Cover image for Health care policy and politics A to Z
Health care policy and politics A to Z
Rovner, Julie.
Personal Author:
Second edition.
Publication Information:
Washington, D.C. : CQ Press, [2003]

Physical Description:
xii, 282 pages : illustrations ; 24 cm
Format :


Call Number
Material Type
Home Location
Item Holds
RA395.A3 R685 2003 Adult Non-Fiction Central Closed Stacks

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A one-volume reference on health care policies and debates in America. Author Julie Rovner explains the significant changes that the private sector, Congress, federal and state courts and state legislatures have made in the nation's health system.

Author Notes

Julie Rovner is a health policy journalist who has covered Capitol Hill for more than a decade. She reports on health policy for National Public Radio and National Journal's CongressDaily and covered health and welfare for the Congressional Quarterly Weekly Report for several years

Reviews 3

Booklist Review

Readers familiar with CQ's A^-Z approach will be comfortable with this volume, which covers Abortion to Zidovudin. In addition to telling the difference between a gag clause (by which managed-care plans limit what doctors can tell their patients about treatment options) and a gag rule (a name applied to regulations that bar abortion counseling and referrals in federally funded family planning facilities), the book gives overviews of the AIDS crisis and the evolution of the office of Surgeon General, describes the Tuskegee experiments, and defines numerous acronyms that pepper anything written about health policy in the U.S. The entries are simply written, which allows the target audience of laypeople to understand the jargon used in debating health policy issues and to appreciate the history and conflict of the issues themselves. The author, a health-care reporter for CQ Weekly Report, the Medical News Network, National Journal's CongressDaily, and NPR, attributes her "Congress centric" approach to the fact that Congress is where health policy is made. One appendix lists "Congressional Committees Responsible for Health Care Policy"; another lists organizations (government agencies, foundations, interest groups, etc.) that can provide further information. In addition to the alphabetical table of contents, there is an index that leads readers to multiple related entries. Although there is nothing here that could not be found elsewhere, the consistent writing, convenience of having all the information in one place, and accessible arrangement make this a recommended purchase for most high-school and public libraries and some medical libraries.

Library Journal Review

This book defines more than just health-care policies like Medicaid; it also provides in-depth analyses of other contemporary lightning-rod regulatory issues, like genetic discrimination, fetal-tissue research, and the politically polarizing contraceptive option called plan B. The alphabetically organized entries, which run in length between several paragraphs to well over a page, are based largely on Rovner's health-policy journalism for NPR and other outlets. Vital sidebar statistics are often provided, as are suggested readings, organizational contacts, and a subject chronology. Also peppering the text are illustrations of government officials furnishing formal testimony. Recommended for medical education and political science collections. (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Choice Review

Rovner's unique encyclopedic guide to the language of health care is intended to "permit lay people to join the continuing conversation about health policy issues." The author reported on health and welfare issues for Congressional Quarterly Weekly Report for seven years and has used much of her own original material from CQ in this work, which she describes as "Congress centric"; many of the entries contain information reflecting Congress's elemental role in developing and setting US health care policy. Individual entries range from health care legislation such as the Patient Self Determination Act of 1990 to nursing home standards. Entries may include charts, see also references, graphs, photos, and facts about federal agencies. The table of contents is thoughtfully laid out to permit quick selection of subjects. The index is detailed and includes photographs and illustrations. In addition, the book contains an acronym guide, a list of congressional committees involved in health care policymaking, and a directory of further information. Highly recommended for public, academic, and special libraries; will supplement many consumer health collections. ; University of Colorado at Denver

