. Similar magnetic “sitters” are used to keep track of patients who, because of confusion, may wander away or enter a dangerous area. Such patients, who would otherwise have to be restrained,…

The economic theory which pertains to forces which determine the decisions and actions of populations, rather than of individuals. The latter theory is called microeconomics. The economic theory which pertains to forces which determine the decisions and actions of individuals, rather than of entire populations. The latter theory is called macroeconomics.  

In health care, refers to steps taken to improve the health care system at the community level (for example, local, state, or national) with respect to such problems as insurance, financing, tort reform, access, and the like, rather than care to individual patients.