Chapt 12 Soc
Terms
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- Fraud
- The providing of unneccassary services or the billing of services not provided
- Access
- The ability to use affordable, convient, and effective health care services in a timely manner
- TQM
- synonymous with continuous quality improvement
- Reliablilty
- extent to which the same result is obtained during repeated trials
- PRO
- Statewide private organization that is paid by the federal government to review the care of Medicare recipient
- APG
- ambulatory patient group
- Clinical practice guidelines
- explicit descriptions of preferred clinical processes or treatment protocols
- Administrative costs
- The costs of financinbg, managing, delivering, and paying for health care
- Validity
- extent to which a scale actually measures what it purports to measure
- Certificate of need
- State legislation intended to control capital expedentures
- Quality
- degree to which the health services increase the desired outcome and follow established professionalknowledge and guidelines
- Outcome
- often viewed as bottom-line measure of effectiveness
- Cost efficiency
- the relationship between increasing medical expedentures and improvement of health levels
- Critical pathway
- time line with specific interventions and expected outcomes
- Quality assurance
- a step beyond quality assessment
- quality assessment
- measurement of quality against and established standard
- defensive medicine
- ordering tests solely to protect against malpractice
- What is meant by the term of "health care costs" Describe the three differentmeanings of the term costs.
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- How do findings of the Rand Health Insurance Experiment reinforce the relationship between growth in third party reimbursement and increase in health care costs?Explain
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- What are some of the reasons for increased health care costs that are attributed to the providers of medical care?
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- Discuss the effectiveness of CON regulation in controlling health care expedentures.
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