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Sydney Williams
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Sydney Williams is Founder and President of Lyceum Associates (http://www.gathersmart.com/), exploring transitions in health care, IT, financials, and the economy.
My company:
Lyceum Associates
My blog:
Talking Transitions
  • A Health Care Reform Glossary 0 comments
    Jun 1, 2009 11:26 AM | about stocks: UNH, AET, CI, HUM

    As the health care reform debate intensifies, so could confusion over certain terms associated with it. The list below – though not exhaustive – details some of the more frequently used ones.

    At its most basic, the debate pits opposing viewpoints on the extent of government involvement. It encompasses many different stakeholders, some more organized than others.

    Adverse Selectionan insurance risk factor where few healthy people purchasing coverage skews the risk pool towards high-cost unhealthy people (see risk pooling)
    Community Ratingan insurance concept prohibiting premium differences based on health status
    Comparative Effectivenessthe practice of side-by-side clinical assessment of medical interventions
    Evidence-based Medicinethe application of current best evidence in patient care, often in connection with quality and value
    Guaranteed Issuean insurance concept in which the insurer offers a policy regardless of the applicant's health status
    Health Insurance Exchangea national, regional, statewide or local registry of all state-licensed private insurers in the non-group and small group markets, and the public health insurance option if applicable; its design is intended to make plan selection more transparent
    Individual Mandatean insurance concept requiring that all adults purchase insurance through their employer, a government program, or in the individual market
    Individual Marketthat portion of the health insurance industry consisting of individuals and their dependents who purchase coverage directly from an insurer
    Interstate Insurancethe ability to purchase policies sold in different states, where state regulation often creates substantial price variation
    Pay-for-Performanceincentive compensation for meeting performance criteria in quality and effectiveness of care
    Pay-or-Play Taxempowers a tax authority to assess employers (pay) while giving them the option to avoid the fee by providing health care or coverage to their workers (play)
    Portabilitythe ability to take health insurance from job to job
    Public Health Insurance Optiona federal plan for non-disabled individuals under 65 years of age; three options are currently under consideration
    Risk Poolingan insurance practice of bringing together different risk profiles to offset any one individual claim; in health care, reformers are looking to apply the concept to small businesses and high-risk individuals, or uninsurables (see adverse selection)
    Shared Responsibilitythe notion that each component of the supply chain contributes to cost savings – manufacturers, providers, private and public payers, and individuals
    Third-Party Payerprivate and public sector insurance arrangements in which an individual pays premiums to an entity (third party), which then pays for agreed-upon health care services

    Also, here's a selected list of recent papers by key players and groups:

    • Pres. Obama letter to Sens. Kennedy and Baucus
    • Sen. Max Baucus (D-MT) white paper detailing his vision for reform
    • Senate Finance Committe policy options for financing reform
    • CBO brief outlining approach to judging the appropriate budgetary treatment of reform legislation
    • Republican opposition plan, The Patient's Choice Act
    • Judd Gregg (R-NH) "CPR" proposal for health care reform
    • Council of Economic Advisors report on health care reform
    • White House reports on health care reform

    Key will be monitoring the legislation's unintended consequences.  Health care, simply, isn't a linear industry.  Multiple players coexist in a disjointed economic fashion, where action inevitably leads to unforeseen reaction. 

    For more information, read our newsletter Perspectives. This publication features commentaries from leading practitioners, many of whom have devised innovative business practices in the delivery of care.

    Themes: Health Care, Managed Care, Health Care Reform, Health Policy Stocks: UNH, AET, CI, HUM
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