Biomaterial Database

Strategies for health care cost containment. 1995

G A Mitchell

Manion, Wilkins & Associates Ltd., Toronto.

UI	MeSH Term	Description	Entries
D007345	Insurance Claim Review	Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.	Claims Review,Insurance Audit,Insurance Claims Processing,Analysis, Claims,Claim Review, Insurance,Claims Analysis,Insurance Claims Analysis,Review, Claims,Review, Insurance Claim,Analyses, Claims,Analyses, Insurance Claims,Analysis, Insurance Claims,Audit, Insurance,Audits, Insurance,Claim Reviews, Insurance,Claims Analyses,Claims Analyses, Insurance,Claims Analysis, Insurance,Claims Processing, Insurance,Claims Reviews,Insurance Audits,Insurance Claim Reviews,Insurance Claims Analyses,Processing, Insurance Claims,Reviews, Claims,Reviews, Insurance Claim
D007347	Insurance, Dental	Insurance providing coverage for dental care.	Prepaid Dental Care,Care, Prepaid Dental,Dental Care Plan,Dental Insurance,Plan, Dental Care,Plans, Dental Care,Dental Care Plans,Dental Care, Prepaid
D007356	Insurance, Pharmaceutical Services	Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.	Drug Benefit Plans,Drug Insurance,Prescription Insurance,Insurance, Pharmaceutic Services,Insurance, Pharmacy Services,Pharmaceutic Services Insurance,Pharmaceutical Services Insurance,Pharmacy Services Insurance,Drug Benefit Plan,Insurance, Drug,Insurance, Prescription,Plan, Drug Benefit,Plans, Drug Benefit
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D002170	Canada	The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.
D003363	Cost Control	The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)	Cost Containment,Containment, Cost,Containments, Cost,Control, Cost,Controls, Cost,Cost Containments,Cost Controls
D006264	Health Benefit Plans, Employee	Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.	CHAMPUS,Employee Health Benefit Plans