Ch 6 Health Care Systems

What is the central role of health services financing in the USFund health insurance
What is the primary mechanism that enables people to obtain health serviceshealth insurance
the phenomenon called moral hazard results directly fromhealth insurance coverage
liberal reimbursement for a given technology will ____ innovation/diffusion of that technologyincrease
controlling total health care expenditures by restricting financing for health insuranceDemand side rationing
in national health care systems total expenditures are controlled mainly bysupply side rationing
national health expenditures E =E = P x Q
in general sense what is primary purpose of insuranceprotection against risk
private health insurance is also calledvoluntary insurance
under community ratingboth high and low risk people are charged the same premium
which method of risk assessment is required by ACA for individual and small group health insuranceadjusted community rating
under experience ratingfavorable risk groups pay a lower premium than high risk
what is the main advantage of group insurancerisk is spread out among a large number of insured
self insurance was spurred bygovernment policy
the employee retirement income security actexempts self insured plans from certain mandatory benefits
cost is shifted from people in poor health to the healthy whenpremiums are based on community rating
health insurance pays for medical care after insured pays first 1000deductible
copayment is generally paiedeach time the insured revives health care services
what was the main conclusion of the rand health insurance experimentcost sharing lowered health care utilization without any significant health consequences
medical policies are sold byprivate insurance companies
the ACA specifies that ____ can be covered under parents insurance planschildren under 26
how are preexisting medical conditions covered under the ACAprivate insurance plans have to cover them starting 2014
under ACA what purpose do the exchanges servethey allow individuals and small businesses to purchase health plans
in general how do bronze, silver and gold health plans differthey differ according to cost sharing
what criterion does ACA use to classify an employer as a large employer50 or more full time employees
to purchase private insurance through an exchange premium subsidies are made available to people with incomes up to400% federal poverty line
majority of beneficiaries reviving health care through medicare areelderly
main function of Medicare payment advisory commission MedPACadvise the US congress on carious issues affecting the medicare program
to finance medicare part Aall income earned by a working person is subject to medicare tax
skilled nursing care is covered under _____ of medicarepart A
the HI portion of medicare is financed throughpayroll taxes
for medicare beneficiaries the max stay in an SNF during a benefit period cannot exceed100 days
for hospitalizations medicare beneficiaries must pay a deductibleonce per benefit period
Medicare part B premiums areincome-based
SMI providesphysicians services
Part C of medicare specifially covers–> NONE OF THE FOLLOWING
rehab services; preventative care; prescription drugs
why was medicare part C createdto channel beneficiaries into managed care programs
the donut hole in medicare prescription drug coverageprovides no benefits until the beneficiary qualifies for the catastrophic level
the SMI trust fund is forparts B an D
the primary criterion to become eligible for medicaidfinancial status
by law federal matching funds to the states for medicaid cannot be less than50%
the insurance arm of military health care is calledtricare
to receive payment for services delivered providers must file a ___ with third party payersclaim
the use of fee for service reimbursementhas been greatly reduced
_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of servicefee for servce
what is the incentive under fee for service reimbursementproviders have an incentive to deliver nonessential services
in general prospective payment systems establish reimbursement forbundled services
RVU’s reflectresource inputs
preferred providers are paidnegotiated discounted fees
when a fixed monthly fee per enrollee is paid to a provider its calledcapitation
capitation removes the incentive toprovide unnecessary services
under retrospective reimbursement a health care organization is paid according tothe costs incurred in operating the institution
wheat perverse incentive is present in retrospective reimbursementproviders can increase their profits by increasing costs
the amount of reimbursement is determined before the services are deliveredprospective reimbursement
what is not a type of prospective reimbursement methodologycost-plus
a DRG representsa group of principal diagnoses
an MS-DRG method of reimbursement an acute care hospital is paieda fixed amount for a particular DRG classification
under the DRG method of reimbursement a psychiatric hospital is paida per diem rate based on psychiatric DRG’s
how is case mix determined for an inpatient facilitya comprehensive assessment of each patient is done
what is the minimum data set (MDS)a patient assessment instrument for skilled nursing facilities
if national health expenditures amount to 18% of the GDPhealth care consumes 18% of the total economic production
the largest share of national health expenditures is attributed topersonal health care
public/government share of the total health care spending in the US is approximately45%
adverse selection makes health insurance less affordable forthose in good health
Medicaid recipients are classified as medically uninsured t/fFALSE
Health insurance increases the demand for heath care services t/ftrue
tax policy in the us provides an incentive to obtain employer based health insurance t/ftrue
people in older age groups represent a higher risk than those in lower age groups t/ftrue
under community rating people are charged in the same regardless of health risk t/ftrue
today the majority of health insurance exists in the form of managed care plans t/ftrue
by law a health insurance plan must cover work related injuries t/ffalse
the government plays a significant role in financing health care services in the united states t/ftrue
it is illegal for an insurance company to sell a medical plan to someone who is covered by medicaid t/ftrue
under the ACA private health insurance will no longer be the main source of coverage t/ffalse
the ACA requires that employers provide health insurance to part time workers if the employer has 50+ woerksfalse
health insurance plans are prohibited from having lifetime dollar limits on medical benefits t/ftrue
health insurance plans are allowed to have annual dollar limits on a persons medical benefit t/ffalse
undr medicare program, eligibility criteria and benefits are consistent throughout the US t/ftrue
part D of medicare does not require the payment of a premium t/ffalse
long term care services for the elderly are covered under medicarefalse
under the medicaid program eligibility criteria and benefits are consistent throughout the us t/ffalse
state governments are required to partially finance the medicaid program t/ftrue
according to a US supreme court decision individual states can decide whether or not to expand their medicaid programs to comply with ACAtrue
research shows that prospectively set bundled payment methods are effective in reducing health care t/ftrue