dynamics of health care 2

Question 1

What is the primary difference between an HMO and EPOs?

Answer 1

An EPO usually doesn’t require that the primary care provider make referrals to specialists.

Question 2

What is the greatest drawback of the HMO?

Answer 2

The fact that enrollee must find a physician within the HMO group for services.

Question 3

______________: Medical care has shifted from the hospital into the community because of advances in medical technology such as mobile units for diagnosing disease and telemedicine.

Answer 3

Distributive health care.

Question 4

What has changed the healthcare system and creates new ways of paying for healthcare?

Answer 4

Distributive health care

Question 5

What is the term that means paying the practitioner or hospital a fixed amount for a specific service?

Answer 5

Capitation

Question 6

What is the type of health care that is the federal-state cooperative health insurance plan for: People not eligible for health insurance through an employer/people who can not afford marketplace or private insurance

Answer 6

Medicaid

Question 7

What is the term that means the provider is financially rewarded for volume rather than quality and cost control (value)

Answer 7

“Fee for Service”

Question 8

totaled $597 billion, about 25% covered hospital inpatient services, another 25% covered private insurance through the Medicare advantage program, (these are the 2 top benefit payments)

Answer 8

Medicare benefit payments

Question 9

Patients on Private insurance vs. medicare

Answer 9

the main difference is that the government pays the healthcare bills instead of the individual or private insurance.

Question 10

What covers care provided on both inside and outside the plan’s provider network?

Answer 10

PPOs

Question 11

Examples of capitation for private insurance:

Answer 11

Health Maintenance organizations (HMOs) which limit consumer choice to health professionals and hospitals that contract with HMO.

Question 12

in 2019, medicaid provided coverage to 1 in 5 Americans, which makes it the nation’s ____________ public health insurance program.

Answer 12

largest

Question 13

The first pre payment plan to cover physicians:

Answer 13

Blue cross-blue shield

Question 14

In 1983 what bill did congress pass that was under which hospitals are paid a set amount for each patient in any of the established disease categories and diagnosis-related groups (DRGs)

Answer 14

Prospective payment bill

Question 15

What were the first managed care insurance programs started with

Answer 15

HMOs: Kraiser permanente in California and group health cooperative in Washington state.

Question 16

what are HMOs and PPOs and EPOs considered?

Answer 16

Managed care

Question 17

The traditional method of reimbursement for health services before passage of affordable care act (ACA) was free-for-service, payment for each service at the time of service

Answer 17

true

Question 18

____________ and ____________ are government or public health insurance programs that benefit one in three Americans.

Answer 18

Medicaid and Medicare

Question 19

________ are a group of providers who have voluntary joined together to render health care on a contractual basis, or a group of providers who have been organized by a payer through contractual arrangement arrangement for a particular delivery system.

Answer 19

PPOs

Question 20

What was the first managed care insurance program/ can not see out of network providers

Answer 20

HMO

Question 21

The first private hospital insurance plan

Answer 21

Blue cross

Question 22

A federal health program for people aged 65 years and older and certain disabled people younger than 65

Answer 22

Medicare

Question 23

Program that usually doesn’t require that primary care provider make referrals to specialists but like an HMO.

Answer 23

EPO

Question 24

Provide Healthcare coverage for low-income kids

Answer 24

CHIP