Cost, Access, and Quality
CHAPTER 12, Cost, Access, and Quality
Study Guide
TERMINOLOGY
*Access to care may be defined as the timely use of needed, affordable, convenient, acceptable, and effective personal health services.
Accessibility refers to the fit between the location of a provider and the location of patients.
*Administrative costs are costs associated with the management of the financing, insurance, delivery, and payment functions. These costs include management of the enrollment process, setting up contracts with providers, claims processing, utilization monitoring, denials and appeals, and marketing and promotional expenses.
*An all-payer system requires the participation of all major health care payers in a nationwide cost-containment program. APG stands for ambulatory patient groups, which are based on a patient classification and payment system designed to identify and explain the amount and type of resources used in an ambulatory visit. Patients in an APG have similar clinical characteristics, similar resource use, and similar cost.
*Clinical practice guidelines (also called "medical practice guidelines") are explicit descriptions representing preferred clinical processes. They are standardized guidelines in the form of scientifically established protocols designed to guide physicians' clinical decisions.
*Competition refers to rivalry among sellers for customers. In health care delivery, it means that providers of health care services would try to attract patients who have the ability to choose from several different providers. Although competition more commonly refers to price competition, it may also be based on technical quality, amenities, access, or other factors.
*Cost-efficiency evaluates the relationship between increasing medical expenditures/risks and improvements in health levels. A service is cost-efficient when the benefit received is greater than the cost incurred in providing the service or the potential health risks from
Study Guide
TERMINOLOGY
*Access to care may be defined as the timely use of needed, affordable, convenient, acceptable, and effective personal health services.
Accessibility refers to the fit between the location of a provider and the location of patients.
*Administrative costs are costs associated with the management of the financing, insurance, delivery, and payment functions. These costs include management of the enrollment process, setting up contracts with providers, claims processing, utilization monitoring, denials and appeals, and marketing and promotional expenses.
*An all-payer system requires the participation of all major health care payers in a nationwide cost-containment program. APG stands for ambulatory patient groups, which are based on a patient classification and payment system designed to identify and explain the amount and type of resources used in an ambulatory visit. Patients in an APG have similar clinical characteristics, similar resource use, and similar cost.
*Clinical practice guidelines (also called "medical practice guidelines") are explicit descriptions representing preferred clinical processes. They are standardized guidelines in the form of scientifically established protocols designed to guide physicians' clinical decisions.
*Competition refers to rivalry among sellers for customers. In health care delivery, it means that providers of health care services would try to attract patients who have the ability to choose from several different providers. Although competition more commonly refers to price competition, it may also be based on technical quality, amenities, access, or other factors.
*Cost-efficiency evaluates the relationship between increasing medical expenditures/risks and improvements in health levels. A service is cost-efficient when the benefit received is greater than the cost incurred in providing the service or the potential health risks from