Actuarial Analysis
The application of statistical methods to assess and quantify financial risk, such as the expected future cost of insurance claims.
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Actuarial Value
A measure representing the percentage of average healthcare costs a health plan is expected to cover for a standard population.
Adjustment Factor
A numerical multiplier applied to a base payment rate to account for specific circumstances affecting the cost of care, such as geographic wage differences.
Administrative Cost Ratio
A measure of the proportion of an insurer's revenue spent on administrative functions, such as claims processing, rather than actual claims.
Adverse Event Rate
A measure of how frequently patients experience unintended harm from medical care, rather than their underlying condition, within a defined population.
Aggregate Stop-Loss
A form of reinsurance protecting a self-insured employer against total claims across its covered population exceeding a predefined threshold.
Attachment Point
The specific threshold at which a stop-loss or reinsurance policy begins covering costs, with the insured responsible for costs below it.
Average Length of Stay
A measure found by dividing total patient-days within a facility by discharges over the same period, an indicator of efficiency.
C. diff Rate
A measure of the frequency of healthcare-associated Clostridioides difficile infections within a facility, tracking infection prevention and stewardship performance.
Capitation
A payment methodology giving a fixed amount per enrolled patient over a defined period, regardless of services used, unlike fee-for-service.
Capitation Payment
The specific fixed amount received per enrolled patient under capitation, typically adjusted for risk factors such as age and health status.
Case Fatality Rate
The proportion of people diagnosed with a disease who die from it within a defined period, a measure of disease severity.
Case Mix Index
A summary statistic representing average patient resource intensity, calculated by averaging relative weights of diagnosis-related groups across a provider's cases.
Case Weight
A relative value assigned to a diagnosis-related group reflecting its expected resource intensity, used to scale payment from a base rate.
Catastrophic Health Expenditure
Out-of-pocket healthcare spending by a household exceeding a defined threshold share of its total income, threatening basic financial stability.
CAUTI Rate
A measure of the frequency of catheter-associated urinary tract infections within a facility, tracking infection prevention performance for catheter care.
CLABSI Rate
A measure of the frequency of central line-associated bloodstream infections within a facility, tracking infection prevention performance for catheter care.
Coinsurance
A cost-sharing form in which an insured person pays a fixed percentage of a covered service's cost, with the insurer paying the rest.
Coinsurance Rate
The specific percentage of a covered service's cost an insured person is responsible for paying under a coinsurance arrangement.
Complaint Rate
A measure of how frequently patients or families formally express dissatisfaction with the care or service received within an organisation.