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A complete list of references.
Glossary entry for A:
| Acceptability |
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| Core definition: | Degree to which a service meets the cultural needs and standards of a community. This in turn will affect utilisation of that service. |
| Source: | Witter, 1997. |
| Example/s: | A family planning service staffed only by male doctors may not be acceptable to a Moslem community. |
| Accessibility of health care |
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| Core definition: | A measure of the proportion of a population that reaches appropriate health services. |
| Source: | WHO, 1998. |
| Notes: | Financial accessibility measure the extent to which people are able to pay for care, usually measured through a community-based willingness and ability to pay survey; Geographical accessibility measures the extent to which services are available and accessible to the population. It is, of course, linked to the distribution of infrastructure in a given region but also to the actual offering of these services at these facilities. Geographical accessibility will vary according to local means of transportation, as well as the local topography; Cultural accessibility considers whether access to health services is impeded by cultural taboos. Three examples are provided: (i) can women use reproductive health services if all the physicians in the facility are male? (ii) will persons who belong to an ethnic minority use services that are staffed by the majority population? (iii) will persons use health services for processes that are considered natural, that is without the need for health intervention (such as pregnancy?) (WHO, 2000). |
| Example/s: | The community´s accessibility of health care is very poor, as they are situated far away from any health care utility and there are limited community services that attend to the major health care problems of the population. |
| Accountability |
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| Core definition: | The obligation to disclose periodically, in adequate detail and consistent form, to all directly and indirectly responsible or properly interested parties, the purposes, principles, procedures, relationships, results, incomes, and expenditures involved in any activity, enterprise, or assignment so that they can be evaluated by the interested parties. |
| Source: | USAID, 1999. |
| Supplementary definition: | “Report cards” on managed care plan performance are an example of accountability in health care (USAID, 1999) |
| Example/s: | The decentralized system contained many checks and balances and there was genuine accountability, with local level general directors making monthly accounts to the regional level on expenditures and activities. |
| Accreditation also, see Licensing |
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| Core definition: | The process by which an authorized agency or organization evaluates and recognises an institution or an individual according to a set of “standards” describing the structures and processes that contribute to desirable patient outcomes. |
| Source: | modified WHO, 1998a. |
| Notes: | As opposed to * licensing of health care facilities which is usually mandatory and government-imposed, accreditation is usually voluntary and mostly administered by non-governmental bodies. Central to accreditation are two features: the principle of external review and the use of standards. |
| Example/s: | While the hospital continued to be licensed, it failed to meet the accreditation standards when the group of experts came to evaluate its facilities. Therefore, the major sickness fund in the area terminated its contract with the hospital. |
| Acute care (short-stay), see Hospital |
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| Core definition: | Hospitals with an average length of stay of 30 days or less. |
| Source: | WHO, 2000a. |
| Example/s: | As long-term care hospitals were in short supply, acute care hospitals were used inappropriately. |
| Adequacy, see Appropriateness |
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| Core definition: | Application of measures, technologies, and resources which are qualitatively and quantitatively sufficient for achieving the desired goal. |
| Source: | USAID, 1999. |
| Notes: | Adequacy and appropriateness are often used interchangeably, although there is a slightly different connotation: when one talks about whether care is adequate there is a tendency to mean “sufficient,” which is different from the connotation of appropriate as meaning the “right thing.” |
| Example/s: | There were concerns about adequacy of care, because even though qualified health care personnel were available, many dispensaries were lacking necessary materials for the provision of basic health care services. |
| Administered Prices, see Price |
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| Adverse selection, in contrast to Cream skimming |
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| Core definition: | A situation where individuals are able to purchase insurance at rates which are below actuarially fair rates, because information known to them is not available to insurers (asymmetric information). |
| Source: | Witter, 1997. |
| Supplementary definition: | A process that occurs when individuals with different expected losses are charged the same premium, whereby those with low expected losses drop out of the insurance pool, leaving only individuals with high expected losses. Adverse selection can make it difficult to sustain private insurance markets (World Bank, 2000). Some population parameter, such as age (e.g., a larger number of persons age 65 or older in proportion to younger persons), that increases the potential for higher utilization than budgeted and increases costs above those covered by the capitation rate (Shouldice, 1991). |
| Example/s: | Many private insurers ended up going bankrupt due to adverse selection, as subscribers mainly consisted of the sick and elderly population.
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| Affordability |
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| Core definition: | Extent to which the intended clients of a service can pay for it. |
| Source: | Witter, 1997. |
| Notes: | This will depend on their income distribution, the cost of services and the financing mechanism (e.g. whether risks are pooled; whether exemptions exist for the low-paid etc.). |
| Example/s: | Subsidized coverage for dental care, which was not previously covered by the public health service, increased affordability for these services a great deal. |
| Agency Principle |
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| Core definition: | The process of having one party (the agent) make decisions on behalf of another (the principal). |
| Source: | Getzen, 1997. |
| Example/s: | The physician/patient relationship is very much an example of the agency principle, as the physician has access to and an understanding of information that the patient does not have, and thus, makes decisions on his/her behalf.
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| Ambulatory care |
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| Core definition: | All types of health services provided to patients who are not confined to an institutional bed as inpatients during the time services are rendered. |
| Source: | USAID, 1999. |
| Notes: | Ambulatory care delivered in institutions which also deliver inpatient care is usually called “outpatient care.” |
| Supplementary definition: | Ambulatory care services are provided in many settings ranging from physicians’ offices to freestanding ambulatory surgical facilities to cardiac catheterisation centres. In some applications, the term does not include emergency services provided in tertiary hospitals (USAID, 1999). |
| Example/s: | Inpatient care is overused and ambulatory care underused, although an increased focus on strengthening health service provision in outpatient settings will hopefully change the current tendency towards hospital care. |
| Appropriate(ness) |
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| Core definition: | If an expected health benefit exceeds the expected negative consequences by a large enough margin to justify performing the procedure rather than other alternatives. |
| Source: | Busse, 1998 (from Herrin et al., 1997). |
| Example/s: | While CT scanning of the spine is appropriate if back pain starts suddenly after an accident, it is inappropriate if the back pain is chronic. |
| Availability |
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| Core definition: | Identifies the presence or absence of needed health care services. |
| Source: | USAID, 1999. |
| Example/s: | Since the primary health care reform, the availability of primary health care services is very good throughout the country: thanks to financial incentives provided to providers for relocating in remote areas, all health care dispensaries have a general practitioner, and all facilities are required to offer a basic package of services. |
| Average length of stay |
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| Core definition: | Average length of stay is computed by dividing the (total) number of days in inpatient or acute care institutions by the number of discharges (or admissions). |
| Source: | OECD, 2000a. |
| Notes: | Whether the day of admission and the day of discharge are counted as one (i.e. the nights are actually counted) or two, differs among countries. This may not only lead to a difference of one day but to an even larger difference as in the first instance, * day cases are automatically excluded, while in the latter they may be counted as 1-day stays. Which system is used, is not always reported and international comparisons should therefore treated with caution. |
| Example/s: | Average length of stay for inpatient care has been steadily decreasing thanks to improved outpatient care at community level, as well as efforts to better coordinate social and health services. |
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