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.
C
- Capitation Payment SystemCapitation System, Capitated Payment System
- The overall structure governing how capitated payments are calculated and administered, covering risk adjustment, frequency, and scope of covered services.
- Concurrent Risk AdjustmentSame-Period Risk Adjustment, Concurrent Risk Model
- A risk adjustment method using diagnoses observed in the same period costs are predicted for, unlike prospective adjustment using prior period data.
D
- Demographic AdjustmentAge-Sex Adjustment, Demographic Risk Adjustment
- A risk adjustment method predicting expected costs based on basic characteristics, such as age and sex, without detailed clinical diagnosis information.
P
- 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.
- Predicted CostForecast Cost, Modelled Cost
- An estimate of expected future healthcare expenditure generated using a risk adjustment model incorporating demographics, diagnoses, and prior utilisation.
- Prior UtilisationPrior Use, Previous Utilisation
- An individual's past pattern of healthcare service use, commonly used as a predictor within risk adjustment models of future costs.
- Prospective Risk AdjustmentForward Risk Adjustment, Predictive Risk Adjustment
- An approach that uses characteristics recorded before a target period to predict that period’s expected health care needs or spending, often to adjust prospective payments across populations with different risk.
R
- Retrospective Risk AdjustmentRetro Risk Adjustment, Concurrent-Year Adjustment
- A risk adjustment method calculating payment adjustments after a coverage period ends, based on actual observed diagnoses and costs.
- Risk AdjustmentRisk-Adjusted Payment, Morbidity Adjustment
- Risk adjustment makes outcomes, costs, utilisation or payments more comparable by accounting for differences in characteristics that affect expected results but are not the focus of the comparison.
- Risk Adjustment DesignAdjustment Model Specification, Risk Model Design
- The methodological choices underlying a risk adjustment system, including which factors are incorporated, how weighted, and adjustment timing.
- Risk Adjustment MechanismRisk Adjustment Formula, Payment Adjustment Formula
- The specific formula used to calculate payment adjustments based on predicted health risk, incorporating diagnoses, demographics, and prior utilisation.
- Risk ClassificationRisk Categorisation, Risk Grouping
- The process of categorising individuals by expected healthcare costs or risk level, used as an input to pricing or risk adjustment.
- Risk ScoreRisk Adjustment Score, Morbidity Score
- A numerical summary of measured predictors used to estimate or rank the likelihood of a specified future outcome in a defined population and time horizon.
S
- Socioeconomic AdjustmentSocioeconomic Risk Adjustment, Deprivation Adjustment
- A modification to a risk adjustment or payment formula accounting for added costs of caring for socioeconomically disadvantaged populations.