Health Financing & Insurance

A hospital funding model allocating resources based on the volume and type of clinical activities performed, rather than a fixed historical budget.

Adverse selection occurs when people use private information about their risk before an agreement to make participation or contract choices, causing those who select into a market or plan to differ systematically from the wider population.

A payment arrangement in which a fixed total covers a defined package of related services, rather than billing each component separately.

Capitation is a provider-payment method that pays a predetermined amount per enrolled or attributed person for a defined period and service package, regardless of the number of covered services that person uses during the period.

A methodology reimbursing a provider a predetermined amount based on a patient's diagnosis category, rather than the specific services delivered.

Catastrophic health expenditure occurs when a household's out-of-pocket health spending exceeds a specified share of its available resources.

Coinsurance is the percentage of the allowed cost of a covered healthcare service that an insured person pays under the plan's cost-sharing rules, commonly after satisfying the applicable deductible.

A method setting premiums that charges all enrollees within a community the same rate, or within narrow limits, regardless of individual risk.