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.
A
- Age RatingAge-Based Rating, Age-Banded Pricing
- A method of setting insurance premiums that varies price by an enrollee's age, reflecting generally higher costs for older groups.
B
- Bronze PlanBronze Tier Plan, Bronze Metal Plan
- A US Affordable Care Act marketplace plan category with a relatively low actuarial value, around sixty percent, giving lower premiums but higher cost-sharing.
C
- Catastrophic PlanCatastrophic Coverage, Minimum Coverage Plan
- A US Affordable Care Act marketplace plan offering very low premiums with very high deductibles, generally limited to under-thirties or hardship cases.
- COBRA CoverageCOBRA, Continuation Coverage
- A US federal provision letting individuals temporarily continue their employer-sponsored insurance after job loss, typically by paying the full premium themselves.
- Commercial PayerCommercial Insurer, Private Health Insurer
- A private insurance company providing coverage funded through premiums paid by employers or individuals, unlike a public payer such as a government programme.
- Community RatingCommunity-Rated Premium, Uniform Premium Setting
- A method setting premiums that charges all enrollees within a community the same rate, or within narrow limits, regardless of individual risk.
- Contract YearPlan Year, Policy Year
- The defined twelve-month period over which specific insurance plan terms, such as premiums and benefits, remain in effect before renewal.
D
- Death SpiralAdverse-Selection Spiral, Premium Spiral
- A destabilising dynamic in which rising premiums, driven by adverse selection, push healthier enrollees to exit, worsening the cycle further.
E
- Employee ContributionEmployee Premium Share, Worker Contribution
- The portion of health insurance premium costs an employee pays directly, distinct from the portion covered by their employer.
- Employer ContributionEmployer Premium Share, Employer-Paid Portion
- The portion of health insurance premium costs an employer pays on behalf of an employee within an employer-sponsored arrangement.
- Employer PerspectiveEmployer Viewpoint, Employer Cost Perspective
- An analytic viewpoint including only costs and outcomes relevant to an employer, such as premium contributions and productivity losses from absenteeism.
- Experience RatingClaims-Based Rating, Experience-Based Premiums
- A method setting premiums based on the actual historical claims experience of a specific individual or group, rather than a community average.
G
- Gold PlanGold Tier Plan, Gold Metal Tier
- A US Affordable Care Act marketplace plan category with a relatively high actuarial value, around eighty percent, giving higher premiums but lower cost-sharing.
H
- High Deductible Health PlanHDHP, High-Deductible Plan
- A plan with a deductible above a regulatory minimum threshold, giving lower premiums but requiring a larger upfront share of routine costs.
I
- Innovation PremiumNovelty Premium, Innovation Price Premium
- The additional price a manufacturer charges for a genuinely novel treatment relative to existing alternatives, reflecting incremental clinical benefit and development investment.
- Insurance PolicyPolicy Contract, Insurance Contract
- A contractual arrangement in which an individual pays a periodic premium for financial protection against specified future events, up to defined terms.
M
- Medical Loss RatioMLR, Insurer Loss Ratio
- A regulatory measure requiring insurers to spend a minimum percentage of premium revenue on claims and quality improvement, rather than administration or profit.
N
- Narrow NetworkLimited Network, Restricted-Panel Network
- An insurance plan design including a limited number of contracted providers, offering less choice in exchange for typically lower premiums.
P
- 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.
- PremiumInsurance Charge, Coverage Contribution
- The periodic payment, typically monthly, an individual or employer makes to an insurer in exchange for health insurance coverage.
- Premium DesignPremium Structure, Contribution Design
- The methodology an insurer uses to determine premium charges, including rating factors such as age, geography, and rating approach.
- Premium SettingPremium Determination, Rate-Making
- The overall process by which an insurer determines the specific premium amount to charge, incorporating actuarial analysis and regulatory rules.
- Premium SubsidyInsurance Subsidy, Premium Assistance
- Financial assistance provided by a government to reduce health insurance premium costs for eligible individuals or households.
- PrepaymentAdvance Payment, Prepaid Financing
- A financing mechanism in which individuals contribute funds toward future healthcare costs before they are incurred, through taxation or premiums.
- Price PremiumPricing Premium, Value Premium
- The additional amount a manufacturer charges for a treatment relative to an existing comparator, reflecting the treatment's demonstrated incremental clinical benefit.
- Private Health InsurancePHI, Voluntary Health Cover
- Health insurance coverage provided by non-governmental insurers, funded through premiums paid by individuals or employers, unlike government-administered public programmes.
- Private Insurance PremiumCommercial Insurance Premium, Private Cover Premium
- The periodic payment an individual or employer makes to a private insurer in exchange for coverage of specified healthcare costs.
R
- Rate BandRating Tier, Premium Band
- A regulatory range within which an insurer may vary premiums by a specific rating factor, such as age, limiting maximum variation.
- Rate ReviewInsurer Rate Filing, Premium Filing Review
- A regulatory process examining a proposed premium increase for reasonableness before an insurer is permitted to implement it.
- Rate SettingReimbursement Price Determination, Payment Level Setting
- The overall process by which an insurer or regulator determines premium or payment rates for a health insurance product or contract.
- ReinsuranceStop-Loss Cover, Insurer-of-Insurers
- An arrangement in which an insurer transfers a portion of its financial risk to another insurer in exchange for a premium.
- Revenue CollectionRevenue Mobilisation, Domestic Resource Mobilisation
- The process by which a health system raises financial resources, through mechanisms such as general taxation, social insurance, and private premiums.
- Risk PoolInsurance Pool, Pooled Group
- The group whose healthcare costs are collectively financed through a shared insurance arrangement, with premiums covering those who become ill.
- Risk RatingRisk-Based Rating, Actuarial Rating
- A method setting premiums based on an individual's or group's specific assessed risk level, unlike a uniform community rating.
- Risk TransferRisk Shifting, Transfer of Risk
- The process by which one party shifts responsibility for financial risk to another, typically in exchange for a premium or fee.
T
- Targeted Therapy CostCost of Targeted Therapy, Precision Drug Cost
- The expense of cancer treatments targeting a specific molecular tumour feature, generally priced at a premium over conventional chemotherapy.
- Therapeutic Group PremiumReference Group Premium, Therapeutic Reference Premium
- The additional price a treatment commands over the reference price for its therapeutic group under internal reference pricing, requiring the difference paid separately.
U
- UnderwritingRisk Assessment Pricing, Premium Rating
- The process by which an insurer evaluates the risk of a potential policyholder and determines whether to offer coverage and at what price.