uncompensated care

Care rendered by hospitals or other providers without payment from the patient or a government-sponsored or private insurance program. It includes both charity care, which is provided without the expectation of payment, and bad debt, for which the provider has made an unsuccessful effort to collect payment due from the patient.


People with public or private insurance policies that do not cover all necessary health services, resulting in out-of-pocket expenses that often exceed their ability to pay.


The failure to provide a health care service when it would have produced a favorable outcome for a patient. Standard examples include failure to provide appropriate preventive services to eligible patients (e.g., Pap smears, flu shots for elderly patients, screening for hypertension) and proven medications for chronic illnesses (steroid inhalers for asthmatics; aspirin, beta-blockers and lipid-lowering agents for patients who have suffered a recent myocardial infarction).

universal coverage

Health insurance coverage for all people, through either public or privately funded programs.

utilization management

Utilization management is a collection of treatment review and cost reduction techniques used by health plans. Health plans frequently employ utilization management techniques in their prescription drug benefit, particularly for high-cost specialty medications. Common utilization management techniques for prescription drugs include prior authorization, step therapy, quantity limits, and mandatory generic substitution.

utilization review (UR)

A health care organization’s review of health care services — particularly specialist referrals, emergency room use and hospitalizations — to evaluate their appropriateness, necessity, and quality. The review can be performed before, during, or after the delivery of care.