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Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
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 Grossman model of health demand is a model for studying the demand for health and medical care outlined by Michael Grossman in a monograph in 1972 entitled: The demand for health: A theoretical and empirical investigation. The model based demand for medical care on the interaction between a demand function for health and a production ...
Donabedian model. The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. [ 1] According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes." [ 2] Structure describes the context in ...
Health policy and management. Health policy and management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks. Health care administrators are considered health care professionals.
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American ...
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 Clinton health care plan of 1993 was an American healthcare reform package proposed by the Bill Clinton administration and closely associated with the chair of the task force devising the plan, first lady Hillary Clinton. Bill Clinton had campaigned heavily on health care in the 1992 United States presidential election. The task force was ...