Table of Contents

Prefacep. x
A Abortionp. 1
Academic health centers (AHCs)p. 9
Accreditation Council on Graduate Medical Education (ACGME)p. 10
Acquired Immune Deficiency Syndrome (AIDS)p. 10
Activities of daily living (ADLs)p. 12
Adjusted average per capita cost (AAPCC)p. 13
Adjusted community rate (ACR)p. 13
Adolescent family life program (AFLP)p. 13
Advance directivesp. 14
Advanced practice nursep. 14
Adverse selectionp. 14
Agency for Health Care Policy and Research (AHCPR)p. 15
Agency for Health Care Research and Quality (AHRQ)p. 15
Agency for Toxic Substances and Disease Registry (ATSDR)p. 16
Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)p. 16
Alternative medicinep. 16
American Association of Health Plans (AAHP)p. 17
American Association of Retired Persons (AARP)p. 17
American Medical Association (AMA)p. 18
Americans with Disabilities Act (ADA)p. 19
Assignment (Medicare)p. 21
Association Health Plans (AHPs)p. 21
Average wholesale pricep. 22
B Balance billing (Medicare)p. 24
Baselinep. 24
Beneficiaryp. 24
Bioterrorismp. 24
Blue Cross/Blue Shield Association (BCBSA)p. 26
Boren amendmentp. 27
Budget reconciliation legislation and health carep. 28
C Cafeteria benefits plansp. 33
California Public Employee Retirement System (CalPERS)p. 33
Capitationp. 33
Carrier (Medicare)p. 34
Carve-out organizationsp. 34
Catastrophic illnessp. 34
Categorical eligibilityp. 34
Centers for Disease Control and Prevention (CDC)p. 34
Centers for Medicare and Medicaid Servicesp. 36
Certified nurse midwifep. 36
Certified registered nurse anesthetist (CRNA)p. 36
Child Custody Protection Actp. 36
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)p. 37
Clinical Laboratory Improvement Act (CLIA)p. 37
Clinical nurse specialist (CNS)p. 38
Clinical practice guidelinesp. 38
Clinical trialsp. 39
Cloning, humanp. 39
Coinsurancep. 42
Common rulep. 42
Community health centersp. 42
Community ratingp. 43
Congressional Budget Office (CBO)p. 43
Conscience clausep. 44
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)p. 44
Consumer-driven health plansp. 45
Contraceptive coveragep. 46
Cost shiftingp. 47
Crowd outp. 47
Current procedural terminology (CPT) codesp. 47
D Deductiblep. 49
Defined benefitp. 49
Defined contributionp. 49
Diagnosis-related group (Medicare)p. 49
Dietary supplement rulesp. 49
Direct medical education paymentsp. 51
Disease managementp. 51
Disproportionate share hospital (DSH) payments (Medicare and Medicaid)p. 52
"Do-not-resuscitate" ordersp. 53
Drive-through deliveriesp. 53
Dual eligiblesp. 53
Durable power of attorney for health carep. 55
E Early and Periodic Screening, Diagnostic, and Treatment (EPSDT; Medicaid)p. 56
Embryo researchp. 56
Emergency contraceptionp. 56
Employee Retirement Income Security Act (ERISA)p. 58
End-stage renal disease (Medicare)p. 59
Entitlementp. 59
Evidence-based medicinep. 60
Experience ratingp. 60
External reviewp. 60
F False Claims Actp. 61
Federal Employee Health Benefits Plan (FEHBP)p. 61
Federal Food, Drug, and Cosmetic Act (FFDCA)p. 62
Federal medical assistance percentages (FMAPs)p. 62
Federally qualified health centers (FQHCs)p. 62
Fee-for-servicep. 63
Fetal tissue researchp. 63
First-dollar coveragep. 65
Food and Drug Administration (FDA)p. 65
Formularyp. 66
Freedom of Access to Clinic Entrances Act (FACE)p. 67
Freedom of Choice Actp. 68
G Gag clauses (in managed care)p. 70
Gag rule (in abortion)p. 71
Gatekeeperp. 72
Generic drugsp. 72
Genetic discriminationp. 74
