Healthcare Policy and Regulation
Expert-defined terms from the Certificate Programme in Healthcare Research Analysis course at London School of Planning and Management. Free to read, free to share, paired with a globally recognised certification pathway.
Healthcare Policy and Regulation Glossary #
1. Affordable Care Act (ACA) #
The Affordable Care Act, also known as Obamacare, is a comprehensive healthcare… #
The ACA aimed to increase access to healthcare, improve quality, and reduce healthcare costs for Americans.
2. Accreditation #
Accreditation is a process by which healthcare organizations are evaluated again… #
Accreditation is typically voluntary and conducted by accrediting bodies such as The Joint Commission.
3. Access to care #
Access to care refers to the ability of individuals to obtain timely and appropr… #
Barriers to access can include cost, geographic location, insurance coverage, and provider availability.
4. Accountable Care Organization (ACO) #
An Accountable Care Organization is a group of healthcare providers who work tog… #
ACOs are incentivized to achieve better outcomes through shared savings programs.
5. Centers for Medicare and Medicaid Services (CMS) #
The Centers for Medicare and Medicaid Services is a federal agency within the U #
S. Department of Health and Human Services that administers the Medicare and Medicaid programs. CMS plays a key role in regulating healthcare policy and reimbursement.
6. Certificate of Need (CON) #
A Certificate of Need is a regulatory process used in many states to control hea… #
CON programs aim to prevent unnecessary duplication of services and control healthcare costs.
7. Cost containment #
Cost containment refers to strategies and policies aimed at reducing healthcare… #
Examples of cost containment measures include utilization review, payment reform, and value-based care initiatives.
8. Electronic Health Record (EHR) #
An Electronic Health Record is a digital version of a patient's paper chart that… #
EHRs are used by healthcare providers to improve care coordination and patient outcomes.
9. Health Insurance Portability and Accountability Act (HIPAA) #
The Health Insurance Portability and Accountability Act is a federal law that pr… #
HIPAA sets standards for the use and disclosure of protected health information by covered entities.
10. Healthcare disparities #
Healthcare disparities refer to differences in access to care, quality of care,… #
Disparities can be influenced by factors such as race, ethnicity, socioeconomic status, and geographic location.
11. Healthcare Quality Improvement Act (HCQIA) #
The Healthcare Quality Improvement Act is a federal law that established the Nat… #
HCQIA aims to improve the quality of care by identifying and addressing provider performance issues.
12. Medicaid #
Medicaid is a joint federal and state program that provides health insurance to… #
Each state administers its own Medicaid program, following federal guidelines and regulations.
13. Medicare #
Medicare is a federal health insurance program for individuals aged 65 and older… #
Medicare has several parts that cover hospital care, medical services, and prescription drugs.
14. Patient Protection and Affordable Care Act (PPACA) #
The Patient Protection and Affordable Care Act, also known as the ACA or Obamaca… #
The PPACA aimed to expand access to health insurance, improve quality of care, and reduce healthcare costs.
15. Public Health Service Act (PHSA) #
The Public Health Service Act is a federal law that authorizes various public he… #
The PHSA also addresses healthcare regulations and standards.
16. Quality Improvement Organization (QIO) #
A Quality Improvement Organization is a group of healthcare professionals who wo… #
QIOs conduct quality reviews, promote best practices, and implement quality improvement initiatives.
17. Reimbursement #
Reimbursement refers to the payment that healthcare providers receive for servic… #
Reimbursement can come from government programs, private insurance companies, or out-of-pocket payments by patients.
18. Single #
Payer Healthcare System:
A Single #
Payer Healthcare System is a healthcare financing system in which the government pays for all healthcare services using a single public fund. Providers may be public, private, or a combination of both, but the payment is centralized.
19. Social Determinants of Health #
Social Determinants of Health are the economic and social conditions that influe… #
These determinants include factors such as income, education, housing, and access to healthcare.
20. Telemedicine #
Telemedicine is the use of technology to provide healthcare services remotely, s… #
Telemedicine can improve access to care, especially in rural or underserved areas.
21. Value #
Based Care:
Value #
Based Care is a healthcare delivery model that focuses on improving patient outcomes while controlling costs. Providers are incentivized to deliver high-quality, efficient care through payment models that reward value over volume.
22. World Health Organization (WHO) #
The World Health Organization is a specialized agency of the United Nations that… #
The WHO sets global health standards, monitors health trends, and provides technical assistance to countries.