Health Care Policy and Politics A to Z

by Rovner, Julie

• ISBN13: 9781568024370
• ISBN10: 1568024371
• Format: Hardcover
• Copyright: 1999-11-01
• Publisher: Cq Pr

Summary

Health care is America's most talked about and controversial issue at the end of the 20th century. No domestic problem has engaged so many persons, from thousands without medical insurance to individuals fed up with real or imagined mistreatment in managed care. Health Care Policy and Politics A to Z brings clarity and understanding to one of the most contentious and important public policy issues in America.

What is managed care and why is it so controversial? What are the roots of the abortion controversy? How do Medicare and Medicaid work, and what is the difference between them? These and hundreds of other questions, terms, and concepts -- almost 300 in all -- are discussed in layman's language by Julie Rovner, a Washington-based reporter specializing in health care issues for many years.

Table of Contents

Preface	x
A
Abortion	1	(7)
Academic health centers	8	(1)
Accreditation Council on Graduate Medical Education (ACGME)	9	(1)
Activities of daily living	9	(1)
ADAMHA	10	(1)
Adjusted average per capita cost (AAPCC)	10	(1)
Adjusted community rate	10	(1)
Adolescent family life program	10	(1)
Advance directives	11	(1)
Advanced practice nurse	11	(1)
Adverse selection	12	(1)
Agency for Health Care Policy and Research (AHCPR)	12	(1)
Agency for Toxic Substances and Disease Registry (ATSDR)	12	(1)
AIDS	12	(2)
Alternative medicine	14	(1)
American Association of Health Plans (AAHP)	15	(1)
American Association of Retired Persons (AARP)	15	(1)
American Medical Association (AMA)	16	(1)
Americans with Disabilities Act (ADA)	17	(2)
Assignment (Medicare)	19	(1)
B
Balance billing (Medicare)	20	(1)
Baseline	20	(1)
Beneficiary	20	(1)
Blue Cross/Blue Shield Association (BCBSA)	20	(1)
Boren amendment	21	(1)
Budget reconciliation legislation and health care	22	(5)
C
Cafeteria benefits plans	27	(1)
CalPERS	27	(1)
Capitation	27	(1)
Carrier (Medicare)	28	(1)
Carve-out organizations	28	(1)
Catastrophic illness	28	(1)
Categorical eligibility	28	(1)
Centers for Disease Control and Prevention (CDC)	28	(1)
Certified nurse midwife	29	(1)
Certified registered nurse anesthetist (CRNA)	30	(1)
Champus	30	(1)
Child Custody Protection Act	30	(1)
Children's Health Insurance Program (CHIP)	31	(2)
Clinical Laboratory Improvement Act (CLIA)	33	(1)
Clinical nurse specialist (CNS)	34	(1)
Clinical practice guidelines	34	(1)
Cloning, human	34	(1)
COBRA	35	(1)
Coinsurance	36	(1)
Community health centers	36	(1)
Community rating	37	(1)
Congressional Budget Office	37	(1)
Conscience clause	38	(1)
Contraceptive coverage	38	(1)
Cost shifting	39	(1)
CPT codes	40	(1)
Crowd out	40	(1)
D
Deductible	41	(1)
Defined benefit	41	(1)
Defined contribution	41	(1)
Diagnosis-related group (Medicare)	41	(1)
Dietary supplement rules	42	(1)
Direct medical education payments	43	(1)
Disproportionate share hospital (DSH) payments (Medicare and Medicaid)	43	(1)
``Do not resuscitate'' orders	44	(1)
``Drive-through'' deliveries	44	(1)
Dual eligibles	45	(1)
Durable power of attorney for health care	46	(1)
E
Early and Periodic Screening, Diagnostic, and Treatment (Medicaid)	47	(1)
Embryo research	47	(1)
Emergency contraception	48	(1)
Employee Retirement Income Security Act (ERISA)	49	(1)
End-stage renal disease (Medicare)	50	(1)
Entitlement	51	(1)
Evidence-based medicine	51	(1)
Experience rating	51	(1)
External review	51	(1)
