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  1. Monopolistic Competition
    A Market structure that is characterized by many competing firms, each producing a slightly differentiated product that is a close substitute to the products produced by competing firms
  2. Monopoly
    A Market structure in which there is a single seller of a product that has no close substitutes
  3. Monopoly Model of physician pricing
    Physicians face a downward-sloping demand curve for their services and set price according to where marginal revenue equals marginal costs
  4. Monopsony
    A Market structure characterized by a single purchaser
  5. Moral Hazard
    A situation where the individual alters their behavior when they have acquired insurance. Since insurance lowers the price of medical care, the insured will consume more care than if they had to pay the full price themselves
  6. Mortality rate
    For a given population, it is the ratio of the number of individuals who die divided by the average size of the population
  7. Mutihospital system
    A system in which a corporation owns, leases, or manages two or more acute care hospitals
  8. Mutipayer system
    A system in which reimbursement for medical services is made by multiple third party payers
  9. Negative Prices
    A negative price is when a person or beneficiary group is paid to use a service. When the time and travel costs of a beneficiary group is lowered, e.g. locating facilities closer to the beneficiaries, these may also be considered to be negative prices
  10. Network Health Maintenance Organization
    A type of HMO that signs contracts with a number of group practices to provide medical services
  11. Non-market care giving
    Medical or nursing care that is provided by the patient's spouse or family without pay
  12. Non-price hospital competition
    Hospitals compete on the basis of their facilities and services and the latest technology rather than on price
  13. Normal good
    An increase in income leads to greater consumption
  14. Normative judgment of a shortage
    A non-economic definition of a health manpower shortage. Estimates of such a shortage are based on a determination of need in the population or upon some professional estimate of health manpower requirements
  15. Not-for-Profit
    An institution that is not allowed to disperse its profits
  16. Nurse participation rates
    The percentage of trained nurses that are employed
  17. Oligopoly
    A market structure characterized by a few firms, with each firm considering the actions of the other firms when making price and output decisions (interdependence among firms)
  18. Omnibus Budget Reconciliation Act of 1989
    Congressional passage of this legislation resulted in restructuring of physician reimbursement under the Medicare program
  19. Opportunity cost
    Relevant costs for economic decision-making, they include explicit as well as implicit costs. For example, the opportunity costs of a medical education include forgone income the student could have earned had they not gone to medical school
  20. Optimal rate of output
    Occurs when the marginal benefit of the last unit equals the price of that unit, which in turn equals the marginal cost of producing the last unit
  21. Optimization techniques (marginal analysis)
    Specify the appropriate criteria to be used when allocating scarce resources so as to minimize the cost of producing a given output or, similarly, maximize output, subject to a budget constraint. For example, costs are minimized when the ration of the marginal product of each input divided by its cost is equal.
  22. Out of Pocket Price
    The amount that the beneficiary must pay after all the other payments have been considered by the health plan
  23. Over the counter drug
    A drug that is available for public purchase and self-directed use without a prescription
  24. Patient dumping
    A situation where high-cost patients are not admitted to or are discharged early from a hospital because the patient either has no insurance or that the amount reimbursed by the third party payer will be less than the cost of caring for that patient
  25. Per Diem payments
    A method of payment to institutional providers that is based on a fixed daily amount and does not differ according to the level of service provided
  26. Periodic re-examination
    Would require physicians to maintain their qualifications by requiring them to undergo periodic testing for re-licensure
  27. Physician agency relationships
    The physician acts on behalf of the patient. Agency relationships may be perfect or imperfect and method of physician payment, fee-for-service or capitation, would produce different behavioral responses among imperfect physician agents.
