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.

1–50 of 74 terms matching “Reimbursement”

A

AIFATermAgenzia Italiana del Farmaco, Italian Medicines Agency
The Italian Medicines Agency, the national regulatory and health technology assessment body responsible for drug approval, pricing, and reimbursement in Italy.
Annuity PaymentConceptInstalment Payment, Installment Payment, Amortised Payment
A reimbursement structure paying a treatment's total cost to the manufacturer in a series of instalments over time, rather than as a single upfront sum.
Average Sales PriceTermMedicare Net Price, ASP Benchmark
A US Medicare pricing benchmark determining reimbursement for physician-administered drugs, based on actual sales prices net of discounts and rebates.

B

Benefit AssessmentTermClinical Benefit Evaluation, Added Benefit Evaluation
A formal evaluation of the clinical benefit a treatment provides relative to an appropriate comparator, used to inform reimbursement and pricing decisions.
Benefit RatingTermBenefit Grade, Clinical Value Grade
A formal classification reflecting a technology's clinical benefit magnitude relative to existing options, used to inform pricing and reimbursement.

C

ClaimTermReimbursement Request, Billing Submission
A formal request submitted by a provider or patient to an insurer seeking payment for covered healthcare services rendered.
Condition of ParticipationTermCoP, Participation Requirement
A specific health and safety standard a provider must meet to be eligible for reimbursement from a government health programme.
Conditional ReimbursementTermOutcomes-Based Reimbursement, Provisional Reimbursement
A coverage arrangement in which a payer reimburses a treatment provisionally, subject to collecting further evidence confirming its value within a set timeframe.
Conversion FactorConceptRVU Multiplier, Fee Multiplier
A monetary amount translating a service's relative value units into an actual payment, the key multiplier connecting physician work to reimbursement.
Cost LimitTermCost Ceiling, Allowable Cost Cap
A maximum amount a payer will recognise as allowable cost for a service category when calculating reimbursement, a cost-containment mechanism.
Cost-Based ReimbursementTermCost Reimbursement, Retrospective Cost Payment
A payment methodology reimbursing a provider based on actual documented cost, unlike prospective payment systems that pay a fixed amount regardless.
Coverage PolicyTermCoverage Rules, Reimbursement Policy Rules
The overall set of rules a payer establishes governing which services and treatments will be reimbursed, and under what conditions.
Critical Access HospitalTermCAH, Small Rural Hospital Designation
A designation for small, rural hospitals meeting defined criteria, qualifying them for enhanced Medicare reimbursement to support financial viability.

D

Data Collection RequirementTermEvidence Generation Requirement, Data Requirement
A condition attached to a conditional reimbursement decision, mandating collection of additional real-world performance data within a defined timeframe.
Digital ReimbursementTermDigital Health Reimbursement, DTx Reimbursement
The policies governing whether and how digital health technologies, such as mobile apps or remote monitoring platforms, are covered and paid for.
Drug Evaluation CommitteeTermDEC, Formulary Committee
A formally constituted expert body responsible for reviewing evidence for a pharmaceutical product and recommending its reimbursement or formulary inclusion.
Duration CapTermReimbursement Time Limit, Cycle Cap
A contractual limit on the number of treatment cycles or the total time for which a payer will reimburse a specific treatment.

E

Episode PaymentTermEpisode Reimbursement, Per-Episode Bundled Payment
A payment covering all services associated with a defined clinical episode, such as surgery and recovery, rather than separate payments per service.
Episode-Based PaymentTermBundled Episode Reimbursement, Care-Episode Reimbursement
A methodology reimbursing a single, comprehensive amount for all care within a defined clinical episode, incentivising efficient, coordinated care.
Evidence Generation PlanTermEvidence Development Plan, Post-Approval Evidence Plan
A prospectively developed strategy outlining what further clinical or real-world evidence will be collected after a technology's initial approval or reimbursement.
External Reference PricingConceptERP, Cross-Country Reference Pricing
A medicine-pricing policy that uses prices for the same or comparable product in other jurisdictions as benchmarks for a domestic price or reimbursement decision.

F

Fee ScheduleTermPayment Schedule, Reimbursement Schedule
A comprehensive list specifying the predetermined payment amount a payer will reimburse for each specific service, organised by standardised procedure codes.

G

Gene Therapy AnnuityTermAnnuity Payment Model, Instalment Reimbursement
A proposed payment model spreading reimbursement for a high-cost gene therapy over annual instalments tied to its demonstrated durability, rather than one upfront lump sum.
Generic Reference PricingTermGeneric-Based Reference Pricing, Cluster Reference Pricing
A reimbursement policy setting a fixed level based on a generic drug's price, requiring patients or the brand manufacturer to cover any difference.

