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In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...
There are basically two types of health insurance: fee-for-service (indemnity) and managed care. Policies may vary from low cost to all-inclusive to meet different demands of customers, depending on needs, preferences, and budget.
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 ...
POS. A Point of Service plan falls between HMOs and PPOs in terms of cost and combines features of both plans. POS plans allow you to choose what type of care you want at the beginning of every ...
Also called resource cost advantage. The ability of a party (whether an individual, firm, or country) to produce a greater quantity of a good, product, or service than competitors using the same amount of resources. absorption The total demand for all final marketed goods and services by all economic agents resident in an economy, regardless of the origin of the goods and services themselves ...
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.
A reescalating battle between pharmaceutical companies and pharmacy benefit managers is brewing in Washington, D.C., as President Donald Trump's new administration takes shape. The drug industry's ...
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 ...