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FIN 350 Exam 4 > Chapter 15 > Flashcards

Chapter 15 Flashcards

1
Q

Major defects in the healthcare system:

  • rising healthcare expenditures
  • large number of uninsured in the population
  • considerable waste and inefficiency
  • ___ insurer practices
A

harmful

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2
Q

the US continues to spend substantially more on healthcare than

A

foreign countries

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3
Q

the US has lower rates of __ ___ ____

A

health insurance coverage

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4
Q

the US has mixed levels of __ in the population

A

health

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5
Q

with the exception of diagnostic tests, number of hospital visits and surgeries in the US are similar to

A

high income countries

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6
Q

when compared with high income countries the US pays substantially more for physician salaries, pharmaceuticals and health care ____

A

administration

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7
Q

important factors that help explain the increase in healthcare expenditures over time:

  • advances in technology
  • cost insulation because of third party payers.
  • employer sponsored ___ ___
  • __ ___ ___ defects
  • high administrative costs
  • lack of transparency in cost and quality information
  • state-mandated benefits
  • cost shifting by medicare and medicaid.
  • rising prices in the healthcare sector
  • ____ medicine
A

healthcare, fee for service, defensive

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8
Q

Under the FFS model, physicians and other providers are paid for each service provided- the more services provided, the

A

higher the total fees

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9
Q

FFS model has several defects:

  • generate strong financial incentives for providers to provide a high volume of medical tests and services rather than on patient outcomes
  • encourages some physicians to prescribe unnecessary medical __ and ___
  • hides the true costs of healthcare to consumers because of the high percentage of cost paid by __ __ insurer
A

tests and treatment, third party

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10
Q

refers to unnecessary diagnostic tests by physicians, tests with little clinical value to patients, and longer than necessary hospital stays.

A

defensive medicine

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11
Q

major reasons for being uninsured:

  • ___ ___ is the major obstacle to coverage for the uninsured
  • another __% were uninsured because they lost their job or changed employers
  • some eligible uninsured persons are not aware that health insurance is available at subsidized rates for those who qualify.
A

high cost, 23%

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12
Q

harmful insurer practices:

  • exclusions for pre-existing conditions
  • rescission of insurance contracts to limit benefits
  • lifetime or annual limits on ____
A

benefits

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13
Q

means insurers could cancel an individual policy because of misrepresentation, fraud or concealment of a pre-existing condition by the insured when the policy was first issued.

A

recission

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14
Q

the ___ ____ ___ has made health insurance available to millions of uninsured americans. provides substantial subsidies to uninsured individuals and to small business firms and contains numerous provisions to lower heathcare costs in the long run.

A

affordable care act

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15
Q

major provisions that affect individuals and families, insurers, and employers are summarized in the following sections:

  • prohibition of harmful insurer practices
  • individual ___
  • essential health benefits
  • health insurance ___
  • advanced premium tax credits
  • cost-sharing subsidies
  • small business healthcare tax credits
  • expansion of _____
  • improving quality and lowering costs
  • cost and financing
A

mandate, marketplace, medicaid

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16
Q

citizens and legal residents in the United States were required earlier to have qualifying health insurance or pay a financial penalty. also called __ ___ ___

A

essential health benefits

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17
Q

transparent and competitive insurance marketplace where individuals and small firms can purchase affordable and qualified health insurance plans.

A

health insurance marketplace

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18
Q

available to reduce annual out of pocket payments for deductibles, coinsurance, and other cost sharing provisions

A

cost sharing reductions

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19
Q

the ACA provides tax credits to small business firms that have fewer than __ full time employees

A

25

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20
Q

protects an individual or family for covered medical expenses because of sickness or injury.

A

individual medical expense insurance

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21
Q

Marketplace has five plans:

  • bronze plan
  • silver plan
  • gold plan
  • __ plan
  • ___ plan
A

platinum, catastrophic

22
Q

aggregate deductible that must be satisfied only once during the calendar year.

A

calendar year deductible

23
Q

percentage of the bill in excess of the deductible, which the insured must pay out of pocket up to some maximum annual dollar limit.

A

coinsurance

24
Q

coinsurance provision has two basic purposes: to reduce ___ and to prevent ____ of plan benefits.

