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The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.
Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any medications prescribed. This information is translated into standardized codes using the appropriate coding system, such as ICD-10-CM or Current Procedural Terminology codes—this part of the process is known as medical coding. These coded records are submitted by medical billing to the health insurance company or the payer, along with the patient's demographic and insurance information. Most insurance companies use a similar process, whether they are private companies or government sponsored programs. The insurance company reviews the claim, verifying the medical necessity and coverage eligibility based on the patient's insurance plan. If the claim is approved, the insurance company processes the payment, either directly to the healthcare provider or as a reimbursement to the patient. The healthcare provider may need to following up on and appealing claims.
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.
...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.
In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.
Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
A review site is a website on which reviews can be posted about people, businesses, products, or services. These sites may use Web 2.0 techniques to gather reviews from site users or may employ professional writers to author reviews on the topic of concern for the site.
The Canadian Medical Protective Association (CMPA) is a membership-based, not-for-profit organization that provides legal defence, liability protection, and risk-management education for physicians in Canada. The CMPA also provides compensation to patients and their families proven to have been harmed by negligent medical care. In 2016, the CMPA's membership list totaled 95,691 physicians.
Concierge medicine, also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors agree to provide enhanced care, including commitments to ensure adequate time and availability for each patient.
The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).
Healthcare in Slovenia is organised primarily through the Health Insurance Institute of Slovenia. In 2015, healthcare expenditures accounted for 8.10% of GDP. The Slovenian healthcare system was ranked 15th in the Euro health consumer index 2015. The country ranked second in the 2012 Euro Hepatitis Index.
Zocdoc is a New York City-based company offering an online service that allows people to find and book in-person or telemedicine appointments for medical or dental care. The platform also functions as a physician and dentist rating and comparison database. The service is free for patients, and doctors pay to advertise their appointment slots. Established in 2007, the private company had a $1.8 billion valuation by August 2015, the third-highest for a startup in New York at the time.
Healthgrades Operating Company Inc., known as Healthgrades, is a US company that provides information about physicians, hospitals, and healthcare providers. Healthgrades has amassed information on over three million U.S. health care providers. The company was founded by Kerry Hicks, David Hicks, Peter Fatianow, John Neal, and Sarah Lochran, and is based in Denver, Colorado. Rob Draughon serves as the company's CEO. According to USA Today, Healthgrades is the first comprehensive physician rating and comparison database. The application is part of a trend in health technology in the United States towards consumer-driven healthcare.
Zero-rating is the practice of providing Internet access without financial cost under certain conditions, such as by permitting access to only certain websites or by subsidizing the service with advertising or by exempting certain websites from the data allowance.
Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy.
Patient choice is a concept introduced into the NHS in England. Most patients are supposed to be able to choose the clinician whom they want to provide them with healthcare and that money to pay for the service should follow their choice. Before the advent of the internal market, in principle, a GP could refer a patient to any specialist in the UK. When contracts were introduced in 1990 these were called extracontractual referrals. From 1999 the concept of Out of Area Treatments was developed. These referrals were not necessarily related to choice made by a patient. Specialised treatments were not, and are not, available in every area.
Lakeside Healthcare Groupwhich operates from a number of sites across Cambridgeshire, Lincolnshire and Northamptonshire, is one of the biggest General practice / Primary Care Providers in the National Health Service with 80 partners and almost 200,000 patients.
Whitecoat Health Service Directory, commonly referred to as Whitecoat, is an online directory of healthcare professionals. It was launched in Australia in 2013 and New Zealand in 2018. The service allows consumers to rate their experience of a healthcare provider and read other users’ recommendations and reviews. By 2016, Whitecoat was the largest website of its kind in Australia. Whitecoat has drawn significant criticism from professional medical bodies.
Becker's Hospital Review is a medical industry trade magazine that does its own research, supplementing this with government-released data and U.S. News & World Report rankings. It is published by ASC Communications, Inc., an Illinois corporation owned or controlled by its registered agent, Scott Becker, and lists with the Illinois Secretary of State its offices as being located at 77 W. Wacker Drive, Chicago, Illinois. It covers its field from the prospective of those involved: doctors, hospitals, and those who pay: patients and the general public. Some of these topics come together, such as a hospital's payout for disclosing a patient's HIV information to the person's employer, and reviewing how their privacy policy can accommodate the needs of hospital staff, those being treated, and the employer's insurance personnel.
References
- ↑ "RateMDs.com Receives One-Millionth Doctor Review". greenatom. PRNewswire. Retrieved 26 November 2014.
- 1 2 Kolm, Josh (June 26, 2014). "Health Media Today acquired by VerticalScope" . Retrieved 2024-03-01.
- ↑ Reddy, Sumathi. "Doctors Check Online Ratings From Patients and Make Change". WSJ.com. The Wall Street Journal. Retrieved 26 November 2014.
- ↑ Rossen, Jake. "Insult And Injury: How Doctors Are Losing The War Against Trolls". www.buzzfeed.com. Buzzfeed. Retrieved 26 November 2014.
- 1 2 3 4 Office of the Privacy Commissioner of Canada (2020-10-08). "PIPEDA Findings #2020-002: Health practitioner ratings site ceases charging for rating takedowns, a PIPEDA "no-go-zone"". www.priv.gc.ca. Retrieved 2024-03-01.
- ↑ "Why is a rating removed or not published?". RateMDs. Retrieved 2024-03-01.
- ↑ "Who's rating doctors on RateMDs? The invisible hand of 'reputation management'". CBC News. 27 October 2018.
- ↑ https://www.canlii.org/en/on/onca/doc/2020/2020onca767/2020onca767.html