Ethics

Question 1

Who funds medicare? eligibility?

Answer 1

Federal govt. >65 yrs- US citizens, perm residents, paid tax >10 yrs, ppl with ESRD on rx, ALS, perm disabilities

Question 2

Medicare coverage

Answer 2

A- hospital insurance, B- medical, C- advantage, D- prescription drugs

Question 3

Who funds medicaid? eligibility?

Answer 3

federal and state. Citizens. Financial criteria- Children and pregnant, < 65 years living in households with income ≤ 133% of the federal poverty level, >65 + disability receiving supplemental security income

Question 4

Who can enroll in medicare and medicaid

Answer 4

> 65 yrs low income- with disabilities

Question 5

CHIP eligibility

Answer 5

Kids from low income that is not low enough to qualify for Medicaid

Question 6

Commercial health insurance plans

Answer 6

HMO, POS, PPO, EPO

Question 7

Plans that require primary care provider and referral

Answer 7

HMO, POS

Question 8

Out of network care covered for

Answer 8

POS, PPO

Question 9

health insurance premium

Answer 9

Paid monthly to provider. Higher premium will have lower out of pocket expenses. Healthy- higher deductible, lower premium vice versa for a diagnosed patient

Question 10

What is included in the out of pocket maximum

Answer 10

deductibles, copayments, coinsurance

Question 11

Paying everytime while visiting a doc

Answer 11

Copayment

Question 12

Coinsurance

Answer 12

% of expenses an individual pays after meeting deductible

Question 13

Utilisation mx to cover for rx

Answer 13

Prior, concurrent, retrospective

Question 14

Payment model- fee for service

Answer 14

Providers compensated for each service- assoc with high overall health care costs. Discounted and per diem payment

Question 15

Pay for performance models

Answer 15

Compensation depends on providers meeting metrics for quality and efficiency

Question 16

pay for perf programs

Answer 16

VBP, PQRS, MIPS

Question 17

VBP

Answer 17

penalises for poor perf- reduced pay by 2%

Question 18

PQRS

Answer 18

To assess quality of care by reporting data on quality of care across health care systems

Question 19

MIPS

Answer 19

Integrates various programs into single system

Question 20

Bundled payment

Answer 20

Fixed payment for all services during a clinically defined episode

Question 21

Capitation

Answer 21

Fixed pay per pt irresp of services utilised

Question 22

Global payment

Answer 22

Single pay for population of pts

Question 23

Health care delivery models

Answer 23

IDS, ACO, PCMH

Question 24

Social injustice types

Answer 24

Distributive, relational

Question 25

Measurement of health care disparities

Answer 25

Quality of care, access to health care

Question 26

Assertive community rx

Answer 26

integrated treatment approach for patients with severe psychiatric conditions, at ongoing risk of hospitalization, incarceration, unstable housing

Question 27

Prevention of healthcare fragmentation

Answer 27

Coordinated health care delivery models like ID, ACO, PCMH, interoperable EHR, error prevention strategies- handoffs

Question 28

Federal disability benefits

Answer 28

By US SSA- SSDI- those who paid social security taxes, after 2 yrs of receiving SSDI- qualify for medicare, supplemental security income- no income, >65 yrs

Question 29

Disability insurance

Answer 29

Short term- 2 wks after illness, duration- 3-12m. Long term- 30 days to 2 yrs after illness

Question 30

Therapeutic misconception

Answer 30

Individual participating in research believes that they are receiving individualized medical treatment or care rather than participating in research

Question 31

Therapeutic missestimation

Answer 31

Individual misjudges the risk or benefit of participating in research

Question 32

Participant compensation in research

Answer 32

Prorated> completion contingent