Search results
Results From The WOW.Com Content Network
The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.
The new findings were based on an analysis of health insurance claims data from more than 4,000 hospitals in 49 states and Washington, D.C., from 2020 through 2022. It included both inpatient and ...
Medical underwriting is a health insurance term referring to the use of medical or health information in the evaluation of an applicant for coverage, typically for life or health insurance. As part of the underwriting process, an individual's health information may be used in making two decisions: whether to offer or deny coverage and what ...
Access to healthcare services is a critical determinant of health outcomes. Factors such as health insurance coverage, proximity to healthcare facilities, availability of primary care providers, and affordability of services significantly influence an individual’s ability to seek timely medical care, preventive services, and treatment for ...
Community rating, as a basis for premium calculation, is fundamentally different from the usual method of determining insurance premiums, i.e. risk rating. In a risk rated insurance market, an insurer calculates the premium payable by a potential policy holder in order to enter into an insurance contract on the basis of various factors particular to that individual, such as the risk of a claim ...
Congress — whose members do enjoy a right to sue over denials of their own health insurance claims — has many options for limiting the extent of insurers’ exposure to lawsuits, such as ...
For example, in group health insurance an insurer is interested in calculating the risk premium, , (i.e. the theoretical expected claims amount) for a particular employer in the coming year. The insurer will likely have an estimate of historical overall claims experience, x {\displaystyle x} , as well as a more specific estimate for the ...
A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization). The contract can be renewable (annually, monthly) or lifelong in the case of private insurance.