H

HASTermHaute Autorite de Sante, French National Authority for Health
The French National Authority for Health, conducting assessment including SMR and ASMR ratings that inform pricing and reimbursement decisions.
Health Reimbursement ArrangementTermHRA, Employer Health Account
A US employer-funded account reimbursing employees for qualified medical expenses tax-free, with unused funds typically staying with the employer.

I

Internal Reference PricingTermDomestic Reference Pricing, Therapeutic Class Pricing
A policy grouping therapeutically similar drugs and setting a single reference reimbursement level, requiring patients to pay any difference for pricier options.

L

Listing DecisionTermPositive Listing, Reimbursement Listing
A formal determination on whether a treatment will be included on a health system's approved formulary, and under what conditions.

M

Manufacturer SubmissionTermCompany Submission, Sponsor Dossier
The complete package of clinical and economic evidence a manufacturer provides in support of a coverage or reimbursement application.
Market AccessTermPatient Access Pathway, Reimbursement Access
The overall process by which a manufacturer secures favourable coverage, reimbursement, and clinical adoption for a new health technology.
Market Access PlanTermReimbursement Plan, Coverage Plan
A manufacturer's strategic document outlining how a new technology will be positioned to achieve favourable coverage and reimbursement across relevant payers.
Market Access StrategyTermMA Strategy, Access Strategy
A manufacturer's overall plan for achieving favourable coverage, reimbursement, and clinical adoption for a new treatment, integrating pricing and evidence generation.

N

Network Meta-Analysis HTAConceptNMA in HTA, NMA for Reimbursement
The application of network meta-analysis specifically within health technology assessment, generating comparative effectiveness estimates when treatments were never studied together.

P

Passive PurchasingTermPassive Reimbursement, Budget-Following Purchasing
A financing approach in which a payer simply reimburses whatever services are provided, without negotiating price or monitoring quality.
Payer Value MessageTermPayer-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 AmountTermPayment Level, Reimbursement Amount
The specific figure a payer reimburses a provider for a service or episode, determined according to the applicable payment methodology.
Payment PolicyTermReimbursement Policy, Provider Reimbursement Policy
The overall set of rules a payer establishes governing how providers will be reimbursed for the services they deliver.
Positive ListTermReimbursement List, Inclusion List
A list explicitly specifying which medications or services are covered under a health plan, unlike a negative list specifying exclusions.
Provider PaymentConceptProvider Reimbursement, Payment Mechanism
Provider payment refers to the methods and arrangements through which healthcare providers are paid for delivering services, including fee-for-service, capitation, bundled payments, salaries, global budgets and value-based payment.

R

Rate SettingTermReimbursement 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.
ReimbursementTermCoverage Payment, Third-Party Payment
The payment made by a health insurer or payer to a healthcare provider for services rendered to a covered patient.
Reimbursement CommitteeTermCoverage Committee, Payer Decision Panel
A formally constituted body responsible for reviewing evidence and deciding whether and how a technology will be reimbursed.
Reimbursement DecisionTermCoverage Verdict, Reimbursement Verdict
The formal determination by a payer regarding whether, and under what conditions, a technology will be financially covered for a population.
Reimbursement DossierTermReimbursement File, Payer Dossier
A comprehensive document submitted by a manufacturer presenting clinical and economic evidence supporting a treatment's requested reimbursement status.
Reimbursement RestrictionTermFunding Restriction, Restricted Coverage
A coverage limitation, such as restricting a treatment to a patient subgroup or requiring prior therapy failure, to manage cost or ensure appropriate use.
Reimbursement SubmissionTermFunding Application, Coverage Dossier
A formal application requesting coverage or reimbursement for a new technology, supported by clinical and economic evidence.
Restricted ListingTermRestricted Reimbursement, Conditional Listing
The inclusion of a treatment on a reimbursement list subject to specific conditions, such as a patient subgroup restriction or prior authorisation.
Retrospective PaymentTermRetrospective Reimbursement, Cost-Reimbursement Payment
A methodology reimbursing a provider based on actual costs or charges incurred, determined after care has been provided, unlike prospective payment.

S

Spending CapTermReimbursement Cap, Payer Spending Limit
A predetermined upper limit on total spending a payer will reimburse for a treatment or drug class within a defined period.

U

Unrestricted ListingTermOpen Listing, Unrestricted Reimbursement
The inclusion of a treatment on a formulary without limitations on patient eligibility or prior authorisation, following a positive value finding.