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  2. UnitedHealth Group - Wikipedia

    en.wikipedia.org/wiki/UnitedHealth_Group

    UnitedHealthcare Community and State – serves state programs that care for the economically disadvantaged, the medically underserved, and people without the benefit of employer-funded health care coverage, in exchange for a monthly premium per member from the state program. [76] UnitedHealthcare Global – provides nearly 2.2 million people ...

  3. Fee-for-service - Wikipedia

    en.wikipedia.org/wiki/Fee-for-service

    Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [ 1 ] In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.

  4. Health care prices in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_care_prices_in_the...

    CMS sets fee schedules for medical services through Prospective Payment Systems (PPS) for inpatient care, outpatient care, and other services. [34] As the largest single purchaser of medical services in the U.S., Medicare's fixed pricing schedules have a significant impact on the market.

  5. Healthcare in the United States - Wikipedia

    en.wikipedia.org/wiki/Healthcare_in_the_United...

    The McKinsey Global Institute estimated that excess spending on "health administration and insurance" accounted for as much as 21% of the estimated total excess spending ($477 billion in 2003). [235] According to a report published by the CBO in 2008, administrative costs for private insurance represent approximately 12% of premiums. Variations ...

  6. Relative value unit - Wikipedia

    en.wikipedia.org/wiki/Relative_value_unit

    The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. [2] The services are classified under a nomenclature based on the Current Procedural Terminology (CPT) to which the American Medical Association holds intellectual property rights. [ 2 ]

  7. Managed care - Wikipedia

    en.wikipedia.org/wiki/Managed_care

    Fee-for-service is a traditional kind of health care policy: insurance companies pay medical staff fees for each service provided to an insured patient. Such plans offer a wide choice of doctors and hospitals. Fee-for-service coverage falls into Basic and Major Medical Protection categories.

  8. Capitation (healthcare) - Wikipedia

    en.wikipedia.org/wiki/Capitation_(healthcare)

    Providers tend to be small in comparison to insurers and so are more like individual consumers, whose annual costs as a percentage of their annual cash flow vary far more than those of large insurers. For example, a capitated eye care program for 25,000 patients is more viable than a capitated eye program for 10,000 patients.

  9. Bundled payment - Wikipedia

    en.wikipedia.org/wiki/Bundled_payment

    Considering the advantages and disadvantages of fee-for-service, pay for performance, bundled payment for episodes of care, and global payment such as capitation, Mechanic and Altman concluded that "episode payments are the most immediately viable approach." [49]