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.

value-based insurance design (VBID)

Aims to increase health care quality and efficiency by using financial incentives to promote cost efficient health care services and consumer choices. It may also use disincentives, such as high cost sharing, to discourage the use of services with minimal or no proven beneficial results over less costly options.


In various health reform proposals, a certificate or fixed dollar amount that is provided to persons, which is used to pay all or part of the cost of health insurance or services.

wellness program

Employment-based program to promote health and prevent chronic disease. Goals of these programs include: reducing health care costs, sustaining and improving employee health and productivity and reducing absenteeism due to illness.

wholesale acquisition cost

A publicly available list price that approximates what retail pharmacies pay wholesalers for single source drugs.

young adult health plan

Health plans designed to meet the needs of young adults. These plans tend to offer lower premiums in exchange for high deductibles and/or limited benefit packages.