A

premiums, overutilization

25
Q

flat amount that the insured must pay for certain benefits

A

copayment

26
Q

marketplace policies have an ____________ by which 100% of the covered medical expenses in excess of the deductible are paid after the insured pays a certain annual amount of out of pocket expenses during the calendar year.

A

out of pocket maximum limit

27
Q

_________ is to reduce the crushing financial burden of a catastrophic loss

A

annual out of pocket limit

28
Q

major advantages of the affordable care act:

  • comprehensive benefits
  • dramatic reduction in the uninsured rate
  • subsidies for large percentage of insureds
  • desirable ___ ___
A

economic benefits

29
Q

disadvantages of the current ACA program:

  • horribly complex and an administrative nightmare
  • high premiums and ___
  • no choice of ___ ___
  • relatively few insurers
  • politically unpopular
A

deductibles, individual benefits

30
Q

generic term for medical expense plans that provide covered medical services to the members in a cost effective manner.

A

managed care

31
Q

most popular form of managed care plans, contracts with physicians, hospitals and other healthcare providers to provide covered medical services to policyholders at discounted fees.

A

preferred provider organization (PPO)

32
Q

tax-exempt or custodial account established exclusively for the purpose of paying qualified medical expenses of the account beneficiary who is covered under a high deductible health insurance plan.

A

health savings account

33
Q

health savings accounts have two components:

  • high deductible health insurance policy that covers catastrophic medical bills
  • investment account from which the account holder can withdraw money ______ for medical costs.
A

tax-free

34
Q

two requirements to qualify for HSA:

  • must be covered by a high deductible health plan and must not be covered by any other comprehensive health plan that is not a qualified high deductible plan
  • must not be eligible for ___
A

medicare

35
Q

coverage that pays a daily or monthly benefit for medical or custodial care received in a nursing facility, in a hospital, or at home.

A

long term care insurance

36
Q

major types of policies under long term care insurance:

  • expense-incurred policies
  • ____ policies
A

indemnity

37
Q

most common type of long term care policy, also called reimbursement policies. pays a daily or monthly benefit limit for covered expenses incurred for long term care up to the policy limits.

A

expense incurred policies

38
Q

long term care policy, also called per diem policy, pays a flat dollar amount per day regardless of your actual long term care expenses.

A

indemnity policies

39
Q

allows you to cover more than one person, or to apply the total dollar amount of coverage to various covered services that best meet your need.

A

pooled benefits.

40
Q 
long term care policies may include coverage for the following:
nursing home care
home healthcare
respite care for a caregiver
\_\_\_ care
personal care in the home
services in \_\_ \_\_\_ facilities
services in adult daycare centers
services in other community services
A

hospice, assisted living

41
Q

waiting period during which time benefits are not paid.

A

elimination period

42
Q

tax-qualified policies have __ ___ that determine whether the insured is chronically ill and eligible for benefits.

A

benefit triggers

43
Q

one trigger is called __________. includes eating, bathing, dressing, transferring from bed to chair, using the toilet, and maintaining continence.

A

activities of daily living (ADLs)

44
Q

most states have long term care partnership programs designed to reduce medicaid expenditures by eliminating or reducing incentives of some people to rely on medicaid to pay for

A

long term care

45
Q

important form of individual health insurance

A

disability income insurance.

46
Q

means that due solely to injury or sickness, you are unable to perform the material and substantial duties of your own occupation.

A

total disability

47
Q

defined as a total disability is presumed to exist if the insured suffers the total and irrecoverable loss of sight in both eyes, or the total loss or use of both hands, both feet, or one hand and one foot.

A

presumptive disability

48
Q

means that you are gainfully employed and not totally disabled but, solely because of sickness or injury, your loss of income is at least 15% of your prior income.

A

residual disability

49
Q

elimination periods in disability income insurance is typically

A

90 days

50
Q

if the insured is totally disabled for 90 days, future premiums will be waived as long as the insured remains disabled.

A

waiver of premium provision

51
Q

optional benefits that can be added to a disability income policy:

  • cost of living rider
  • option to purchase additional insurance
  • ___ ___ rider
  • return of premiums
A

social security

FIN 350 Exam 4 (3 decks)

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