gatekeeper/care manager

A health care professional, usually a primary care physician, who coordinates, manages, and authorizes all health services provided to a person covered by certain types of health plans. Unless an emergency exists, the gatekeeper generally must pre-authorize referrals to specialists, and for hospitalizations, and lab and radiology tests.

generic

A generic drug is a drug identical to an innovator drug that is marketed after the innovator’s patent period ends. Generic drugs can cost 75-80 percent less than the original brand-name drug.

global budget

A fixed maximum expenditure for a defined set of health care services for a covered population. Global budgets are intended to constrain both the level and rate of increase in health care costs by limiting them directly.

green house project

Small communities of elders and staff set in a home-like environment that function as long-term care facilities. The centers provide the assistance and support necessary for each resident, but focus on social living, rather than on medical care.

grievance

In a health policy sense, a complaint filed because of dissatisfaction with the quality of care by a provider or with customer service or some other action by a health plan. Medicare fee-for-service, Medicare health maintenance organizations and Medicare Part D prescription drug plans, as well as Medicaid and most other health plans, have formal procedures for handling and responding to grievances. If a Medicare beneficiary files a grievance against a hospital, a Quality Improvement Organization will review the case and guarantee the patient’s stay, possibly free-of-charge, until the review has been completed. Under the Affordable Care Act (ACA), all consumers will have the right to challenge decisions, including coverage denials and rescissions, made by their health plans. (Also see appeal.)

group insurance

Health insurance offered through business, union trusts or other groups and associations. The policy holder is generally the employer or other entity. This system of health insurance is the most common in the United States.

guaranteed issue

A requirement that health plans cannot reject coverage for an applicant based on the person’s medical history. Under the Affordable Care Act (ACA), guaranteed issue for new coverage and guaranteed renewability for existing coverage is the law of the land as of January 1, 2014, and applies to policies issued after that date. For those under age 19, the provision went into effect September 23, 2010.