Chpt 2- Health Care Economics Study Guide Flashcards
Medicare
federally funded health care program for older Americans
Tricare
a system of that provides medical coverage for active and retired service personnel and their dependents; for military personnel
Which program provides states with the matching funds to expand health coverage for uninsured children?
SCHIP: uninsured children
Which program provides coverage for low-income individuals and families and the disabled?
Medicaid: Low income and disabled
Which program provides coverage for active military and retired military personnel and their dependents?
Tricare: Retired military personnel
Managed care
puts health care providers in the position of managing a patient’s use of health care
Types of Plans: Health Maintenance Organization (HMO) plan, Preferred Provider Organization (PPO) plan, Point of Service (POS) plan
Regulatory compliance
Rules and/or guidelines that have to be followed by healthcare organizations and providers.
Quality assurance
Assessing, monitoring and correcting patient care to enhance the quality of Health Maintenance Services which pursues perfecting patient care.
Resource utilization
Responsibility of all health care professionals, Conscientious time management, Electronic documentation
Which care describes the management of time, staff, equipment, technology, and facilities in providing health care?
Resource utilization
Which type of health insurance coverage is obtained through an employer or purchased as an individual policy?
individual coverage
Which type of health care facility receives federal, state, and local tax exemptions in exchange for providing a community benefit, such as care for Medicaid and other low-income patients?
Nonprofit hospitals
Measures designed to lower health care costs are known as _________.
managed care
Health Maintenance Organization (HMO)
this plan provides coverage only if the care is delivered by a member of its hospital, physician, or pharmacy panel
Point of Service Plan
this is a physician-coordinated plan that combines characteristics of both HMO and PPO plans
Preferred Provider Organization (PPO)
this plan allows patients to receive care from a non-plan provider, but requires them to pay a higher out-of-pocket price if they do so
Restricted Network plan
a limited network of health providers
Which type of plan has a contracted network of providers but also allows members to receive care from non-participating providers?
Preferred Provider Organization (PPO)
Which plan involves coordination of care by a primary care physician and is a hybrid of HMO and PPO structures?
Point of Service plan
Which plan provides coverage only if services are provided by members of its hospital, physician, or pharmacy panel?
Restricted network plan
Define Prospective Payment System
is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount
Outpatient facility
medical facilities that perform procedures that do not require an overnight stay in a hospital or care facility
Government funded facility
Public health care facility that receives most of its funding from local, state, or federal resources
Nonprofit facility
Community facility which receives federal, state, and local tax exemptions in exchange for providing a community benefit
Proprietary facility
For-profit healthcare facility which is usually owned by a corporation
To which type of facility listed in #12 would a VA hospital belong to?
Government funded
What is the purpose of a diagnostic related group?
driving force behind the effort to contain health care costs which is used by Medicare and Medicaid to determine payment for health services; health care paid in standard fees, regardless of actual costs, offers incentive to hospitals for operating more efficiently; members are based on diagnostic and other demographic info
Which type of health care facility is privately owned and is operated as a for-profit organization?
proprietary
What does it mean when a provider is “out-of-network”?
providers who are not in the plan
Which government health plan provides coverage for citizens age 65 and older?
medicare
What is a copay?
a contribution made by an insured person toward the cost of medical treatment or other services
What is a flexible spending account?
offered through an employer and is usually paired with a traditional health insurance policy
What is a health savings account?
commonly paired with a high-deductible health insurance plan
What is coinsurance?
The percentage of costs of a covered health care service you pay
What is an insurance premium?
the amount you pay for an insurance policy
What is a deductible?
the money a person pays before the insurance policy provides benefits
What is the role of a “gatekeeper” in a health insurance company?
the primary care provider
