2020 Exam Flashcards
four things included in PPACA SATA
- voucher program for medicare
- expansion of dependent coverage up to 26 yo
- elim of lifetime benifit cap
- elim of denying coverage based on conditions
- dec part d coverage gap
- expansion of dependent coverage up to 26 yo
- elim of lifetime benifit cap
- elim of denying coverage based on conditions
- dec part d coverage gap
limitation of resources?
rationing
major federal health policy initiatives are rarely successful without support from..
The American Medical Association
Which are defining trends of present day US Healthcare
- growth of specialist services due to higher reimb.
- dramatic inc in power of patient
- “provider counter-revolution” to fight aggressive reimb from private ins
- improved perception of manufacturers
- consolidation of payers so that 3 ins providers cover 60% of the non-CMS populaiton
- growth of specialist services due to higher reimb.
- dramatic inc in power of patient
- “provider counter-revolution” to fight aggressive reimb from private ins
- consolidation of payers so that 3 ins providers cover 60% of the non-CMS populaiton
in the 2000s, HMOs faded, hospital consolidation expanded, physicians formed multi-specialty groups
what was the major theme
providers consolidated and became the major power in healthcare
major actors in healthcare in US
purchasers
suppliers
insurers
providers
with PLATINUM PPACA plan, insurer covers ____% of total costs
90%
with BRONZE PPACA plan, insurer covers ____% of total costs
60%
What are essential benefits defined by PPACA
emergency care, inpatient care, prescription drug coverage
which country has mandatory sick funds
Germany
two types of scarcities
fiscal - money issue
commodity - supply of a product issue
elements of quality care
safe effective patient-centered efficient equitable
components of high quality care
access
adequate scientific knowledge
competent providers
separation of financial and clinical decisions
organization of healthcare institutions to maximize quality
most common reimbursement model in US
FFS
Medicare parts A, B, C and D are for what?
A = hospital B = physician services, tests, equipment C = Medicare managed care plans D = prescription drug coverage
How does ACA incentivize enrollment in a health ins plan
INDIVIDUAL mandate with an INDIVIDUAL penalty tax for any individuals failing to enroll in health insurance
T or F
The US uses its own health ins marketplace, not the national marketplace
T
What covers custodial care
Medicaid
What covers skilled care
Medicare
SATA People w/out ins are more likely to experience 1. preventative care 2. death 3. avoidable hospitalizations 4. early dx 5. overall worse clinical outcomes
- death
- avoidable hospitalizations
- overall worse clinical outcomes
cost-sharing leads to
- patients use less care that is inappropriate
- patients use less care that is appropriate
- medication persistence increases
- amb care utilization by the poor is decreased
- patients use less care that is inappropriate
- patients use less care that is appropriate
- amb care utilization by the poor is decreased
out of pocket payment, government financing, employment-based private ins
list in order from least to most expenditures in the US
out of pocket –> employment based priv ins–> government financing (spends most)
which area of pharmacy is responsible for the most # of drug expenditures
community pharmacy
Medicare covers which individuals
elderly and sick
Medicaid covers which individuals
poor
regulatory price controls is an example of which cost containment category
reimbursement, finance, utilization
reimbursement
regulatory limits on ins premiums is an example of which cost containment category
reimbursement, finance, utilization
finance
step-therapy requirements is an example of which cost containment category
reimbursement, finance, utilization
utilization
SATA
which are painless cost control strategies
- est limits on # of procedures
- reduce administrative waste
- inc preventative care–> reduce late stage illness
- inc copays
- generic sibstitution
- reduce interventions which offer no benefit
2,3,5,6
T or F
prescribing max statins to reduce cholesterol of a patient w hx sig for MI is secondary prevention
true dat
