Health Policy and Management Glossary

A network of providers that jointly accepts responsibility for the quality and total cost of care for a defined patient population, sharing savings when benchmarks are met.

A situation in which higher-risk individuals are more likely to purchase insurance, leading to higher average costs in the risk pool and potential market instability.

Comprehensive U.S. health reform law (2010) that expanded coverage through Medicaid expansion, Health Insurance Marketplaces, individual mandates, and insurance market regulations.

A health system model in which the government provides and finances health care through general taxation, with government-owned facilities and salaried providers.

A health system model financed through mandatory employer-employee payroll contributions to nonprofit sickness funds, with private providers.

A payment method in which providers receive a fixed amount per enrolled patient per time period, regardless of services delivered.

An economic evaluation comparing the costs and health outcomes of alternative interventions, typically reported as cost per QALY gained.

A patient classification system that groups hospital cases by diagnosis and procedure to determine prospective payment amounts.

The Emergency Medical Treatment and Labor Act requiring hospitals to provide emergency medical screening and stabilization regardless of a patient's ability to pay.

A payment model in which providers are reimbursed for each individual service or procedure performed.

Preventable differences in health outcomes and their determinants experienced by socially disadvantaged populations.

The attainment of the highest level of health for all people, requiring the removal of systemic obstacles to fair health opportunities.

An organized platform, established under the ACA, where individuals and small businesses can compare and purchase standardized health insurance plans.

The Health Insurance Portability and Accountability Act establishing national standards for the protection of individually identifiable health information.

A health care delivery approach that integrates financing and service delivery to control costs and improve quality through provider networks, utilization management, and gatekeeping.

A joint federal-state health insurance program providing coverage to eligible low-income individuals and families in the United States.

A U.S. federal health insurance program primarily covering individuals aged 65 and older, as well as certain younger people with disabilities.

The increased use of health services by insured individuals because they do not bear the full cost of care.

Plan-Do-Study-Act: an iterative quality improvement method for testing changes on a small scale before broader implementation.

The health outcomes of a defined group of individuals, including the distribution of outcomes within the group.

A measure of disease burden that accounts for both the quantity and quality of life lived, used in cost-effectiveness analysis.

A statistical methodology used to account for differences in patient health status when comparing outcomes or setting payment rates across providers or plans.

A health financing arrangement in which a single public entity pays for health care services on behalf of the entire population, funded through taxation.

A framework from the Institute for Healthcare Improvement pursuing three simultaneous goals: better population health, better patient experience, and lower per capita cost.

A delivery and payment model that links provider reimbursement to the quality and efficiency of care delivered rather than to service volume.