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US HCS Final > 2020 Exam > Flashcards

2020 Exam Flashcards

1
Q

four things included in PPACA SATA

  1. voucher program for medicare
  2. expansion of dependent coverage up to 26 yo
  3. elim of lifetime benifit cap
  4. elim of denying coverage based on conditions
  5. dec part d coverage gap
A
  1. expansion of dependent coverage up to 26 yo
  2. elim of lifetime benifit cap
  3. elim of denying coverage based on conditions
  4. dec part d coverage gap
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2
Q

limitation of resources?

A

rationing

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3
Q

major federal health policy initiatives are rarely successful without support from..

A

The American Medical Association

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4
Q

Which are defining trends of present day US Healthcare

  1. growth of specialist services due to higher reimb.
  2. dramatic inc in power of patient
  3. “provider counter-revolution” to fight aggressive reimb from private ins
  4. improved perception of manufacturers
  5. consolidation of payers so that 3 ins providers cover 60% of the non-CMS populaiton
A
  1. growth of specialist services due to higher reimb.
  2. dramatic inc in power of patient
  3. “provider counter-revolution” to fight aggressive reimb from private ins
  4. consolidation of payers so that 3 ins providers cover 60% of the non-CMS populaiton
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5
Q

in the 2000s, HMOs faded, hospital consolidation expanded, physicians formed multi-specialty groups

what was the major theme

A

providers consolidated and became the major power in healthcare

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6
Q

major actors in healthcare in US

A

purchasers
suppliers
insurers
providers

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7
Q

with PLATINUM PPACA plan, insurer covers ____% of total costs

A

90%

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8
Q

with BRONZE PPACA plan, insurer covers ____% of total costs

A

60%

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9
Q

What are essential benefits defined by PPACA

A

emergency care, inpatient care, prescription drug coverage

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10
Q

which country has mandatory sick funds

A

Germany

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11
Q

two types of scarcities

A

fiscal - money issue

commodity - supply of a product issue

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12
Q

elements of quality care

A 
safe
effective
patient-centered
efficient
equitable
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13
Q

components of high quality care

A

access
adequate scientific knowledge
competent providers
separation of financial and clinical decisions
organization of healthcare institutions to maximize quality

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14
Q

most common reimbursement model in US

A

FFS

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15
Q

Medicare parts A, B, C and D are for what?

A 
A = hospital
B = physician services, tests, equipment
C = Medicare managed care plans
D = prescription drug coverage
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16
Q

How does ACA incentivize enrollment in a health ins plan

A

INDIVIDUAL mandate with an INDIVIDUAL penalty tax for any individuals failing to enroll in health insurance

17
Q

T or F

The US uses its own health ins marketplace, not the national marketplace

A

T

18
Q

What covers custodial care

A

Medicaid

19
Q

What covers skilled care

A

Medicare

20
Q 
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
A
  1. death
  2. avoidable hospitalizations
  3. overall worse clinical outcomes
21
Q

cost-sharing leads to

  1. patients use less care that is inappropriate
  2. patients use less care that is appropriate
  3. medication persistence increases
  4. amb care utilization by the poor is decreased
A
  1. patients use less care that is inappropriate
  2. patients use less care that is appropriate
  3. amb care utilization by the poor is decreased
22
Q

out of pocket payment, government financing, employment-based private ins

list in order from least to most expenditures in the US

A

out of pocket –> employment based priv ins–> government financing (spends most)

23
Q

which area of pharmacy is responsible for the most # of drug expenditures

A

community pharmacy

24
Q

Medicare covers which individuals

A

elderly and sick

25
Q

Medicaid covers which individuals

A

poor

26
Q

regulatory price controls is an example of which cost containment category
reimbursement, finance, utilization

A

reimbursement

27
Q

regulatory limits on ins premiums is an example of which cost containment category
reimbursement, finance, utilization

A

finance

28
Q

step-therapy requirements is an example of which cost containment category
reimbursement, finance, utilization

A

utilization

29
Q

SATA
which are painless cost control strategies

  1. est limits on # of procedures
  2. reduce administrative waste
  3. inc preventative care–> reduce late stage illness
  4. inc copays
  5. generic sibstitution
  6. reduce interventions which offer no benefit
A

2,3,5,6

30
Q

T or F

prescribing max statins to reduce cholesterol of a patient w hx sig for MI is secondary prevention

A

true dat

US HCS Final (1 decks)

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