F
False Claims Act	52	(1)
Federal Employee Health Benefits Plan	52	(1)
Federal Food, Drug and Cosmetic Act	53	(1)
Federal Medical Assistance Percentages	53	(1)
Federally qualified health centers	53	(1)
Fee-for-service	53	(1)
Fetal tissue research	54	(2)
First dollar coverage	56	(1)
Food and Drug Administration	56	(1)
Formulary	57	(1)
Freedom of Access to Clinic Entrances Act (FACE)	57	(1)
Freedom of Choice Act	58	(2)
G
Gag clauses (in managed care)	60	(1)
Gag rule (in abortion)	61	(1)
Gatekeeper	62	(1)
Generic drugs	62	(1)
Genetic discrimination	63	(1)
Global tobacco settlement	64	(2)
Graduate medical education	66	(1)
Guaranteed issue	67	(1)
Guaranteed renewability	68	(1)
H
Health and Human Services Department	69	(2)
Health Care Financing Administration	71	(1)
Health care fraud and abuse	72	(2)
Health care spending	74	(2)
Health Insurance Association of America	76	(1)
Health Insurance Portability and Accountability Act (HIPAA)	77	(3)
Health jurisdiction in Congress	80	(1)
Health maintenance organization	81	(1)
Health plan	82	(1)
Health professional shortage area	82	(1)
Health Resources and Services Administration (HRSA)	83	(1)
Health Security Act	83	(3)
Health services research	86	(1)
HEDIS	86	(1)
Hill-Burton Act	86	(1)
Home health care	87	(1)
Hospice	87	(1)
Hospital Insurance (HI)	87	(1)
Hospitalist	88	(1)
House Appropriations Committee	88	(1)
House Commerce Committee	89	(1)
House Education and Workforce Committee	89	(1)
House Ways and Means Committee	89	(1)
Hyde amendment	90	(4)
I
ICD-9 codes	94	(1)
Incidence	94	(1)
Income-related premium	94	(1)
Indian Health Service	95	(1)
Indirect Medical Education Payments	96	(1)
Infertility clinic regulation	96	(1)
Institute of Medicine	97	(1)
Intermediary (Medicare)	97	(1)
J
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)	98	(1)
Judicial bypass	98	(1)
K
Kennedy-Kassebaum bill	99	(1)
Kerr-Mills bill	99	(1)
L
Labor--House and Human Services--Education Appropriation	100	(1)
Late-term abortion	100	(1)
Lifetime limits	101	(1)
Living wills	102	(1)
Long-term care	103	(1)
Loss ratios	104	(1)
M
Managed behavioral health care	105	(1)
Managed care	105	(3)
Managed competition	108	(1)
Maternal and Child Health (MCH) Services Block Grant	108	(1)
Means testing (Medicare)	108	(1)
Medicaid	109	(5)
Medicaid drug rebate program	114	(1)
Medical malpractice	115	(2)
Medical necessity	117	(1)
Medical records confidentiality	117	(2)
Medical savings accounts (MSAs)	119	(1)
Medical underwriting	120	(1)
Medically needy	120	(1)
Medicare	121	(5)
Medicare+Choice	126	(2)
Medicare Catastrophic Coverage Act	128	(2)
Medicare Payment Advisory Commission (MedPAC)	130	(1)
Medigap insurance	130	(2)
Mental health parity	132	(1)
Mexico City policy	133	(2)
Migrant health centers	135	(1)
N
National Abortion and Reproductive Rights Action League	136	(1)
National Association of Insurance Commissioners	136	(1)
National Bipartisan Commission on the Future of Medicare	137	(1)
National Committee on Quality Assurance	138	(1)
National Federation of Independent Business	139	(1)
National Health Service Corps	139	(1)
National Institutes of Health (NIH)	139	(3)
National Practitioner Data Bank	142	(1)
National Right to Life Committee	143	(1)
Needle exchange	144	(1)
Nurse practitioner	145	(1)
Nursing home standards	145	(1)
Nutrition Labeling and Education Act	146	(1)
O
Off-label use	147	(1)
Oregon Health Care Plan	147	(1)
Organ donations	148	(2)
Orphan drugs	150	(1)
Outcomes	150	(1)
P
Parental consent	151	(1)
