Chapter 5 Flashcards
Insurance
Mechanism for managing the financial exposure to risk via two basic principles:
- Transferring risk from an individual to a group.
2. Sharing loses on an equitable basis by all members of a group.
Principles of insurance
A loss is slowed to be something out of the ordinary as well as something to be avoided.
Ex: shot on the head
4 employment benefits
Medical
Dental
Vision
Prescription drug
Indemnity
Pay more money out of pocket
Comprehensive deign
Pocket maximum is reached
Capitation deign
Cheaper to prevent a disease than to cure a disease.
Health savings account
Give consumers financial incentives to choose their health care providers and manage their own health expenses.
Long term care coverage
For abuelos
Indemnity product offering a fixed daily reimbursement payment for LTC services.
Short-term programs
Coverage for loss of income due to illness. 5-7 days
Ex: pregnant on bed rest.
Long-term programs
Are often entirely employer-finances
Long-term disability maintains a waiting period before employees are eligible for coverage.
7 objectives of managed care?
- Enhance cost containment
- Implement some forms of rationing
- Promote administrative & clinical efficiency
- Reduce duplication of services
- Enhance appropriateness of care
- Promote comprehensive contracting mechan
- Manage care process by managing provider and consumer behavior.
PPO
Preferred provider organizations
Don’t need s referral as long as they’re in the book
HMO
Health maintenance organizations
Have to go to family physicians
The staff model
Employs its own physicians
Ex: BMW healthcare clinic
Managed care areas of management AREAS U CAN WORK IN
Provider contracting and network management Utilization management Quality management General administration Health info system Sales and marketing management
