ch 3 Flashcards
-What are examples of a government-funded health insurance programs?
Medicare, Medicaid, and CHIP
-In 2019, which programs comprised a total of 25% of the federal budget?
Medicare, medicaid, CHIP, Market place subsidies
what is “fee for service”
volume of service paid to provider
- What were the top two Medicare benefit payments in 2014
Hospital inpatient services and private insurance
- What were the highest and the lowest Medicare expenditures in 2013
Acute care and mental health
- In 2019 Medicaid provided coverage to 1 in 5 Americans, which makes it the nation’s largest public health insurance program. T/F
true
- True or False? The first pre-payment plan to cover physician services was Medicare.
false
- True or False? In 1983, Congress passed a prospective payment bill under which hospitals are paid a set amount for each patient in any of the established disease categories and Diagnosis-Related Groupe (DRGS).
true
- True or False? The first managed care insurance programs were started with PPOs: Kaiser Permanen in Califomia and Group Health Cooperative in Washington State.
false
- True or False? About 85% of those offered health insurance through their employer actually enroll.
false
- In an effort to control rising healthcare costs, both public and private health insurance programs have moved to _____
capitation
- The
______
program is a federal health program for people aged 65 years and
older, certain disabled people younger than 65, and any adult with permanent kidney failure (end-stage renal disease) or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).
Medicare
____ is the federal-state cooperative health insurance plan for people who are
not eligible for health insurance through an employer and who cannot afford to buy health insurance through the Marketplace.
Medicaid
- Private funding is primarily through private health insurance, with what percentage of Americans having employer-sponsored health insurance in 2015?
57%
- Health care in the United States is funded through a variety of private payers, as there are no public programs available in this country. T/F
false
- Capitation as a method of reimbursement is best described as
amount paid to the provider for medical
service
- The traditional method of reimbursement for health services before the passage of the Affordable Care Act was fee-for-service. T/F
true
- Examples of government or public health insurance programs include
Medicare, Medicaid, and
TRICARE
Medicaid is the federal-state cooperative health insurance plan for which group of people?
Individuals with low income
- Medicare and Medicaid are government or public health insurance programs that benefit 1 in 10
Americans. T/F
false
- What best describes a Health Maintenance Organization (HMO)?
HMO does not cover out-of-network care except an emergency
- The first managed care insurance programs were started with HMOs. T/F
true
- Managed Care Organizations are divided primarily into HMOs, PPOs, and Exclusive Provider Organizations. T/F
true
- In what year was Medicare expanded to include those with certain disabilities, chronic kidney disease, and ALS?
1972
- Government-sponsored healthcare efforts were initiated at the state and federal level at the same time.
at different times
-The availability of employer-sponsored coverage has been increasing, with an increase from 50% to 67% between 2000 and 2015. T/F
true
-Nearly two-thirds of total Medicaid expenditures cover either the elderly or persons with disabilities. T/F
false
- In 2019, what was the total amount of the annual premium for employer-based health insurance for family coverage?
$20,576
- In 2019, total Medicaid expenditures were nearly $613 billion, with one-third of expenditures spent on long-term services and supports in 2018. T/F
true
-Nearly two-thirds of total Medicaid expenditures cover either the elderly or persons with disabilities. T/F
false
-Changes in the way health care is being paid for in both the public and private sectors will impact healthcare personnel and career opportunities. How would you describe the way in which career opportunities will be impacted?
more job opportunities.
