Health Policy and Management Cheat Sheet

The core ideas of Health Policy and Management distilled into a single, scannable reference — perfect for review or quick lookup.

PiqCue — piqcue.com/health-policy-and-management/cheatsheet

Quick Reference

Universal Health Coverage

A health system goal in which all individuals and communities receive the health services they need without suffering financial hardship. It encompasses the full spectrum of essential, quality health services, from promotion to prevention, treatment, rehabilitation, and palliative care.

Value-Based Care

A health care delivery model in which providers are paid based on patient health outcomes rather than the volume of services delivered. It aims to align financial incentives with quality improvement and cost efficiency.

Social Determinants of Health

The conditions in the environments where people are born, live, learn, work, play, and age that affect a wide range of health outcomes and risks. These include factors such as income, education, housing, food security, and neighborhood safety.

Health Insurance Market Design

The set of rules, regulations, and structures that govern how health insurance is sold, priced, and administered. Key design elements include risk pooling, community rating, mandates, subsidies, and benefit standardization.

Quality Improvement (QI)

A systematic, data-driven approach to improving processes, outcomes, and patient experience in health care organizations. Common frameworks include Plan-Do-Study-Act (PDSA) cycles, Lean, and Six Sigma methodologies.

Health Equity

The principle that everyone should have a fair and just opportunity to attain their highest level of health. Achieving health equity requires removing obstacles such as poverty, discrimination, and structural racism that contribute to disparities.

Fee-for-Service vs. Capitation

Two contrasting payment models: fee-for-service pays providers separately for each service rendered, which can incentivize overuse, while capitation pays a fixed amount per patient per period, which incentivizes efficiency but may risk underservice.

Health Information Technology (Health IT)

The application of information processing involving computer hardware and software to the storage, retrieval, sharing, and use of health care information for communication and decision-making. Key components include electronic health records, telehealth, and clinical decision support systems.

Population Health Management

An approach that aims to improve the health outcomes of a defined group of individuals by monitoring and identifying health conditions, implementing targeted interventions, and measuring results across the full continuum of care.

Regulatory Compliance and Accreditation

The processes by which health care organizations meet standards set by government agencies and independent accrediting bodies. Compliance ensures patient safety, data privacy, and quality of care, while accreditation signals organizational competence to payers and the public.

Key Terms at a Glance

Accountable Care Organization (ACO):A network of providers that jointly accepts responsibility for the quality and total cost of care for a defined patient population, sharing savings when benchmarks are met.

Adverse Selection:A situation in which higher-risk individuals are more likely to purchase insurance, leading to higher average costs in the risk pool and potential market instability.

Affordable Care Act (ACA):Comprehensive U.S. health reform law (2010) that expanded coverage through Medicaid expansion, Health Insurance Marketplaces, individual mandates, and insurance market regulations.

Beveridge Model:A health system model in which the government provides and finances health care through general taxation, with government-owned facilities and salaried providers.

Bismarck Model:A health system model financed through mandatory employer-employee payroll contributions to nonprofit sickness funds, with private providers.

Capitation:A payment method in which providers receive a fixed amount per enrolled patient per time period, regardless of services delivered.

Cost-Effectiveness Analysis (CEA):An economic evaluation comparing the costs and health outcomes of alternative interventions, typically reported as cost per QALY gained.

Diagnosis-Related Groups (DRGs):A patient classification system that groups hospital cases by diagnosis and procedure to determine prospective payment amounts.

EMTALA:The Emergency Medical Treatment and Labor Act requiring hospitals to provide emergency medical screening and stabilization regardless of a patient's ability to pay.

Fee-for-Service (FFS):A payment model in which providers are reimbursed for each individual service or procedure performed.

Health Disparities:Preventable differences in health outcomes and their determinants experienced by socially disadvantaged populations.

Health Equity:The attainment of the highest level of health for all people, requiring the removal of systemic obstacles to fair health opportunities.

Health Insurance Marketplace:An organized platform, established under the ACA, where individuals and small businesses can compare and purchase standardized health insurance plans.

HIPAA:The Health Insurance Portability and Accountability Act establishing national standards for the protection of individually identifiable health information.

Managed Care:A health care delivery approach that integrates financing and service delivery to control costs and improve quality through provider networks, utilization management, and gatekeeping.

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