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Some HMOs pay gatekeeper PCPs set fees for each defined medical procedure they provide to insured patients (fee-for-service) and then capitate specialists (that is, pay a set fee for each insured person's care, irrespective of which medical procedures the specialists performs to achieve that care), while others use the reverse arrangement.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Beach wall construction in the 1990s. Operation Gatekeeper was a measure implemented during the presidency of Bill Clinton by the United States Border Patrol (then a part of the Immigration and Naturalization Service (INS)), aimed at halting illegal immigration to the United States at the United States–Mexico border near San Diego, California. [1]
Iconographic Collections. Keywords: E. Walker; Florence Nightingale; W.J. Simpson. Health administration, healthcare administration, healthcare management or hospital management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks in all the primary, secondary, and tertiary sectors.
The management and administration of health care is vital to the delivery of health care services. In particular, the practice of health professionals and the operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance. [41]
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 ...
Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. [ 1 ]
Health systems engineering or health engineering (often known as health care systems engineering (HCSE)) is an academic and a pragmatic discipline that approaches the health care industry, and other industries connected with health care delivery, as complex adaptive systems, and identifies and applies engineering design and analysis principles in such areas.