Instruct: Given a question, retrieve relevant documents that can help answer the question.
Query: How are PPOs different from HMOs?
The terms "open panel" and "closed panel" are sometimes used to describe which health care providers in a community have the opportunity to participate in a plan. In a "closed panel" HMO, the network providers are either HMO employees (staff model) or members of large group practices with which the HMO has a contract. In an "open panel" plan the HMO or PPO contracts with independent practitioners, opening participation in the network to any provider in the community that meets the plan's credential requirements and is willing to accept the terms of the plan's contract.
Deductibles are typically used to deter the large number of claims that a consumer can be reasonably expected to bear the cost of. By restricting its coverage to events that are significant enough to incur large costs, the insurance firm expects to pay out slightly smaller amounts much less frequently, incurring much higher savings. As a result, insurance premiums are typically cheaper when they involve higher deductibles. For example, health insurance companies offer plans with high premiums and low deductibles, or plans with low premiums and high deductibles. One plan may have a premium of $1,087 a month with a $6,000 deductible, while a competitive plan may have a premium of $877 a month with a $12,700 deductible. The consumer with the $6,000 deductible will have to pay $6,000 in health care costs before the insurance plan pays anything. The consumer with the $12,700 deductible will have to pay $12,700.
Medicare () is an unofficial designation used to refer to the publicly funded, single-payer health care system of Canada. Canada does not have a unified national health care system; instead, the system consists of 13 provincial and territorial health insurance plans that provides universal health care coverage to Canadian citizens, permanent residents, and certain temporary residents. These systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the "Canada Health Act" and the health insurance legislation of the individual provinces and territories.
Prices vary from one pharmacy to another as listed prices determine what the insurance companies will have to pay for the drug. Therefore, patients are rarely expected to pay the high prices listed for each prescription. According to the 2017 consumer reports, it is important to compare prices of various retail pharmacies to get the best deal. Other tips include seeking 90-day prescription when possible, asking for the lowest price when deciding to pay for a medication, asking for generics (refer to "Generics versus Brand-name Products" for more details regarding generic drugs vs. brand-name drugs), comparing insurance plans and talking to your doctor about costs in order to find cheaper alternative(s).
Article 10C of the New York State Public Authorities laws gives the New York State (NYS) County Legislatures the authority to establish public benefit corporations (PBCs) for health in NYS. In 1969, the New York State (NYS) Legislature created the first PBC for health to better manage the public hospitals in New York City. The name of this PBC for health is the New York City Health and Hospitals Corporation (HHC). Since the creation of HHC additional PBCs for health have been created in Westchester, Nassau, and Erie Counties. In 2002, the Albany County comptroller's office submitted the county's Medicaid reform proposal. The county's Medicaid waiver is one of the earliest references to a county long-term care system.
Policies in the United States and Canada either pay off a benefit schedule or pay a percentage of the vet costs (70-100%), after reaching a deductible, depending on the company and the policy. The owner usually pays the amount due to the veterinarian and then sends in the claim form and receives reimbursement, which some companies and policies limit according to their own schedules of necessary and usual charges. For very high bills, some veterinarians allow the owner to put off payment until the insurance claim is processed. Some insurers pay veterinarians directly on behalf of customers. Most American and Canadian policies require the pet owner to submit a request for fees incurred.
A 2008 article in the journal "Health Affairs" suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US. However,
an assessment of the 2006 Dutch health insurance reforms published in Duke University's "Journal of Health Politics, Policy and Law" in 2008 raised concerns. The analysis found that market-based competition in healthcare may not have the advantages over more publicly based single payer models that were originally envisioned for the reforms:
The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. If the patient in the previous example had a $5.00 copay, the physician would be paid $45.00 by the insurance company. The physician is then responsible for collecting the out-of-pocket expense from the patient. If the patient had a $500.00 deductible, the contracted amount of $50.00 would not be paid by the insurance company. Instead, this amount would be the patient's responsibility to pay, and subsequent charges would also be the patient's responsibility, until his expenses totaled $500.00. At that point, the deductible is met, and the insurance would issue payment for future services.
People of lower socioeconomic status are found to be more vulnerable to air pollutant, PM 2.5, due to their location. PM 2.5 is an air pollutant, arising from the blend of power plants, refineries, and diesel engines, among other sources, and this particle penetrates the lungs. Communities of low socioeconomic statuses are frequently concentrated in areas near highways, busy roads, and refineries. Therefore, limiting one's exposure to air pollution in an impoverished environment is nearly impossible. Communities of low socioeconomic status face an unequal access to environmental health services and resources.
