chapter 5 economics of US health care delivery

Question 1

fixed amounts of money paid per person by
health plan to provider for services

Answer 1

capitation

Question 2

cost sharing (fee) required by health plan –
the individual must pay fixed $ amount for service provided

Answer 2

co-payment

Question 3

cost sharing the individual pays a specified
amount before health plan pays for covered services

Answer 3

deductible

Question 4

Medicare-originated system to classify hospital cases, developed as part of the
prospective payment system to encourage cost-efficient management of care. The hospital is typically paid a flat
rate for it, regardless of the actual services provided

Answer 4

diagnosis related group (DRG)

Question 5

person in Managed Care Organization (MCO) who decides whether a patient will be referred for specialty care

Answer 5

gatekeeper

Question 6

system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company

Answer 6

managed care

Question 7

federal health insurance program for persons over 65, disabled, or end-stage disease

Answer 7

medicare

Question 8

joint federal and state funded health care services for low income persons

Answer 8

medicaid

Question 9

compensates provider on a case basis for health services

Answer 9

prospective payment

Question 10

service provided & payment follows after the service

Answer 10

retrospective payment

Question 11

state mandated, and state funded; income replacement and health care to workers who sustain a work-related injury

Answer 11

workers’ compensation

Question 12

4 factors affecting resource allocation in healthcare

Answer 12

-uninsured
-poor americans
-access to health services (medicaid, affordable healthcare act)
-rationing healthcare (american health benefit exchanges)

Question 13

4 phases of development of healthcare systems

Answer 13

-1: preindustrial era
-2: postindustrial era
-3: corporate era
-4: challenges for 21st century

Question 14

examples of challenges for 21st century

Answer 14

-Reemergence of old communicable and infectious diseases
-Larger foodborne disease outbreaks
-Acts of terrorism
-Chronic disease
-Health disparities
-Technology
-Labor force changes
-Changes in nursing education
-Doctorate of Nursing Practice
-Affordable Care Act

Question 15

3 big factors influencing healthcare costs

Answer 15

-demographics (aging, life expectancy, health policy reform, ethnicity and health disparities)
-technology and intensity
-chronic illness

Question 16

public support for finances of healthcare

Answer 16

-medicare
-medicaid
-prospective payment groups
-diagnosis related groups
-TRICARE
-VA
-affordable care act’s prevention and public health fund (PPHF)

Question 17

what are the 4 parts of medicare

Answer 17

part A: hospitalization
part B: some medical expenses, home health, preventive services
part C: medicare advantage care plans
part D: prescription drugs

Question 18

examples of people who might qualify for medicare

Answer 18

-65+ yo who have worked
-long term disabilities
-end stage renal disease
-ALS

Question 19

how is medicare funded

Answer 19

tax on wages (employers and employees)

Question 20

how is medicaid funded

Answer 20

jointly funded state federal program

Question 21

examples of people who might qualify for medicaid

Answer 21

-low income families
-children
-pregnant women
-aged
-blind
-disabled

preventative, acute, and long term care

Question 22

who might qualify for TRICARE

Answer 22

-active duty service members and their families
-retirees from the armed services
-those who cannot get care at a military health hospitals or clinics

Question 23

those who do not have health insurance
coverage, do not qualify for government HC assistance, and are unable to pay healthcare costs on their own

Answer 23

medically indigent