chapter2 intro to health ins & healthcare Flashcards
insurance
contract that protects the insured from loss
Insurance company
guarantees payment to insured for an unforeseen event
Premium
mount the insured pays to an insurance company for coverage
Other types of insurance
automobile, disability, liability, malpractice,
property, life
Managed health care
or managed care) (delivery of benefits and services
through contracted arrangements
Health care insurance
s a more traditional form of reimbursing
health care costs and involves a contract between a policyholder and a third-party
payer or government health program
Managed health care
focuses on cost management (or cost
containment), utilization, and quality by delivering health plan benefits through
contracted arrangements between individuals or health care programs and
managed care organizations (MCOs). MCOs accept a predetermined per member
per month (capitation) payment for services
advantage of health insurance
is the availability of providers for care, while
managed care can provide cost savings. A disadvantage of health insurance is it
can be costly, while managed care may limit the availability of providers in a
service area.
Private health insurance
66.5%
Private health insurance
17.8%
Medicare
18.4%
Military health care
3.7%
Group health insurance
Coverage subsidized by employers and other organizations
Distributes cost of health insurance among group members
Individual health insurance
Private health insurance policy purchased by individuals or families who do not have
access to group health insurance coverage
Public health insurance
Federal and state government health programs
- Include Medicare, Medicaid, CHIP, and TRICARE
Single-payer plan
- National health service model adopted by some Western nations
- Funded by taxes
- Government pays for residents’ health care as a basic social service
Socialized medicine
- Single-payer health system
- Government owns and operates health care facilities
- Government pays providers their salaries
Universal health insurance
- Social insurance model with goal of providing every individual with access to health
coverage, regardless of the system implemented - Combination of private and public health insurance
- Example: PPACA of 2010 extended health coverage to millions of uninsured
Americans by (originally) requiring them to purchase health insurance
Health Insurance Coverage Statistics
that 106.4 percent of
people in the United States are covered by some form of health insurance.
hat is because some are covered by more than one health insurance
plan and they are counted more than once when percentages are calculated
