Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3) Health Care Delivery 1 > 3) Health Care Financing, Access, Payment, and Formats > Flashcards

3) Health Care Financing, Access, Payment, and Formats Flashcards

1
Q

What are the types of payment for health care?

A
  • Out-of-pocket
  • Individual private insurance
  • Employer-based private insurance
  • Govt financing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

As of 2013, the highest percentage of the national health expenditure went towards what type of payment?

A

Government financing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Out-of-pocket payment

A

2 party-deal involving cash or barter

  • Was the most common payment type until the mid-20th century
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Individual Private Insurance

A

Third-party system where the insurer acts as the third party and is included in transactions btwn the two basic parties (pt/consumer & provider)

  • Requires 2 transactions:
    • Consumer premiums to insurance company
    • Insurer reimburses the provider
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Employment-Based Private Insurance

A

Type of third-party payment system where the employer pays the premiums to the insurance company

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the purpose of govt-financed health care

A
  • Redistributes the funds from wealthy to the poor, elderly, and people who can access insurance through their job
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does govt-financed health care work?

A

An individual enrolls and taxpayers subsidize and then the govt pays the provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medicare Part A

A

Inpatient hospital insurance plan financed through social security

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medicare Part B

A

For outpatient/physician services; Financed by federal taxes and monthly beneficiary premiums

  • You have to pay into it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Medicaid

A

State-run programs for low-income peeps; Funded by federal and state taxes

  • Have to qualify for this
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Medicare Part D

A

Prescription drug coverage

  • Optional
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CHIP

A

Companion program to Medicaid to make it easier for kids to get coverage

  • Implemented in the 1990’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the 3 types of health care financing

A

Progressive - Pay more as you make more based on tax brackets

Regressive- Pay a fixed percent; Not based on income

  • Most common in US

Proportional- Proportional to income

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Access

A

The timely use of personal health services to achieve the best health outcomes; A person’s ability to obtain health care services when needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Availability

A

Can you get the (special) services you need?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Accessibility

A

Payment options, Convenience, Physical access to the office

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Affordability

A

Individual’s ability to afford coverage and meet cost-sharing requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acceptability

A

Bedside manner; Cultural competance

19
Q

How does lack of insurance affect access to health care?

A

It delays the seeking of care, the condition worsens, and then more skilled/costly care is needed

20
Q

True or false: Uninsured kids can access care more easily than uninsured adults?

A

True

21
Q

Market Justice

A

Free market where health care is an economic good and based on people’s ability to pay

  • Tends to be the school of thought for the politically conservative
22
Q

Social Justice

A

Runs under the belief that health care is a right so the government assists w/allocation

  • Tends to be the belief for democrats
23
Q

Moral Hazard

A

People are more likely to seek care when someone else is paying for it

24
Q

Health Disparity

A

A higher burden of illness, injury, disability, or morality on one group relative to another

25
Q

Health Care Disparity

A

Differences btwn groups in health coverage, access to care, and quality of care

26
Q

What are the types of payment methodologies?

A
  • Self-pay
  • Fee for service
  • Bundled
    • Per diem/per visit
    • Per episode
    • Capitation
27
Q

Self-Pay

A

Cash-based services where the pt directly pays the provider for services

  • Bill is given directly to the pt
  • Pt can submit to insurance
  • Maximizes cash flow and minimizes administrative burden on the provider
  • Limits market to those who are willing/able to pay
28
Q

Fee for Service

A

Provider reports each service delivered w/a fee for each

  • Basis of payment for outpatient PT
  • Uses CPT codes
  • Fees/charges are set by the provider
    • Leads to overutilization
29
Q

Per-Visit/Per Diem

A

Bundled payment where one lump sum payment is given for each visit regardless of a number of services provided

  • Moving more towards this trend
  • Can require CPT codes
30
Q

Per-Episode Payment

A

One lump-sum payment is given for an episode of care

  • Not based on charges→Quality measures are attached to this
  • Allows the provider freedom to select which services will be provided
  • Associated w/reduced administrative costs
  • Basis for diagnosis-related groups
  • Issues=Accuracy of dx/px, outliers, definition of “episode”
31
Q

Capit

A

A monthly/yearly lump-sum payment that covers all subscribers

  • Incentivizes to keep the population healthy
  • High risk to provider
32
Q

Describe risk pattern for self-pay

A

High risk to pt; Low risk for provider

33
Q

Describe the risk pattern for fee-for-service

A

High risk to payer

34
Q

Describe the risk pattern for bundled services

A

High risk for provider

35
Q

What payment methods are used for hospitals?

A

Fee-for-service and Per-diem

36
Q

Diagnostic Related Group

A

A type of per-diem payment under medicare part A where payment rates are based on the resources needed to care for each DRG

37
Q

What payment methods are used for inpatient rehab?

A

Per-diem, Private managed care, or prospective payment system (PPS)

38
Q

PPS

A

Utilizes info from the pt assessment instrument to classify pt’s into groups and payment is linked to the pt’s fxnl level

39
Q

What payment methods are used for SNF’s?

A

Contract, Per-diem, or Medicare PPS

  • Part A rates based on case mix using a resident classification system
40
Q

What payment methods are used for long-term care hospitals?

A

PPS

41
Q

What payment methods are used for home health?

A

Medicare, Medicaid, Fee-for-service, Managed care, or Private Pay

42
Q

Describe Medicare Part A: Home Health

A
  • PPS
    • Predetermined base payments are given to the agency based on case mix adjustments for pt’s conditions and needs of pt
    • Rates are adjusted to geography
    • Based on the OASIS
    • Consolidated billing for nursing, therapy services, medical supplies, home health aides. & medical social services
43
Q

What is the basis of payment for Medicare Part B?

A

Physician Fee Schedules

Medicare pays the provider 80% of the fee schedule amount and the pt is responsible for the remaining 20%

3) Health Care Delivery 1 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions