Chapter 4

Question 1

America spent how much on healthcare in 2004?

Answer 1

$1.878 trillion

Question 2

Healthcare comprised how much of GDP?

Gross domestic product

Answer 2

16 %

Question 3

Who pays for health care?

Answer 3

Third party reimbursers. = insurance companies.

blue shield, signa.

Question 4

Disproportionate growth in health care expenditures

Answer 4

Aging population
Lack of competitive forces in H.C.S.
Maldistribution of phys. & other providers of H.C.S.

(healthcare services)

Question 5

Payment sources

Answer 5

-private Heath insurance
    37%
-out of pocket payment
   13%
-philanthropy & other private sources
   4%
-fed, state, local gov't 46%

Question 6

Health insurance: distributing risk

Answer 6

Illness is an anticipated event, but it is uncertain for the individual patient.

Ex: pooling risk- health insurance will tell Dr. They will pay $50 for every female coming in to the office ages 25.

Question 7

Violations to insurance assumptions

Answer 7

What beliefs one person does not affect another.

Question 8

MORAL HAZARD

Answer 8

To the extent that the event insured against can be controlled, there exists a temptation to use insurance.

                                      (cont.. Question)

Question 9

Moral hazard

Answer 9

If you have insurance you are more likely to go to the dr. than of you don’t.

Question 10

ADVERSE SELECTION

Answer 10

higher number of claims due to sickness than would be probable on a random basis.

[You picked wrong]

Question 11

How do we pay insurance? Premium

Answer 11

Taken out of check by employer.

Question 12

Deductible

Answer 12

Sum of $ which must be paid by the

Patient on an annual basis before the insurance policy becomes active.

Question 13

Copayment

Answer 13

Sum of money paid as the beneficiary uses the insurance.

Question 14

Coinsurance

Answer 14

Percentage of the total charges incurred and is paid by the patient.

Question 15

DME

Answer 15

Durable medical equipment

Question 16

3 items most insurance pay for?

Answer 16

Crutches
Walkers
Wheelchairs

Question 17

Medicare

Answer 17

Persons 65 and over
Disabled indiv. Who r entitled to soc sec ben.
End-stage renal disease victims.

Question 18

Part A

Answer 18

Hospital

Question 19

Part B

Answer 19

Dr. Office

Question 20

Part C

Answer 20

Medicare advantage

Question 21

Part D

Answer 21

Drugs

Question 22

Basic health benefits (10)

Answer 22

1. Hospital inpatient care
2. Hospital outpatient services
3. Certified nurse practitioner services
4. Lab and X-ray services
5. Nursing facility services for those aged 21 and older

Question 23

Basic Health benefits

Answer 23

6. Home heal services for those eligible for nursing services.
7. Physicians services
8. Family planning services and supplies
9. Rural health clinic services
10. Early periodic screening, diagnosis, and treatment for children under 21.

Question 24

Basic health benefits

Answer 24

12. Nurse midwife services
13. Certain federally qualified health care serv.
14. Medicaid and surgical services furnished by a dentist.

Question 25

Most common optional services

Answer 25

1. Clinic services
2. Nursing service in a care facility for the aged and disabled.
3. Intermediate care facility services for the mentally restarted.
4. inpatient psychiatric services.

Question 26

Common optional services

Answer 26

5. Optometrist services and eyeglasses
6. Prescribed drugs
7. Prosthetic devices
8. Dental care

Question 27

NIH

Answer 27

National institution of health

Question 28

Physician reimbursement

Answer 28

Fee for service
Indemnity
Fixed fees
Prepayment 
Salary

Question 29

Bonus

Answer 29

If you are set to have 20 and end up with 25. You are paid for the extra 5.

Question 30

Capitation

Answer 30

Used as a fixed budget. Prepay.

Advantages: admin simple, facilitates budgeting, phys control cost of services.
Disadvantage: decrease cost and serv prov.
Incentives for dumping patients on others.
Little transparency of phys profile practice.

Question 31

Salary

Answer 31

Set salary to take care of everyone.

Adv: admn simple, medical tray,wants selected are not influenced by profitability, encourage cooperatiion among phys, facilitate advance budgeting.
Disad: fewer patients, patient loose acono,it clout over phys, lil transparency of phys profile practice.

Question 32

Resource-based relative values

Answer 32

Initiated by amedicare on Jan 1,92 as a new sys for reimbursing phys.

Question 33

Relative value unit is comprised of 3 things…

Answer 33

1. Physician work
2. Practice expenses
3. Malpractice insurance