Concept
Fee-for-service
Concepts associés (11)
Managed Care Organization
Une Managed Care Organisation (MCO) est un type d'organisation d'assurance maladie aux États-Unis. Il compte deux types d'organisations avec des modèles différents : les PPO () et les HMO (). Les HMO restreignent les soins de santé à l'intérieur d'un réseau spécifique (d'hôpitaux, de médecins, etc.), mais avec un PPO, plus coûteux, il est possible de consulter où on veut. Les HMO sont devenus très répandus depuis le , qui a notamment requis des entreprises employant plus de 25 salariés qu'elles offrent à ces derniers la possibilité de souscrire gratuitement à une HMO.
Preferred provider organization
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. A preferred provider organization is a subscription-based medical care arrangement.
Obamacare
Le Patient Protection and Affordable Care Act (en français, Loi sur la Protection des Patients et les Soins Abordables), surnommée « Obamacare », est une loi votée par la législature du Congrès des États-Unis et promulguée par le président Barack Obama le . Elle constitue le principal volet de la réforme du système de protection sociale aux États-Unis, avec le Health Care and Education Reconciliation Act.
Pay for performance (healthcare)
In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking.
Independent practice association
In the United States, an independent practice association (IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. An HMO or other managed care plan can contract with an IPA, which in turn contracts with independent care providers or physicians to treat members at discounted fees or on a capitation basis.
Capitation (healthcare)
Capitation is a payment arrangement for health care service providers. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. The amount of remuneration is based on the average expected health care utilization of that patient, with payment for patients generally varying by age and health status. There are differing arrangements in different healthcare systems.
Bundled payment
Bundled payment is the reimbursement of health care providers (such as hospitals and physicians) "on the basis of expected costs for defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement (in which providers are paid for each service rendered to a patient) and capitation (in which providers are paid a "lump sum" per patient regardless of how many services the patient receives), given that risk is shared between payer and provider.
Health maintenance organization
Aux États-Unis, un health maintenance organization ou HMO (en français, organisme d'assurance maladie) est un groupe d'assurance médicale qui fournit des services de santé moyennant une cotisation annuelle fixe. Il s'agit d'un organisme qui fournit ou organise la gestion des soins de santé pour les compagnies offrant des plans d'assurance maladie, les compagnies ayant des régimes de prestations de soins de santé autofinancés, les particuliers et d'autres entités, en assurant la liaison avec les prestataires de soins de santé (hôpitaux, médecins, etc.
Assurance maladie
L’assurance maladie est un dispositif chargé d'assurer un individu face à des risques financiers de soins en cas de maladie, ainsi qu'un revenu minimal lorsque l'affection prive la personne de travail. Dans la plupart des pays occidentaux, une grande part de l'assurance maladie est prise en charge par l'État. C'est d'ailleurs une des composantes fondamentales de la sécurité sociale, et un devoir de l’État selon la Déclaration universelle des droits de l'homme de 1948.
Primary care physician
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past, the equivalent term was 'general practitioner' in the US; however in the United Kingdom and other countries the term general practitioner is still used. With the advent of nurses as PCPs, the term PCP has also been expanded to denote primary care providers.