Chpt 2- Health Care Economics Study Guide

Question 1

Medicare

Answer 1

federally funded health care program for older Americans

Question 2

Tricare

Answer 2

a system of that provides medical coverage for active and retired service personnel and their dependents; for military personnel

Question 3

Which program provides states with the matching funds to expand health coverage for uninsured children?

Answer 3

SCHIP: uninsured children

Question 4

Which program provides coverage for low-income individuals and families and the disabled?

Answer 4

Medicaid: Low income and disabled

Question 5

Which program provides coverage for active military and retired military personnel and their dependents?

Answer 5

Tricare: Retired military personnel

Question 6

Managed care

Answer 6

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

Question 7

Regulatory compliance

Answer 7

Rules and/or guidelines that have to be followed by healthcare organizations and providers.

Question 8

Quality assurance

Answer 8

Assessing, monitoring and correcting patient care to enhance the quality of Health Maintenance Services which pursues perfecting patient care.

Question 9

Resource utilization

Answer 9

Responsibility of all health care professionals, Conscientious time management, Electronic documentation

Question 10

Which care describes the management of time, staff, equipment, technology, and facilities in providing health care?

Answer 10

Resource utilization

Question 11

Which type of health insurance coverage is obtained through an employer or purchased as an individual policy?

Answer 11

individual coverage

Question 12

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?

Answer 12

Nonprofit hospitals

Question 13

Measures designed to lower health care costs are known as _________.

Answer 13

managed care

Question 14

Health Maintenance Organization (HMO)

Answer 14

this plan provides coverage only if the care is delivered by a member of its hospital, physician, or pharmacy panel

Question 15

Point of Service Plan

Answer 15

this is a physician-coordinated plan that combines characteristics of both HMO and PPO plans

Question 16

Preferred Provider Organization (PPO)

Answer 16

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

Question 17

Restricted Network plan

Answer 17

a limited network of health providers

Question 18

Which type of plan has a contracted network of providers but also allows members to receive care from non-participating providers?

Answer 18

Preferred Provider Organization (PPO)

Question 19

Which plan involves coordination of care by a primary care physician and is a hybrid of HMO and PPO structures?

Answer 19

Point of Service plan

Question 20

Which plan provides coverage only if services are provided by members of its hospital, physician, or pharmacy panel?

Answer 20

Restricted network plan

Question 21

Define Prospective Payment System

Answer 21

is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount

Question 22

Outpatient facility

Answer 22

medical facilities that perform procedures that do not require an overnight stay in a hospital or care facility

Question 23

Government funded facility

Answer 23

Public health care facility that receives most of its funding from local, state, or federal resources

Question 24

Nonprofit facility

Answer 24

Community facility which receives federal, state, and local tax exemptions in exchange for providing a community benefit

Question 25

Proprietary facility

Answer 25

For-profit healthcare facility which is usually owned by a corporation

Question 26

To which type of facility listed in #12 would a VA hospital belong to?

Answer 26

Government funded

Question 27

What is the purpose of a diagnostic related group?

Answer 27

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

Question 28

Which type of health care facility is privately owned and is operated as a for-profit organization?

Answer 28

proprietary

Question 29

What does it mean when a provider is “out-of-network”?

Answer 29

providers who are not in the plan

Question 30

Which government health plan provides coverage for citizens age 65 and older?

Answer 30

medicare

Question 31

What is a copay?

Answer 31

a contribution made by an insured person toward the cost of medical treatment or other services

Question 32

What is a flexible spending account?

Answer 32

offered through an employer and is usually paired with a traditional health insurance policy

Question 33

What is a health savings account?

Answer 33

commonly paired with a high-deductible health insurance plan

Question 34

What is coinsurance?

Answer 34

The percentage of costs of a covered health care service you pay

Question 35

What is an insurance premium?

Answer 35

the amount you pay for an insurance policy

Question 36

What is a deductible?

Answer 36

the money a person pays before the insurance policy provides benefits

Question 37

What is the role of a “gatekeeper” in a health insurance company?

Answer 37

the primary care provider