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
- Medicinal ProductTermMedicine, Pharmaceutical Product, Drug Product
- In health economics, a manufactured product containing one or more active substances used to treat, prevent, or diagnose disease, and the unit whose price, value, and reimbursement pharmacoeconomic evaluation assesses.
N
- National HTA AgencyTermNational HTA Body, HTA Agency
- A government or government-mandated organisation conducting assessment to inform coverage, pricing, and reimbursement decisions within a country's health system.
- NCPETermNational Centre for Pharmacoeconomics, Irish HTA Agency
- The National Centre for Pharmacoeconomics, Ireland's body conducting pharmaceutical assessment to inform national reimbursement decisions.
- Negative ListTermDelisted Formulary, Non-Reimbursed List
- A list of medications or services explicitly excluded from reimbursement coverage, unlike a positive list specifying what is covered.
O
- Out-of-Pocket CostConceptOOP Cost, Patient Out-of-Pocket Spending
- The amount a patient or household pays directly for health care without third-party reimbursement, including applicable cost sharing and uncovered care.
- Outcomes-Based PaymentTermPay-for-Outcomes, Results-Based Payment
- A reimbursement arrangement in which some or all of a manufacturer's payment depends on the treatment achieving a predefined clinical outcome in actual practice.
P
- Patient Access SchemeTermPAS, 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.
- Pay-for-PerformanceTermP4P, Performance-Related Pay
- A methodology linking a portion of provider reimbursement directly to measured performance on quality, efficiency, or outcome metrics, rather than volume alone.
- Payment by ResultsTermPbR, Tariff-Based Payment
- A reimbursement arrangement linking a manufacturer's payment explicitly to specific, predefined clinical results achieved by patients, rather than paying regardless of outcome.
- Payment Rate SettingTermPayment 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.
- Performance-Based AgreementTermPBA, Performance Agreement
- A contractual arrangement in which pricing or continued reimbursement depends on a treatment achieving specified performance criteria in real-world use.
- Pharmaceutical PolicyTermDrug Policy, Medicines Policy
- Government or organisational policy governing pharmaceutical development, approval, pricing, and use, covering regulatory standards and reimbursement criteria.
- Pharmacoeconomic ModelTermPE 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.
- Pricing DossierTermPrice Justification Dossier, Value-and-Price File
- A comprehensive document supporting pricing and reimbursement discussions with a payer or assessment body, including clinical, economic, and comparative pricing evidence.
- Product ModelTermMultiplicative Model, Product-Form Structure
- A decision-analytic model supporting the commercial and reimbursement strategy for a specific pharmaceutical or device, maintained by its manufacturer over the product's life.
- Prospective PaymentTermPPS, Fixed Prospective Rate
- A methodology establishing a fixed reimbursement in advance of care delivery, based on diagnosis or procedure type, rather than actual incurred costs.
R
- Reference-Based PricingTermRBP, Reference Price Cap
- A general term for policies anchoring a drug's price or reimbursement to a defined reference point, such as a similar drug or another country.
- Registry RequirementTermMandatory Registry Enrolment, Post-Approval Data Duty
- A condition attached to a conditional reimbursement decision, mandating patients be enrolled in a data collection registry to generate further evidence.
- Resource-Based Relative ValueConceptRBRVS, Resource-Based Payment Scale
- A methodology determining physician reimbursement based on a standardised measure of resources required, incorporating work, practice expense, and malpractice risk.
- Resource-Based ValueTermResource-Cost Value, Input-Based Value
- A payment concept tying reimbursement to actual resources, such as time and skill, required for a service, rather than historical charges.
T
- Therapeutic Reference PricingTermTherapeutic Class Reference Pricing, Class-Based Reference Pricing
- A policy grouping drugs believed to produce similar therapeutic effects and setting one reference reimbursement level, encouraging use of the most cost-effective option.
U
- UpcodingTermCode Inflation, Overcoding
- A billing practice assigning a higher-level, more complex code than the clinical documentation actually supports, inappropriately increasing reimbursement.
- Usual Customary ReasonableTermUCR, UCR Charge
- A methodology insurers use to determine reimbursement for out-of-network care, based on typical charges for similar services in a geographic area.
V
- Value-Based PaymentTermVBP, Outcome-Linked Payment
- A general term for arrangements tying provider reimbursement to quality, efficiency, or outcomes, rather than volume alone under fee-for-service.