NHS England is supporting initiatives to place pharmacists in GP practices in order to improve the management of medication for patients with long term conditions. About 420 million repeat prescriptions are generated in the UK each year — about 200 for each general practitioner each week. In the practice pharmacists can do more Medicine use reviews. By April 2017 there were plans for 1350 practices in England to have access to clinical pharmacists. It is intended to have 1,500 pharmacists in general practice by 2020. NHS England’s announced funding for 180 pharmacists and 60 technicians to work in care homes in March 2018. The cost of medicines in primary care in England in 2017/2018 was £8.87 billion, slightly less than the previous year.
Today, this system is more or less intact. All citizens and legal foreign residents of France are covered by one of these mandatory programs, which continue to be funded by worker participation. However, since 1945, a number of major changes have been introduced. Firstly, the different health care funds (there are five: General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). This regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. Finally, to counter the rise in health care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specialist visits, and which installed a mandatory co-pay of €1 for a doctor visit, €0.50 for each box of medicine prescribed, and a fee of €16–18 per day for hospital stays and for expensive procedures.
When Randy Vogenberg of the Institute for Integrated Healthcare in Massachusetts and a co-leader of the Midwest Business Group initiative, began investigating specialty drugs in 2003, it "wasn't showing up on the radar". By 2009 specialty drugs had started doubling in cost and payers such as employers began to question. Vogenberg observed that by 2014 health care reform had changed the landscape for specialty drugs. There is a shift away from a marketplace based on a predominately clinical perspective, to one that puts economics first and clinical second.
Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals that are classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused (although some are oral medications). They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, in the mid-1990s there were fewer than 30, by 2008 there were 200, and by 2015 there were 300. Drugs are often defined as specialty because their price is much higher than that of non-specialty drugs. Medicare defines any drug for which the negotiated price is $670 per month or more, as a specialty drug which is placed in a specialty tier that requires a higher patient cost sharing. Drugs are also identified as specialty when there is a special handling requirement or the drug is only available via a limited distributions network. By 2015 "specialty medications accounted for one-third of all spending on drugs in the United States, up from 19 percent in 2004 and heading toward 50 percent in the next 10 years", according to IMS Health, which tracks prescriptions. According to a 2010 article in Forbes, specialty drugs for rare diseases became more expensive "than anyone imagined" and their success came "at a time when the traditional drug business of selling medicines to the masses" was "in decline". In 2015 analysis by "The Wall Street Journal" suggested the large premium was due to the perceived value of rare disease treatments which usually are very expensive when compared to treatments for more common diseases.
Progestins in birth control pills are sometimes grouped by generation. While the 19-nortestosterone progestins are consistently grouped into generations, the pregnane progestins that are or have been used in birth control pills are typically omitted from such classifications or are grouped simply as "miscellaneous" or "pregnanes". In any case, CPA has been described as a "first-generation" progestin similarly to closely related progestins like chlormadinone acetate, medroxyprogesterone acetate, and megestrol acetate.
"Charging function addresses" are addresses distributed to each IMS entities and provide a common location for each entity to send charging information. "charging data function" (CDF) addresses are used for offline billing and "Online Charging Function" (OCF) for online billing.IMS-based PES (PSTN Emulation System) provides IP networks services to analog devices. IMS-based PES allows non-IMS devices to appear to IMS as normal SIP users. Analog terminal using standard analog interfaces can connect to IMS-based PES in two ways:
HBO broadcasts its primary and multiplex channels on both Eastern and Pacific Time Zone schedules. The respective coastal feeds of each channel are usually packaged together (though most cable providers only offer the east and west coast feeds of the main HBO channel, as well as HBO2 in some cases), resulting in the difference in local airtimes for a particular movie or program between two geographic locations being three hours at most. The premium film service Cinemax, which is also owned by Time Warner through Home Box Office Inc., operates as a separate service from HBO; although HBO is very frequently sold together in a package with Cinemax, subscribers to one of the services do not necessarily have to subscribe to the other.
