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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Unwarranted variations in medical practice refer to the differences in care that cannot be explained by the illness/medical need or by patient preferences. The term “unwarranted variations” was first coined by Dr. John Wennberg when he observed small area (geographic) and practice style variations, which were not based on clinical rationale. [5]
Based on studies of barriers to shared decision-making as perceived by health professionals [64] and patients, [65] many researchers are developing sound, theory-based training programs and decision aids, and evaluating their results. Canada has established a research chair that focusses on practical methods for promoting and implementing ...
Moral hazard, the additional healthcare consumed because of insurance, can be decomposed into an efficient (welfare increasing) portion and an inefficient (welfare decreasing) one, based on what the insured patient would have done with the income if they had been written a cashier's check for the insurance spending, instead of the insurer ...
Before the spread of health insurance, doctors charged patients according to what they thought each patient could afford. This practice was known as sliding fees and became a legal rule in the 20th century in the U.S. [7] [10] Eventually, changing economic conditions and the introduction of health insurance in the mid-20th century ushered an ...
There is a definite need for nurses, and all practitioners, to have an open mind when dealing with the modern inventions of the future because these could potentially improve the health of patients. There are many barriers to promoting evidence-based practice. The first of which would be the practitioner's ability to critically appraise research.
The health care should be based on the unique person's needs and his or her right to health; The health institution should focus on the abilities of the person and encourage activity; The health care should be coherent; Health professionals should always approach patients with dignity, compassion and respect. They should work with an ethical ...
Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refer to the effects of healthcare on the health status of patients and populations. [2] Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. [3]