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A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, psychologist, dentist, veterinarian, or other health care provider.
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past, the equivalent term was general practitioner in the US; however in the United Kingdom and other countries the term 'general practitioner' is still used.
Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff. Defensive medicine is a reaction to the rising costs of malpractice insurance premiums and patients’ biases on suing for missed or delayed diagnosis or treatment but not for being overdiagnosed. U.S. physicians are at highest risk of being sued, and overtreatment is common. The number of lawsuits against physicians in the USA has increased within the last decades and has had a substantial impact on the behavior of physicians and medical practice. Physicians order tests and avoid treating high-risk patients to reduce their exposure to lawsuits, or are forced to discontinue practicing because of overly high insurance premiums. This behavior has become known as defensive medicine, "a deviation from sound medical practice that is indicated primarily by a threat of liability".
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately.
Physicians for a National Health Program (PNHP) is an advocacy organization of more than 20,000 American physicians, medical students, and health professionals that supports a universal, comprehensive single-payer national health insurance program. Since being co-founded in 1987 by physicians David Himmelstein and Steffie Woolhandler, PNHP has advocated for reform in the U.S. health care system.
Consumer-driven healthcare (CDHC), or consumer-driven health plans (CDHP) refers to a type of health insurance plan that allows members to use health savings accounts (HSAs), health reimbursement accounts (HRAs), or similar medical payment accounts to pay routine healthcare expenses directly, but a high-deductible health plan protects them from more costly medical expenses. Users keep any unused balance or "rollover" at the end of the year to increase future balances or to invest for future expenses. CDHC plans are subject to the provisions of the Affordable Care Act, which mandates that routine or health maintenance claims must be covered, with no cost-sharing to the patient. High-deductible policies cost less than traditional insurance plans.
John E. "Jack" Wennberg is the pioneer and leading researcher of unwarranted variation in the healthcare industry. In four decades of work, Wennberg has documented the geographic variation in the healthcare that patients receive in the United States. In 1988, he founded the Center for the Evaluative Clinical Sciences at Dartmouth Medical School to address that unwarranted variation in healthcare.
An integrated delivery system (IDS), also known as integrated delivery network (IDN), is a health system with a goal of logical integration of the delivery (provision) of health care as opposed to a fragmented system or a disorganized lack of system.
Donald M. Berwick is a former Administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement a not-for-profit organization.
In economics, supplier induced demand (SID) may occur when asymmetry of information exists between supplier and consumer. The supplier can use superior information to encourage an individual to demand a greater quantity of the good or service they supply than the Pareto efficient level, should asymmetric information not exist. The result of this is a welfare loss.
Health care in the United States is provided by many distinct organizations. Health care facilities are largely owned and operated by private sector businesses. 58% of community hospitals in the United States are non-profit, 21% are government-owned, and 21% are for-profit. According to the World Health Organization (WHO), the United States spent $9,403 on health care per capita, and 17.1% on health care as percentage of its GDP in 2014. Healthcare coverage is provided through a combination of private health insurance and public health coverage. The United States does not have a universal healthcare program, unlike most other developed countries.
Joseph P. Newhouse is an American economist and the John D. MacArthur Professor of Health Policy and Management at Harvard University, as well as the Director of the Division of Health Policy Research and of the Interfaculty Initiative on Health Policy. At Harvard, he is a member of the four faculties at Harvard Kennedy School in Cambridge, Harvard Medical School in Boston, Harvard T.H. Chan School of Public Health in Boston, and Harvard Faculty of Arts and Sciences in Cambridge.
Health care ratings are ratings or evaluations of health care. In the United States they have been an increasingly used tool to try to drive accountability among health care providers and in the context of classic supply/demand view of Health economics, to help health care consumers make better choices.
The Center for Medicare and Medicaid Innovation is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation. "The center is to test innovative payment and delivery system models that show important promise for maintaining or improving the quality of care in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), while slowing the rate of growth in program costs". The center "is to give priority to twenty models specified in the law, including medical homes, all-payer payment reform, and arrangements that transition from fee-for-service reimbursement to global fees and salary-based payment". It is "intended to overcome antireform inertia by creating a mechanism for the diffusion of successful pilot programs" without requiring Congressional approval.
Blue Cross Blue Shield of Massachusetts (BCBSMA) is a state licensed nonprofit private health insurance company under the Blue Cross Blue Shield Association with headquarters in Boston. The Boston location located on 133 Federal Street is currently under study as a pending Boston Landmark by the Boston Landmarks Commission.
Balance billing, sometimes called surprised billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. It is an especially common problem in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty.
Paul M. Ellwood Jr. is a prominent figure in American health care. Often referred to as the "father of the health maintenance organization," he not only coined the term, he also played a role in bringing about structural changes to the American health care system to simultaneously control cost and promote health by replacing fee-for-service with prepaid, comprehensive care. The term "HMO" was coined by Dr. Paul M. Ellwood Jr. in a January 1970 Fortune Magazine article. More recently, he has advanced an agenda for monitoring health outcomes, so that patients, providers, and payers can make health care decisions based on real information about what treatments and providers are actually effective.
Peter B. Bach is a physician, epidemiologist, and writer at Memorial Sloan-Kettering Cancer Center where he is Director of the Center for Health Policy and Outcomes. His research focuses on healthcare policy, particularly as it relates to Medicare, racial disparities in cancer care quality, and lung cancer. Along with his scientific writings he is a frequent contributor to The New York Times and other newspapers.
Health policy and management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks. Health care administrators are considered health care professionals.
Fitzhugh Mullan was an American physician, writer, educator, and social activist. He participated in the founding of the Student Health Organization, the National Coalition for Cancer Survivorship, Seed Global Health, and the Beyond Flexner Alliance. Mullan was a professor of Health Policy and Management and of Pediatrics at the George Washington University and the George Washington University Health Workforce Institute, now renamed the Fitzhugh Mullan Institute for Health Workforce Equity. He was an elected member of the National Academy of Medicine.
References
- ↑ "Curriculum Vitae: Alain C. Enthoven" (PDF). Stanford University. June 2004. Archived from the original (PDF) on 2007-06-11.
- ↑ "Integrated systems improve medical care, control costs, according to Enthoven" . Retrieved 2017-03-07.
