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HTH354 > 5 medical technology, 6 health services financing > Flashcards

5 medical technology, 6 health services financing Flashcards

1
Q

medical technology def.

A

the practical application of the scientific body of knowledge for the purpose of improving health and creating efficiencies in the delivery of health care

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2
Q

nanomedicine def.

A

an emerging area which involves the application of nanotechnology for medical use

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3
Q

information technology

A

deals with the transformation of data into useful information. Involves determining data needs, gathering appropriate data storing and analyzing the data and reporting the information in a format desired by its end users

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4
Q

clinical information systems

A

organized processing storage, and retrieval of information to support patient care delivery
e.g. electronic records, computerized physician order entry CPOED

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5
Q

Administrative information systems

A

Assist in carrying out financial and administrative support activities such as payroll, patient accounting, billing. etc

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6
Q

Decision support systems

A

provide info and analytical tools to support managerial and clinical decision making
two types: managerial, clinical

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7
Q

two types of decision support systems

A

managerial, clinical

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8
Q

managerial decision support systems

A

forecast patient volume, project staffing requirements etc.

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9
Q

clinical decision support systems

A

general references, treatment protocols

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10
Q

health informatics

A

application of info science to improve the efficiency accuracy and reliability of health care services

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11
Q

HITECH law

A

George w. bush
part of the American recovery and reinvestment act
2009
promotes EHR’s

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12
Q

E- health

A

all forms of electronic health care delivered over the internet

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13
Q

M- health

A

mobile health use of a wireless device

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14
Q

E- therapy

A

any type of professional therapeutic interaction that makes use of the internet

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15
Q

what percent of physicians use EHR?

A

78

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16
Q

FDA

A

food and drug administration

regulation of drugs, medical devices and equipment, and biological products

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17
Q

CON

A

certificate of need
varies by state, requires hospitals to seek approval before acquitting major equipment or embarking on new construction/modernization projects

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18
Q

AHRQ

A

agency for healthcare research and quality

research on technology cost

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19
Q

NIH

A

national institution of health

conducts and supports biomedical research

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20
Q

ACA med. tech.

A

placed a 2.3% tax on medical devices except glasses, contacts, hearing aids

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21
Q

The insurance company is considered _______ because they _______

A

the underwriter, asses risk

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22
Q

deductible, copayment, coinsurance, and stop-loss prevention are all part of which strategy

A

cost-sharing

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23
Q

deductible

A

until deductible point is reach insurance doesnt kick in

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24
Q

cost- sharing protects against?

A

moral hazard

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25
Q

copayment

A

a set fee that you pay when you use a specific service

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26
Q

coinsurance

A

percentage of a service or something that has been provided

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27
Q

stop-loss prevention

A

no matter what you’ll only spend a certain amount of out of pocket for each fiscal year

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28
Q

public insurance

A

medicare, medicaid, indian health service, military health services, system, TriCare veterans health administration, CHAMPVA

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29
Q

what portion of the population is covered under public health insurance

A

1/3

30
Q

medicare covers?

A

65+, disabled with social security benefits, end stage renal disease

31
Q

balanced budget act

A

1997 medPAC advices congress on medicare

32
Q

what type of program is medicare? why?

A

entitlement, because we pay taxes

33
Q

how is part A financed?

A

payroll taxes

34
Q

what does Part A cover?

A

hospital insurance

35
Q

how is Part B financed?

A

75% general federal tax revenue 25% monthly premiums

36
Q

what does part B cover?

A

supplementary medical insurance, physician services, emergency department services, outpatient surgery, diagnostic test and lab services

37
Q

what does part C cover?

A

allows people to use an MCO to administer their medicare benefits

38
Q

what does part D cover?

A

drugs

39
Q

how is part D financed?

A

with premiums and deductibles

40
Q

what type of program is medicaid?

A

means tested program

41
Q

how is medicaid funded?

A

by states and federal government

42
Q

types of private insurance

A

group insurance, self-insurance, individual, high deductible health plans, medigap

43
Q

what is the main source of coverage?

A

private healthcare

44
Q

private hc coverage for dependents under ACA

A

does not require coverage for dependents but if the plan does include coverage they have to be covered until 26 yrs old

45
Q

coverage for preventative services under ACA

A

required to include recommended preventative services and immunizations with no cost sharing

46
Q

recommended preventative services include:

A

services that will have substantial benefits
immunizations that are routine
services for infants, children and adolescents
women: contraceptives, well visits, screening, etc.

47
Q

medical loss ratios

A

% of premium revenue spent on medical expenses in 2011 minimum mlr of 85%

48
Q

what is the minimum essential coverage under the ACA?

A

have to have at least a bronze level plan

49
Q

ACA individual mandate

A

required to have a minimum essential plan if not must qualify for exemption of pay tax

50
Q

exemptions to individual mandate

A

cant afford it more than 8% of household income, religious opposition

51
Q

penalty tax for individual mandate

A

695$

52
Q

four tiers of insurance

A

bronze 60%
sliver 70%
gold 80%
platinum 90%

53
Q

employer mandate ACA

A

also known as employer shared responsibility
play or pay: employers have to provide employees with HI or pay penalty
50 or more employees
must satisfy minimum value test and affordability

54
Q

minimum value test and affordability

A

pays for at least 60%
must not exceed 9.5% of household income
must provide for families up to the age of 26 at least a bronze level plan

55
Q

employer penalty ACA

A

two types: annual tax of 2,000 per full time employee minus first 30, when they fail minimum value and/or affordability have to pay 3,000 per full time employee

56
Q

Third party payers

A

insurance company or medicaid/medicare

57
Q

charge

A

set by provider hospital/physician

58
Q

rate

A

set by a third party insurance company

59
Q

claim

A

what providers give to insurance companies to pay

60
Q

reimbursement methods

A

fee for service, bundled charges, resources based relative value scale, managed care approaches, cost plus reimbursement `

61
Q

fee for services

A

balanced bill

62
Q

bundled charges

A

package picking, one comprehensive price that includes everything

63
Q

resources based relative value scale

A

medicare physician fee schedule

64
Q

managed care approaches

A

preferred provider, capitation, salary

65
Q

cost plus reimbursement

A

retrospective- per-patient day

prosepective- how much the patient should stay limits to that

66
Q

group insurance

A

anticipates that a substantial number of people in the group will purchase insurance though its sponsor

67
Q

self- insurance

A

employer acts as its own insurer instead of obtaining through company
61%

68
Q

managed care plans

A

high deductible health plans, medigap

69
Q

high deductible health plans

A

savings option combined with health plan
gaining popularity
low premiums
consumers have more control

70
Q

medigap

A

medicare supplement insurance

private health insurance that can be purchased only by those enrolled in the original medicare program

HTH354 (8 decks)

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