Dictionary
The Dictionary provides concise definitions of health economics terms, arranged alphabetically for quick reference. Use it to understand unfamiliar terminology or confirm the meaning of a specific term.
M
- Money-Back GuaranteeRefund Guarantee, Money-Back Scheme
- An outcomes-based agreement in which a manufacturer refunds some or all of a treatment's cost if the patient does not achieve a predefined outcome.
- Monopoly PricingMonopolist Pricing, Single-Seller Pricing
- The pricing behaviour of a firm with monopoly power, setting price above marginal cost to maximise profit and reduce quantity supplied.
- Moral HazardHidden Action, Post-Contract Opportunism
- Moral hazard occurs when protection from the consequences of an action changes a person’s behaviour because some resulting costs or risks are borne by another party.
- Multi-Objective OptimisationMOO, Pareto Optimisation
- An optimisation approach used when a decision involves competing objectives, such as maximising benefit while minimising cost, producing a set of trade-off solutions.
- Multi-Sectoral AnalysisCross-Sectoral Analysis, Intersectoral Evaluation
- An economic evaluation considering costs and benefits arising across more than one sector, such as health, education, and social care.
- Multi-Way Threshold AnalysisMultiway Threshold, Joint Threshold Analysis
- A sensitivity analysis identifying the combinations of two or more parameter values at which a model's conclusion, such as cost-effectiveness, would change.
- Myocardial Infarction EconomicsHeart Attack Economics, AMI Economics
- The application of health economic evaluation to heart attack diagnosis and treatment, covering emergency reperfusion therapy, medication, and rehabilitation costs.
N
- National PerspectiveCountry-Level Perspective, National-Level Perspective
- An analytic viewpoint considering costs and outcomes relevant to an entire country's health system, rather than a single institution, region, or payer.
- Negative RecommendationDo-Not-Reimburse Recommendation, Rejection
- A body's formal decision not to recommend a technology for funding, based on unacceptable cost-effectiveness at the reviewed price.
- Net Benefit ApproachNB Framework, Money-Metric Evaluation
- A framework for economic evaluation that converts health outcomes into money at a set value per unit of effect, then subtracts cost.
- Net Health BenefitNHB, Incremental Health Benefit
- A summary measure expressing an intervention's value in health units, converting incremental cost into health forgone and subtracting it from health gained.
- Net Monetary BenefitNMB, Money-Valued Benefit
- A summary measure expressing an intervention's value in money, converting its incremental health effect into cash at a set threshold and subtracting incremental cost.
- Network DesignNetwork Configuration, Plan Network Build
- The process of selecting and contracting with providers for a plan's network, balancing cost, quality, and geographic coverage.
- Network ReferralIn-Plan Referral, Directed Referral
- A referral from a provider to another within their contracted insurance network, generally resulting in lower patient cost-sharing.
- Non-Dominated AlternativeEfficient Option, Frontier Option
- An intervention on the cost-effectiveness frontier, meaning no other option or combination of options is both less costly and more effective.
- Non-Preferred DrugNon-Formulary Drug, Excluded Drug
- A medication assigned to a higher-cost formulary tier, typically with greater patient cost-sharing than a preferred alternative, to encourage lower-cost use.
- Northwest QuadrantNW Quadrant, Dominated Quadrant
- The region of the cost-effectiveness plane where a new intervention is both more costly and less effective than its comparator.
O
- Obsolete TechnologyOutdated Technology, Superseded Technology
- A technology superseded by a more effective, safer, or more cost-effective alternative, such that its continued routine use is inappropriate.
- Oncology Value FrameworkASCO Value Framework, ESMO-MCBS
- A structured tool from professional oncology societies combining clinical benefit, toxicity, and cost into a single comparative score for assessing treatment value.
- Optimal Sample SizeENBS-Based Sample Size, Efficient Sample Size Choice
- A study sample size selected to meet a stated design objective, such as adequate power or precision, or to maximise the expected value of information after accounting for research costs and decision delays.
- Optimized RecommendationOptimised Recommendation, Restricted Positive Recommendation
- A decision recommending a technology for funding only within a narrower patient subgroup than its full licensed population, typically the most cost-effective subgroup.
- Out-of-NetworkOON, Out-of-Plan Provider
- A designation for providers without a contractual agreement with a specific plan, typically resulting in higher cost-sharing or no coverage.
- Out-of-Network ReferralOON Referral, External Referral
- A referral to a provider without a contractual relationship with the patient's insurance plan, typically resulting in higher cost-sharing or no coverage.
- Out-of-Pocket MaximumOOP Maximum, Maximum Out-of-Pocket
- The highest total amount an insured person will pay for covered costs within a period, beyond which the plan covers everything further.
- Out-of-Pocket PaymentOOP Payment, Direct Patient Payment
- A general term for healthcare spending paid directly by a patient, rather than through insurance, covering cost-sharing and uncovered services.
- Outcome StructureOutcome Model Structure, Results-Pathway Architecture
- The way a decision-analytic model links its outcomes, including how intermediate clinical events translate into measures such as QALYs and total cost.
- Outcome-Based BudgetResults-Based Budget, Outcome-Linked Budget
- A budgeting approach that allocates funds according to expected or achieved health outcomes rather than historical spending or input costs.
- Output InterfaceResults Interface, Model Results Panel
- The component of a health economic model that presents its results, such as cost-effectiveness ratios, in a format accessible to users.
P
- Parameter InputModel Input Value, Entered Value
- A specific numerical value or probability distribution entered into a decision-analytic model to represent a required clinical, cost, or utility quantity.
- Partial Economic EvaluationPartial Evaluation, Incomplete Economic Evaluation
- A study examining either the costs or the outcomes of an intervention, or both without comparison to an alternative, short of a full economic evaluation.
- Patient Access SchemePAS, Confidential Access Scheme
- A managed entry agreement, most associated with the UK, offering a discount to improve a treatment's cost-effectiveness enough to secure reimbursement.
- Patient Family PerspectivePatient-and-Family Perspective, Carer Perspective
- An analytic viewpoint including costs and outcomes experienced by a patient's family, such as informal caregiving time and lost income, alongside the patient's own.
- Patient PerspectivePatient Viewpoint, Patient-Level Perspective
- An analytic viewpoint including only costs and outcomes directly experienced by the patient, such as out-of-pocket expenses and personal time costs.
- Payback PeriodRecoupment Period, Break-Even Time
- The length of time required for the cumulative cash inflows from an investment to equal its initial cost.
- Payer PerspectivePayer Viewpoint, Insurer Perspective
- An analytic viewpoint including only costs and outcomes relevant to a specific healthcare payer, such as an insurer or government health programme.
- Payer Value MessagePayer-Focused Value Message, Reimbursement Value Story
- A concise statement summarising a technology's value specifically framed to address payer priorities, such as budget impact and cost-effectiveness.
- Payment Adjustment FactorBase-Rate Multiplier, Rate Adjuster
- A numerical multiplier applied to a base payment rate to account for specific circumstances affecting the cost of care, such as geographic wage differences.
- Payment Rate SettingPayment Rate Determination, Tariff Setting
- The process by which a payer determines reimbursement for a service or payment category, incorporating resource cost, market rates, and policy goals.
- PayoffGame Reward, Strategy Outcome
- The value, such as cost, outcome, or utility, associated with a particular pathway or outcome within a decision-analytic or game-theoretic model.
- Pharmaceutical EconomicsPharma Economics, Medicines Economics
- The broad application of economic analysis to the pharmaceutical industry, covering drug development costs, pricing strategy, market competition, and individual drug evaluation.
- Pharmacoeconomic ModelPE Model, Pharmacoeconomic Evaluation Model
- A decision-analytic model built specifically to evaluate the cost and outcomes of pharmaceutical treatments, typically supporting pricing and reimbursement decisions.
- Pharmacy-Based Risk ScorePharmacy Risk Score, Rx-Based Risk Adjustment
- A numerical estimate of expected future healthcare costs calculated using prescription drug utilisation patterns as an indicator of health status.
- Piggyback EvaluationAlongside-Trial Evaluation, Trial-Piggybacked CEA
- An economic evaluation conducted by collecting cost and outcome data alongside an existing clinical trial designed primarily for another purpose.
- Pigouvian TaxCorrective Tax, Externality Tax
- A tax on an activity that generates negative externalities, set in principle equal to the external cost not borne by the private decision-maker.
- Plan DesignCoverage Design, Benefit Structure Design
- The overall set of decisions determining a plan's covered benefits, cost-sharing structure, provider network, and utilisation management features.
- Platinum PlanPlatinum Tier, Platinum Metal Level
- A US Affordable Care Act marketplace plan category with the highest standard actuarial value, around ninety percent, giving the highest premiums but lowest cost-sharing.
- Point of Service PlanPOS Plan, Point-of-Service Insurance
- A managed care plan combining HMO and PPO features, requiring a primary care provider while still allowing costlier out-of-network care.
- Policy Option AssessmentOption Appraisal, Policy Alternatives Assessment
- The systematic evaluation of alternative approaches to a health policy problem, comparing options across criteria such as cost and equity.
- Positive RecommendationFavourable Recommendation, Recommend-For Decision
- A body's formal decision to recommend a technology for funding, based on acceptable cost-effectiveness at the reviewed price.
- Practice Expense RVUPE RVU, Overhead Relative Value Unit
- A US Medicare relative value component reflecting the overhead costs of operating a practice, such as staff and office space, attributable to a service.