Glossary

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Click one of the letters above to be taken to a page of all terms beginning with that letter.

Access: The ease with which a patient can gain entry to or utilize health care in the face of financial, geographical, organizational, cultural and emotional barriers.
Accountability: The state of being answerable for one's actions as a result of taking professional, legal, ethical, administrative, or personal responsibility.
Accreditation: A determination by an authorizing body that an eligible organization, network, program, group, or individual complies with applicable standards.
ACE Inhibitor: A drug used to treat high blood pressure and congestive heart failure.
ACOVE: see RAND Assessing Care of Vulnerable Elders
Activities of Daily Living: The basic personal activities (for example, bathing, dressing) that are used as standards for a patient to perform independently of home health, nursing assistance, or more intensive health services.
Actuarial value: The proportion of medical expenses an insurance plan is expected to cover; an actuarial value of 100 means that a plan would pay all medical expenses.
Actuarially fair: When an insurance premium is equal to the cost to insure a population.
Acute care: Health care, often necessary for only a short period of time, in which a patient is treated for a specific illness or injury. Such care is often delivered in the hospital setting by specialized personnel and may involve intensive and/or emergency care.
Acute myocardial infarction: Death of tissue in the heart muscle resulting from insufficient blood supply to the heart, sometimes leading to cardiac arrest; also referred to as a heart attack, coronary or MI (myocardial infarction).
Adherence: — see compliance
Administrative data: Information that is collected, processed, and stored in automated information systems, including enrollment or eligibility, claims and encounters information. The claims and encounters may be for services at hospitals and other health care facilities, professional services, prescription-drug services, laboratory services, etc.
Administrative overhead: Costs necessary to carry out the functions of the organization but not directly associated with providing clinical services. These may include: transaction-related activities (claims billing and processing); general management activities (e.g., contracting); selling and marketing (e.g., insurance underwriting, provider credentialing); and compliance with regulatory mandates (e.g., licensure, preparation for accreditation).
Administrative waste: The portion of administrative overhead that does not add value or is not necessary to effectively execute business functions and therefore might be reduced or eliminated to improve efficiency.
Admission: Formal acceptance of a patient into care by a hospital or other health care organization, agency or practice.
Adverse event: Any injury caused by medical care, even if there is no permanent effect on the patient. Identifying something as an adverse event does not necessarily imply error, negligence, or poor quality care. It simply indicates that an undesirable clinical outcome resulted from some aspect of diagnosis or therapy, not an underlying disease process.
Adverse selection: The enrollment (in a health plan) of a disproportionate number of individuals with the potential for higher utilization of health services (and thus higher costs) than the average population, so that premiums do not cover the costs of providing services.
Aexcel High Performance Network: Aetna's network of specialist physicians who meet certain thresholds for clinical performance and cost efficiency.
Agency for Healthcare Research and Quality: The health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of its sister federal agency, the National Institutes of Health (NIH). AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access.
Aggregate measure: Generally refers to a summary measure of performance (e.g., quality of medical care, patient experience with care) that is derived by adding together the performance on individual measures.
Alternative Dispute Resolution: Methods to settle disputes or claims other than through the litigation; examples include arbitration and mediation. Settlement of claims may be binding or non-binding.
Ambulatory care: Also referred to as outpatient care. Health care services that are rendered on an outpatient basis, or to patients who are not confined overnight in a health care institution. Such care may be provided within a doctor's office, a medical clinic, an acute hospital, or a freestanding ambulatory surgery center.
Ambulatory Care Sensitive Condition: A medical condition for which appropriate outpatient care, in many cases, should prevent the need for hospitalization.
Ambulatory Payment Classification: The method to government uses to pay facilities for outpatient services under the Medicare Outpatient Prospective Payment System.
America's Health Insurance Plans: A national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. AHIP's members include those that provide medical expense insurance, long-term care insurance, disability income insurance, dental insurance, supplemental insurance, stop-loss insurance and reinsurance to consumers, employers, and public purchasers.17
American Health Information Community: A federally chartered commission made up of leaders from public and private health sectors, formed in 2005 to provide recommendations on how to make health records digital and interoperable and to ensure that the privacy and security of those records are protected
AmeriCare Health Act of 2006: A bill introduced in Congress that would provide universal coverage by building on Medicare and employer-based health coverage. AmeriCare would provide prevention, physician and hospital benefits as well as prescription drug benefits, and would impose a limit on out-of-pocket costs. Efficiencies would be achieved by utilizing Medicare's administrative infrastructure.
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: A large 8-year study funded by the National Institutes of Health (NIH) and begun in 1994. The study had two parts: one compared the effects of a diuretic with three newer, more costly blood pressure-lowering drugs; the other compared the effects of a cholesterol-lowering statin and diet with usual care (which included a diet but no cholesterol-lowering drug).
Appropriate: The degree to which the treatment provided is relevant to or proper for an individual's clinical needs, given the current state of knowledge.
Armed Forces Health Longitudinal Technology Application: The electronic medical and dental record covering all of those entitled to U.S. Department of Defense military health care.
Assisted living: A system of housing and limited care that is designed for senior citizens who need some assistance with day-to-day activities but are not sufficiently incapacitated to require care in a nursing home.
Association Health Plan: An arrangement for purchasing small-group insurance, limited in participation to members of a trade or professional association.
Asymmetric information: This refers to the case when, in a transaction, the buyer and seller do not have access to the same amount or quality of information. The health care market is characterized by many instances of information asymmetry.

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