Chapter 13: Health Care Delivery Systems

Question 1

What is Medicare?

Answer 1

• Federal government program that makes health care payments to those on social security
• program pays health care costs for older (age > 65), disabled, and dependents of disabled

Question 2

What does Medicare part A cover?

Answer 2

pays for hospital care

Question 3

What does medicare part B cover?

Answer 3

pays for physician services

Question 4

What Medicaid?

Answer 4

joint/federal program that covers all care for those on welfare

Question 5

Compare and contrast deductibles and copayments in medicare vs medicaid.

Answer 5

Medicare = annual deductibles and copayments
Medicaid = no deductibles or copayments

Question 6

What is HMO?

Answer 6

health maintenance organization

prepaid group practice that hires physicians or contracts with physicians to provide services

Question 7

How is payment made in HMO?

Answer 7

made by capitation: fixed payment for the number of patients in your care

Question 8

What is incentivized in HMOs?

Answer 8

preventive care

Question 9

What is PPO?

Answer 9

preferred provider organization

fee for service at a discount

Question 10

What does the provider mainly make money for in PPO?

Answer 10

money on volume i.e less money per patient but more patients