Glossary |
Our glossary of terms explains the jargon and defines the common acronyms you will come across at Health Care Reform Plans. Please email us at editor@reformplans.com to make comments or with suggestions about the Glossary.
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| A third-party payer (or payor) system | A third-party payer (or payor) system is an arrangement in which an individual or employer pays health insurance premiums to a third party (an insurer), which then pays for approved health services. Opponents of the third-party payer system claim that because consumers are not paying their own bills, they disregard costs and do not "shop" wisely for health care services.
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| Alternative healthcare delivery | Alternative healthcare delivery is the delivery of healthcare at places other than doctors’ offices, hospitals, and medical centers--for example, the delivery of care at retail clinics. (See Retail healthcare clinics.)
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| Best practices | Best practices are the methods and processes that are most effective in delivering successful patient care. Best practices are also defined as the most efficient ways of accomplishing a task, based on a series of proven procedures
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| Biogenerics | Biogenerics (also called follow-on biologics) are generic (non-brand-name, nonproprietary) versions of biotechnology drugs. The United States Food and Drug Administration is trying to establish a set of procedures for the approval of biogenerics, because experts agree that it is much more difficult to exactly copy a biotechnology drug than traditional drugs. If a safe and fair official pathway for biogenerics can be developed, these drugs will be much less expensive than the originals that they are copying. But there is much debate about exactly how much money biogenerics will save the health care system. (See Food and Drug Administration [FDA].)
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| Catastrophic costs | Catastrophic costs are medical costs that add up to more than a patient can pay out-of-pocket. Typically, these are costs related to sudden, unexpected illnesses, such as cancer, an appendectomy, or injuries sustained in a car crash. The American Academy of Pediatrics (AAP) defines “catastrophic costs” as those that reach a maximum of 10% of a family’s annual adjusted gross income. Some health insurance policies cover only catastraophic costs. Such insurance is usually less expensive than comprehensive health insurance, and does not cover things like routine doctors' visits or visits to the emergency room for minor injuries or illnesses. Such policies are particularly popular among young healthy people who are only concerned about large unexpected health-related costs.
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| Centers for Medicare & Medicaid Services | Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the U.S. Department of Health and Human Services. CMS administers the Medicare program, works with states to administer Medicaid, sets certain standards for health insurance and long-term care facilities, and works toward simplifying the Health Insurance Portability and Accountability Act of 1996 (HIPAA), among other responsibilities. (See cms.hhs.gov.) (See Medicare and Medicaid.)
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| Chronic Care Coordination | Chronic Care Coordination is a Medicare benefit guaranteed under the Geriatric Assessment and Chronic Care Coordination Act of 2007. The Act requires that a senior patient receive a comprehensive evaluation and plan for staying healthy as well as coordinated medical care that addresses the individual’s multiple chronic conditions. Certain presidential candidates, including Hillary Clinton and John Edwards, would like to see chronic care coordination expanded and emphasized through federal mandates. Other politicians and interest groups also believe it is a priority, but that it must be expanded through disease management initiatives led by insurers, drug manufacturers, and/or providers.
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| Chronic disease management | Chronic disease management (See Disease management.)
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| Chronic diseases | Chronic diseases are diseases that persist—lasting three months or more, according to the U.S. National Center for Health Statistics. They include heart disease, cancer, and diabetes, diseases that cause 70% of all deaths in the United States and account for about 75% of the nation's $1.4 trillion annual bill, according to the Centers for Disease Control and Prevention. (See cdc.gov.) These diseases are costly in part because the patients usually have multiple conditions (making treatment more challenging), patients often have difficulty complying with doctors' orders, and chronic disease treatment is often poorly coordinated.
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| Commonwealth Fund | The Commonwealth Fund is a private foundation whose goal is to improve the U.S. healthcare system so that it offers, according to its website, “better access, improved quality, and greater efficiency,” especially for “low-income people, the uninsured, minority Americans, young children, and elderly adults.” The foundation supports research and offers grants to improve healthcare policy and practice in the United States and around the world. (See commonwealthfund.org.)
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