Global tobacco settlementp. 75
Graduate medical education (GME)p. 77
Guaranteed issuep. 78
Guaranteed renewabilityp. 78
H Health and Human Services Department (HHS)p. 80
Health Care Financing Administration (HCFA)p. 82
Health care fraud and abusep. 83
Health care spendingp. 85
Health Insurance Association of America (HIAA)p. 87
Health Insurance Portability and Accountability Act (HIPAA)p. 87
Health jurisdiction in Congressp. 91
Health maintenance organization (HMO)p. 92
Health planp. 93
Health Plan Employer Data and Information Set (HEDIS)p. 93
Health professional shortage area (HPSA)p. 94
Health Resources and Services Administration (HRSA)p. 94
Health Security Actp. 94
Health services researchp. 97
Hill-Burton Actp. 97
Home health carep. 98
Hospicep. 98
Hospital Insurance (HI)p. 99
Hospitalistp. 99
House Appropriations Committeep. 99
House Education and Workforce Committeep. 100
House Energy and Commerce Committeep. 100
House Ways and Means Committeep. 100
Human research subject protectionp. 100
Hyde amendmentp. 102
I ICD-9 codesp. 106
Incidencep. 106
Income-related premiump. 106
Indian Health Servicep. 107
Indirect Medical Education Payments (IME)p. 108
Infertility clinic regulationp. 108
Informed consentp. 109
Institute of Medicinep. 109
Institutional Review Boards (IRBs)p. 109
Intermediary (Medicare)p. 111
J Joint Commission on Accreditation of Healthcare Organizations (JCAHO)p. 112
Judicial bypassp. 112
K Kennedy-Kassebaum lawp. 113
Kerr-Mills billp. 113
L Labor-Health and Human Services-Education Appropriation (Labor-HHS)p. 114
Late-term abortionp. 114
Lifetime limitsp. 115
Living willsp. 115
Long-term carep. 115
Loss ratiosp. 116
M Managed behavioral health carep. 117
Managed carep. 117
Managed competitionp. 120
Maternal and Child Health (MCH) Services Block Grantp. 120
Means testing (Medicare)p. 120
Medicaidp. 121
Medicaid drug rebate programp. 126
Medical Device User Fee Actp. 127
Medical errorsp. 127
Medical malpracticep. 129
Medical necessityp. 132
Medical records confidentialityp. 132
Medical savings accounts (MSAs)p. 135
Medical underwritingp. 136
Medically needyp. 137
Medicarep. 137
Medicare Catastrophic Coverage Actp. 146
Medicare+Choicep. 148
Medicare givebacksp. 150
Medicare Payment Advisory Commission (MedPAC)p. 151
Medigap insurancep. 151
Mental health parityp. 153
Mexico City policyp. 155
Mifepristonep. 157
Migrant health centersp. 157
N NARAL-Pro-Choice Americap. 158
National Association of Insurance Commissioners (NAIC)p. 158
National Bipartisan Commission on the Future of Medicarep. 158
National Committee for Quality Assurance (NCQA)p. 159
National Federation of Independent Business (NFIB)p. 160
National Health Services Corpsp. 160
National Institutes of Health (NIH)p. 161
National Practitioner Data Bankp. 163
National Right to Life Committee (NRLC)p. 164
Needle exchangep. 165
Nuclear transplantationp. 166
Nurse practitioner (NP)p. 166
Nursing home standardsp. 166
Nutrition Labeling and Education Act (NLEA)p. 167
O Off-label usep. 169
Oregon Health Care Planp. 169
Organ donations and transplantsp. 171
Orphan drugsp. 173
Outcomesp. 173
P Parental consentp. 174
Parental involvement lawsp. 174
Parental notificationp. 175
Partial-birth abortionp. 176
Participating physician (Medicare)p. 180
Patient "dumping"p. 180
Patients' Bill of Rights (PboR)p. 181
Patient Self-Determination Act of 1990p. 184
Payersp. 185
Pediatric exclusivityp. 185
Pediatric Rulep. 186
Peer reviewp. 187
Pepper Commissionp. 187