  28. Physician control model of the hospital
    The hospital's behavior, pricing, cost control, and investments, are expected to be determined according to the medical staff's economic interests
  29. Physician Hospital Organization
    PHO, An organization where hospitals and their medical staffs develop new types of group practice arrangements that will allow the hospitals to see contracts from new HMOs and other carriers on behalf of physicians and the hospitals together
  30. Physician market entry barriers
    Licensure, graduation from an approved medical school, and continual increases in training times cause the supply of physicians to be smaller than if such barriers did not exist. The ostensible reasons for such barriers, namely, a high-quality work force, could be achieved more directly
  31. Physician to population ratio
    The number of physicians per 100,000 population has often been used as an indicator of a shortage or surplus of physicians. These ratios do not consider changes in demands for physicians, increases in physician productivity, nor differences in these ratios over time indicate the importance, n terms of physician fees, of shortages or surpluses using this approach
  32. Play or pay
    Under this form of national health insurance (also referred to as an employer mandate), employers are required to either provide some basic level of medical insurance to their employees, play, or pay a certain amount per employee into a government pool that would provide the employee with insurance
  33. Point o Service
    A plan that allows the beneficiary to select from participating providers (HMO) or use a non-participating provider and pa a higher copayment
  34. Portability
    Included as part of health insurance reform that enables the insured to change jobs without losing their insurance or having to be liable for another preexisting exclusion period
  35. Pre existing exclusion
    To protect themselves against adverse selection by new enrollees, insurers use a pre existing exclusion clause that excludes treatment for any or specified illnesses that have been diagnosed within the previous (usually) 12 months
  36. Preferred Provider Organization
    PPO, An arrangement between a panel of health care providers and purchasers of health care services in which a closed panel of providers agree to supply services to a defined group of patients on a discounted fee for service basis. This type of plane offers a limited number of physicians and hospitals, negotiated fee schedules, utilization review, and consumer incentives to use PPO participating providers
  37. Preferred risk selection
    Occurs when insurers receive the same premium for everyone in an insured group and try to attract only those with lower risks whose expected medical costs would be less than the group's average premium
  38. Prepaid Group Practice
    PGP, A type of practice where the providers are reimbursed a capitates amount per enrollee for a stipulated length of time
  39. Prescription drug
    A drug that can be obtained only with a physicians prescription
  40. Prestige maximization goal
    Not for Profit providers (hospital and medical school) whose pricing and investment behavior is directed to increase the prestige of the institution rather than increase the rate of return on their investments
  41. Price discrimination
    An indication of monopoly power by a provider. The provider is able to charge different purchasers different prices according to the purchasers elasticity of demand, willingness to pay, for the same or similar service
  42. Price fixing
    Occurs when competing firms agree to set prices to increase profits. The competing firms act like monopolists in that they use the industry demand curve, which is less price elastic, to establish their prices. Such actions are considered to be a per se violation of the anti trust laws
  43. Price of legislation
    Is the political support an organized group can offer to legislators, namely campaign contributors, volunteer time, and votes
  44. Primary Care Physician
    PCP, A physician that coordinates all of the routine medical care needs of an individual. Typically, this type of physician specializes in family practice, internal medicine, pediatrics, obstetrics/gynecology
  45. Process measures of quality
    A type of quality assessment that evaluates process of care by measuring the specific way in which care is provided or, with respect to health manpower, their training requirements
  46. Producer legislation
    May be characterized into five types: Demand-Increasing, Secure the highest Method of Payment, Reduce the price and/or Increase the quantity of Compliments, Decrease Availability and/or Increase the Price of Substitutes, and Limit Increases in Supply
  47. Product market definition
    Used in anti trust cases to determine whether the product or services in question has close substitutes, which depends on the willingness of purchasers to use other services if their relative prices change. The closer the substitutes, the smaller is the market share of the product being examined
  48. Product possibilities curve
    Shows the different combinations (trade-off) of two different goods or outputs that can be produced with a fixed amount of resources
  49. Professional licensure
    A prerequisite that requires health professionals, such as physicians, who want to practice to obtain a license from the government
  50. Profit maximizing model of hospital behavior
    Not-for-profit hospitals act as though they tried to maximize profits by setting price a that point on the demand curve where marginal revenue equals marginal cost. Further, such hospitals would invest so as to receive the highest rate of return on their assets. Any profits generated would be internally invested rather than paid out to shareholders
  51. Prospective payment
    A method of payment for medical services in which providers are paid based on a predetermined rate for the services rendered regardless of the actual costs of care incurred. Medicare uses a prospective payment system for hospital cased on a fixed price per hospital admission by diagnosis
  52. Public interest theory of Government
    Assumes that legislation is enacted to serve the public interest. The two basic objectives of government according to this theory are to improve market efficiency and based on societal value judgment, redistribute income
  53. Pure Premium
    Is the expected claims experience for an insured group, exclusive of the loading charge. As described in the text, the pure premium for an individual is calculated by multiplying the size of the loss by the probability the loss will occur
Card Set:
2011-11-17 02:19:04

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