Chapter 6 & 9 Flashcards
Health Services Financing
What is the primary reason that a segment of the U.S. population is uninsured?
The U.S. has a voluntary system of health insurance
What is the central role of health services financing in the United States?
Fund health insurance
What is the primary mechanism that enables people to obtain health care services?
Health insurance
In national health care systems, total expenditures are controlled mainly through
supply-side rationing
In a general sense, what is the primary purpose of insurance?
Protection against risk
What is the primary function of insurance?
Protection against catastrophic risk
What is the main advantage of group insurance?
Risk is spread out among a large number of insured
The majority of beneficiaries receiving health care through Medicare are
elderly
For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed
100 days
The dependents of U.S. military personnel receive health care through
TriCare
The managed care phenomenon was welcomed mostly by
employers
With the growth of managed care, the balance of power in the medical marketplace swung toward
the demand side
A managed care organization functions like
an inusrer
What is the purpose of cost sharing with providers?
It makes providers cost conscious
Capitation is best described as
per member per month payment
Under capitation, risk is shifted
from the MCO to the provider
Under which payment method is a fee schedule used?
discounted fees
The HMO Act of 1973 required
employers to offer an HMO alternative to conventional health insurance
In the term, managed care, ‘manage’ refers to
management of utilization
Under the fee-for-service system, providers had the incentive to
deliver more services than what would be medically necessary because a greater volume would increase their incomes
Integrated delivery system
A network of organizations that provides or arranges to provide a coordinated continuum of service to a defined population and is willing to be held clinically and fiscally accountable for outcomes and health stAtus of the population services
Healthcare effective as data and information set
The standard for reporting quality information on managed care plans . The standards are developed by national commuter for quality assurance . A private nonprofit organization .