Personal Responsibility and Work Opportunity Reconciliation Actp. 188
Pharmacy benefit managersp. 188
Physician assistantsp. 189
Physician Payment Review Commissionp. 189
Planned Parenthood Federation of America (PPFA)p. 189
Planned Parenthood of Southeastern Pennsylvania v. Caseyp. 191
Play or payp. 191
Point of service plan (POS)p. 191
Portabilityp. 191
Poverty statisticsp. 192
Preexisting conditionp. 193
Preferred provider organization (PPO)p. 193
Premiumsp. 193
Premium supportp. 194
Prescription Drug User Fee Act (PDUFA)p. 194
Prevalencep. 195
Primary carep. 195
Primary care physician (PCP)p. 195
Prior authorizationp. 196
Private contracting (Medicare)p. 196
Private fee-for-service (Medicare)p. 197
Program of All-Inclusive Care for the Elderly (PACE)p. 197
Prospective Payment Assessment Commission (ProPAC)p. 198
Prospective payment system (PPS)p. 198
Providersp. 199
Provider-sponsored organizations (PSOs)p. 199
Prudent laypersonp. 199
Public healthp. 200
Public Health Service (PHS)p. 200
Public Health Service, Commissioned Corpsp. 202
Q Qualified Medicare beneficiary (QMB)p. 203
Qualifying Individual Program (QI-1 and QI-2)p. 203
Quality improvement organizations (QIO)p. 204
R Rationingp. 205
Referralp. 205
Regenerative medicinep. 205
Reimportation, prescription drugp. 206
Report cardsp. 208
Residency review committees (RRCs)p. 208
Resource-based relative value scalep. 208
Respite carep. 208
Retiree health insurancep. 208
Ribicoff childrenp. 209
Ricky Ray Hemophilia Relief Fund Actp. 209
Risk adjustmentp. 210
Roe v. Wadep. 210
RU486p. 211
Ryan White Comprehensive AIDS Resource and Emergency (CARE) Actp. 214
S Safety net facilitiesp. 216
Secondary carep. 216
Secondary payer (Medicare)p. 217
Self-insurancep. 217
Self-referral curbsp. 217
Senate Appropriations Committeep. 218
Senate Finance Committeep. 219
Senate Health, Education, Labor and Pensions Committee (HELP)p. 219
Single payerp. 220
Small market variationp. 221
Social Security Actp. 221
Social Security Disability Insurance (SSDI)p. 222
Somatic cell nuclear transferp. 222
Specialty carep. 222
Specified Low-Income Medicare Beneficiaries (SLMB)p. 223
Spend-downp. 223
Spousal impoverishmentp. 223
State Children's Health Insurance Program (SCHIP)p. 224
Stem cell researchp. 225
Stem cellsp. 227
Substance Abuse and Mental Health Services Administration (SAMHSA)p. 228
Suicide, assistedp. 228
Supplemental Medical Insurance (SMI)p. 230
Supplemental Security Income (SSI)p. 230
Surgeon general of the United Statesp. 231
T Taft-Hartley plansp. 234
Technology assessmentp. 234
TennCarep. 234
Tertiary carep. 236
Tiered pricingp. 236
Title X Family Planning Programp. 236
Tuskegee experimentsp. 238
U Unborn Victims of Violence Actp. 240
Uncompensated carep. 240
Underinsuredp. 240
Underwritingp. 241
Uninsuredp. 241
Unions, doctorp. 243
United Nations Population Fund (UNFPA)p. 244
United Network for Organ Sharing (UNOS)p. 246
Universal coveragep. 246
Upper Payment Limit (UPL)p. 247
Utilization review (UR)p. 248
V Veterans health carep. 249
Voluntary health agencies (VHAs)p. 250
W Webster v. Reproductive Health Servicesp. 251
WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)p. 252
Women's Health, Office of Research onp. 253
Z Zidovudinep. 254
Reference Materialp. 255
Health Policy Time Linep. 257
Health Care Policy Acronymsp. 261
Suggested Readingsp. 263
Congressional Committees Responsible for Health Care Policyp. 266
Sources of Further Informationp. 267
Indexp. 271