Parental involvement laws	151	(1)
Parental notification	152	(1)
Partial-birth abortion	153	(3)
Participating physician (Medicare)	156	(1)
Patient ``dumping''	157	(1)
Patients' Bill of Rights	157	(2)
Patient Self Determination Act of 1990	159	(1)
Payers	160	(1)
Peer review	160	(1)
Peer review organization (Medicare)	160	(1)
Pepper Commission	161	(1)
Personal Responsibility and Work Opportunity Reconciliation Act	161	(1)
Pharmacy benefit managers	162	(1)
Physician assistants	162	(1)
Physician Payment Review Commission	162	(1)
Planned Parenthood Federation of America	163	(1)
Planned Parenthood of Southeastern Pennsylvania v. Casey	164	(1)
Play or pay	165	(1)
Point of service plan (POS)	165	(1)
Portability	165	(1)
Poverty statistics	165	(1)
Preexisting condition	166	(1)
Preferred Provider Organization (PPO)	166	(1)
Premiums	167	(1)
Premium support	167	(1)
Prescription Drug User Fee Act	167	(1)
Prevalence	168	(1)
Primary care	168	(1)
Primary care physician	168	(1)
Private Contracting (Medicare)	169	(1)
Private fee-for-service (Medicare)	170	(1)
Program of All-inclusive Care for the Elderly	170	(1)
Prospective Payment Assessment Commission	171	(1)
Prospective payment system	171	(1)
Providers	172	(1)
Provider-sponsored organizations (PSOs)	172	(1)
Public health	172	(1)
Public Health Service	172	(2)
Public Health Service, Commissioned Corps	174	(2)
Q
Qualified Medicare beneficiary	176	(1)
R
Rationing	177	(1)
Referral	177	(1)
Report cards	177	(1)
Residency review committees	178	(1)
Resource-based relative value scale	178	(1)
Respite care	178	(1)
Retiree health insurance	178	(1)
Ribicoff children	179	(1)
Ricky Ray Hemophilia Relief Fund Act	179	(1)
Risk adjustment	180	(1)
Roe v. Wade	180	(1)
RU486	181	(2)
Ryan White Comprehensive AIDS Resource and Emergency (CARE) Act	183	(2)
S
Safety net facilities	185	(1)
Secondary care	185	(1)
Secondary Payer (Medicare)	185	(1)
Self-insurance	186	(1)
Self-referral curbs	186	(1)
Senate Appropriations Committee	187	(1)
Senate Finance Committee	187	(1)
Senate Health, Education, Labor and Pensions Committee	188	(1)
Single payer	188	(1)
Small market variation	189	(1)
Social Security Act	190	(1)
Social Security Disability Insurance (SSDI)	190	(1)
Special Supplemental Food Program for Women, Infants, and Children	191	(1)
Specialty care	191	(1)
Specified Low-Income Medicare Beneficiaries (SLMB)	191	(1)
Spend-down	191	(1)
Spousal impoverishment	191	(1)
State Children's Health Insurance Program	192	(1)
Substance Abuse and Mental Health Services Administration	192	(1)
Suicide, assisted	193	(1)
Supplemental Security Income (SSI)	194	(1)
Supplementary Medical Insurance (SMI)	195	(1)
Surgeon general of the United States	195	(3)
T
Taft-Hartley plans	198	(1)
Technology assessment	198	(1)
TennCare	198	(1)
Tertiary care	199	(1)
Title X Family Planning Program	199	(2)
Tricare	201	(1)
Tuskeegee experiments	201	(2)
U
Uncompensated care	203	(1)
Underinsured	203	(1)
Underwriting	203	(1)
Uninsured	203	(3)
Unions, doctor	206	(1)
United Nations Population Fund	207	(1)
United Network for Organ Sharing	208	(1)
Universal coverage	208	(1)
Utilization review	209	(1)
V
Veterans health care	210	(1)
Voluntary Health Agencies	211	(1)
W
Webster v. Reproductive Health Services	212	(1)
WIC	213	(1)
Women's Health, Office of Research on	214	(1)
Z
Zidovudine	215	(2)
Reference Material	217	(16)
Health Care Policy Acronyms	219	(2)
Congressional Committees Responsible for Health Care Policy	221	(7)
Sources of Further Information	228	(5)
Index	233