dynamics of health care 2 Flashcards
What is the primary difference between an HMO and EPOs?
An EPO usually doesn’t require that the primary care provider make referrals to specialists.
What is the greatest drawback of the HMO?
The fact that enrollee must find a physician within the HMO group for services.
______________: 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.
Distributive health care.
What has changed the healthcare system and creates new ways of paying for healthcare?
Distributive health care
What is the term that means paying the practitioner or hospital a fixed amount for a specific service?
Capitation
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
Medicaid
What is the term that means the provider is financially rewarded for volume rather than quality and cost control (value)
“Fee for Service”
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)
Medicare benefit payments
Patients on Private insurance vs. medicare
the main difference is that the government pays the healthcare bills instead of the individual or private insurance.
What covers care provided on both inside and outside the plan’s provider network?
PPOs
Examples of capitation for private insurance:
Health Maintenance organizations (HMOs) which limit consumer choice to health professionals and hospitals that contract with HMO.
in 2019, medicaid provided coverage to 1 in 5 Americans, which makes it the nation’s ____________ public health insurance program.
largest
The first pre payment plan to cover physicians:
Blue cross-blue shield
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)
Prospective payment bill
What were the first managed care insurance programs started with
HMOs: Kraiser permanente in California and group health cooperative in Washington state.
what are HMOs and PPOs and EPOs considered?
Managed care
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
true
____________ and ____________ are government or public health insurance programs that benefit one in three Americans.
Medicaid and Medicare
________ 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.
PPOs
What was the first managed care insurance program/ can not see out of network providers
HMO
The first private hospital insurance plan
Blue cross
A federal health program for people aged 65 years and older and certain disabled people younger than 65
Medicare
Program that usually doesn’t require that primary care provider make referrals to specialists but like an HMO.
EPO
Provide Healthcare coverage for low-income kids
CHIP