Though the Commonwealth government has its own tax laws, Puerto Ricans are also required to pay many kinds of U.S. federal taxes, not including the federal personal income tax for Puerto Rico-sourced income, but only under certain circumstances. In 2009, Puerto Rico paid into the U.S. Treasury. Residents of Puerto Rico pay into Social Security, and are thus eligible for Social Security benefits upon retirement. They are excluded from the Supplemental Security Income (SSI), and the island actually receives a smaller fraction of the Medicaid funding it would receive if it were a U.S. state. Also, Medicare providers receive less-than-full state-like reimbursements for services rendered to beneficiaries in Puerto Rico, even though the latter paid fully into the system.
The Public Affairs Officer (PAO) is responsible for developing a working relationship with reporters and other media representatives, maintaining a robust community relations program, keeping contact with other government agencies, and keeping internal and external publics informed on issues that may affect them. Known as "PAO's" for short, they are expected to coordinate with the appropriate agencies prior to contacting and releasing information to the media on conditions that might result in favorable or unfavorable public reaction, including releases and public statements involving local, regional and national news.
Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. Eligibility for PACE requires that individuals be 55 years old or older, certified by the state to need nursing home-level care, reside near a PACE program, and able to live safely in the community. Services include primary and specialty medical care, nursing, social services, therapies (occupational, physical, speech, recreation, etc.), pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health.
The People's Power Party (PPP) is a political party in Singapore. The party was first registered on 15 May 2015, and was founded on 16 July 2015. The current leader was Goh Meng Seng.
The most common form of hormonal contraception is the combined birth control pill, which contains both estrogen and progestogen. It is typically taken in 28-day cycles, 21 hormonal pills with either a 7-day break from pills, or 7 placebo pills during which the woman menstruates. Although the primary function of the pill is to prevent pregnancy, it may be used to treat some menstrual symptoms and syndromes which affect menstruation, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation). Using the combined birth control pill, it is also possible for a woman to delay or completely eliminate menstrual periods, a practice called menstrual suppression. Some women do this simply for convenience in the short-term, while others prefer to eliminate periods altogether when possible. This can be done either by skipping the placebo pills, or using an extended cycle combined oral contraceptive pill, which were first marketed in the U.S. in the early 2000s.
Just as the more loosely managed PPOs have edged out HMOs, HMOs themselves have also evolved towards less tightly managed models. The first HMOs in the U.S., such as Kaiser Permanente in Oakland, California, and the Health Insurance Plan (HIP) in New York, were "staff-model" HMOs, which owned their own health care facilities and employed the doctors and other health care professionals who staffed them. The name health maintenance organization stems from the idea that the HMO would make it its job to maintain the enrollee's health, rather than merely to treat illnesses. In accordance with this mission, managed care organizations typically cover preventive health care. Within the tightly integrated staff-model HMO, the HMO can develop and disseminate guidelines on cost-effective care, while the enrollee's primary care doctor can act as patient advocate and care coordinator, helping the patient negotiate the complex health care system. Despite a substantial body of research demonstrating that many staff-model HMOs deliver high-quality and cost-effective care, they have steadily lost market share. They have been replaced by more loosely managed networks of providers with whom health plans have negotiated discounted fees. It is common today for a physician or hospital to have contracts with a dozen or more health plans, each with different referral networks, contracts with different diagnostic facilities, and different practice guidelines.
While an APO will show greater levels for higher priced securities and smaller levels for lower priced securities, a PPO calculates changes relative to price. Subsequently, a PPO is preferred when: comparing oscillator values between different securities, especially those with substantially different prices; or comparing oscillator values for the same security at significantly different times, especially a security whose value has changed greatly.
Along with the four PPO plan options administered by Blue Cross Blue Shield of Texas, a part of Health Care Service Corporation, and Medco, there are three health maintenance organization (HMO) options offered under TRS-ActiveCare for the 2011-2012 plan year: FirstCare Health Plans, Scott & White Health Plan, and Valley Baptist Health Plans. These HMO options will provide additional plan choices to the employees of participating entities in areas served by these HMOs. These employees will be able to select TRS-ActiveCare coverage under one of the PPO plans or through the authorized HMO serving their part of the state.
HMSA offers a variety of health plans, including Preferred Provider Organization (PPO) plans and Health Maintenance Organization (HMO) plans.
HMSA offers plans through employers and individual plans for those not eligible through employer groups. 
Some health plans may include supplemental benefit coverage for prescription drugs and dental, vision, and complementary care (acupuncture, chiropractic care and massage therapy).