Glossary
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- Data warehouse
- A central repository of electronically stored data from multiple administrative systems. Centralized storage facilitates analysis and reporting.
- Decision support
- Any system for advising or providing guidance about a particular clinical decision at the point of care. Typically, such a system responds to "triggers" or "flags," such as specific diagnoses, laboratory results, medication choices, or complex combinations of such parameters, and provides information or recommendations directly relevant to a specific patient encounter. (See also computerized decision support).
- Deductible
- The fixed amount of covered health care expenses (typically $100-500) that an insured person must pay before benefits are paid by the insurer.
- Defensive medicine
- Diagnostic or therapeutic measures conducted primarily as a safeguard against possible subsequent malpractice liability.
- Deficit Reduction Act of 2005
- The Deficit Reduction Act of 2005, Pub. Law No. 109-171 (2005) included a provision that the Centers for Medicare & Medicaid Services (CMS) develop a plan for implementing value-based purchasing for Medicare hospital services, beginning in Fiscal Year 2009.
- Demand curve
- The amount that consumers are willing to purchase given a specific price. In economics, the demand curve can be depicted as a graph with price on the vertical axis and quantity demanded on the horizontal axis, showing that consumers are willing to purchase more of a commodity as the price falls, all else being equal. It is used to estimate the behavior of consumers in a competitive market.
- Demonstration
- An experimental health care program, organization or system that measures important data (such as costs per unit of service, rates of use by patients, and clinical outcomes). The aim of such an initiative is to determine (and, if necessary, improve) the efficiency, effectiveness, and other dimensions of performance and quality before a system, program, or organization is implemented more broadly.
- Determinant(s) of health
- The broad range of factors that influence health and generally include individual behavior, environmental influences, and genetic predisposition.
- Diagnosis-Related Group
- A Yale University-derived system of classification for inpatient hospital services. This system is used as a financing mechanism to reimburse hospitals. For example, the Center for Medicare & Medicaid Services (CMS) pays for acute care hospital inpatient stays based on prospectively set rates. Each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
- Direct costs
- Costs that can be attributed to a particular product, activity, or program.
- Discharge
- The formal release of a patient from a physician's care or from a hospital.
- Disease Management
- An organized, proactive approach to health care for members of a population with a specific disease or combination of diseases or to prevent the development of diseases. The aim of DM is to increase the delivery of appropriate care to enrolled patients. Improved care is expected to lead to better health outcomes and lower costs.
- Disproportionate Share Hospital
- A hospital with a disproportionately large share of low-income patients. Medicare inpatient hospital payments are adjusted for this added burden using a complex statutory formula. Federal law also requires state Medicaid programs to take into account the situation of hospitals that serve a disproportionate number of low-income patients with special needs when determining payment rates for inpatient hospital care.
- Disutility of insurance
- When individuals do not value insurance, remaining uninsured even if they have access to insurance.
- Doctor of Osteopathic Medicine
- A physician certified in the practice of osteopathic medicine, in contrast to a physician who is certified in allopathic medicine (M.D.). Both types of physicians are licensed to prescribe medication and practice in all specialties including surgery.
- Dose-response
- Of, relating to, or graphing the pattern of physiological response to varied dosage (as of a drug or radiation), in which there is typically little or no effect at very low dosages and a toxic or unchanging effect at high dosages, with the maximum increase in effect somewhere between the extremes.
- Doughnut hole
- Coverage gaps between the lower and upper tiers of insurance coverage, such as with Medicare Part D prescription drug benefits. Once total costs exceed $2,400 (at which point beneficiaries' out-of-pocket costs are just under $800), beneficiaries are again responsible for paying 100 percent of their drug costs until they reach the out-of-pocket maximum of $3,850.
- Drug Effectiveness Review Project
- A collaboration of public and private organizations, including 13 states, to provide systematic evidence-based reviews of the comparative effectiveness and safety of drugs in many widely-used drug classes and to apply the findings to inform public policy and related activities.
- Dual-eligible(s)
- Persons entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid.