Exam 3.4

Question 1

Public health professionals

Answer 1

usually financed by tax dollars, available to everyone, primarily serve economically disadvantaged, public health physicians, environmental health workers, epidemiologists, health educators, public health nurses, research scientists, clinic workers, biostatisticians

Question 2

Health care facilities

Answer 2

physical settings where health care is provided, inpatient care and outpatient care

Question 3

Inpatient care facilities

Answer 3

hospitals, nursing homes, assisted living

Question 4

Clinics

Answer 4

two or more physicians practicing as a group, do not have inpatient beds, for and not-for profit, tax funded

Question 5

Outpatient care facilities

Answer 5

care in a variety of settings but no overnight stay, practitioner’s offices, clinics, primary care centers, ambulatory surgery centers, urgent care centers, services offered in retail stores, dialysis centers, imaging centers

Question 6

Rehabilitation centers

Answer 6

work to restore function, may be part of a clinic or hospital, or freestanding facilities, may be inpatient or outpatient

Question 7

Long-term care options

Answer 7

nursing homes, group homes, transitional care, day care, home health care

Question 8

Home health care

Answer 8

growing due to restructuring of health care system, technological advances, and cost containment

Question 9

Affordable Health Care Act

Answer 9

goal to put American consumers back in charge of their health coverage and care

Question 10

Structure of the health care system

Answer 10

US structure, complex, expensive, many stakeholders, intertwined policies, politics, major issues: cost containment, access, quality

Question 11

Major goal of ACA

Answer 11

to increase the number of Americans with health insurance and decrease costs, unfortunately premiums are going up dramatically for most Americans as a result

Question 12

Quality health care should be

Answer 12

effective, safe, timely, patient centered, equitable, efficient

Question 13

Sources of health care payments

Answer 13

consumers, third party payments

Question 14

1st party payment

Answer 14

consumer pays the provider for services rendered using cash, flex plans, medical savings plans

Question 15

3rd party payment

Answer 15

government or private insurance pays the provider for services rendered

Question 16

Fee for service

Answer 16

patient pays a % of care

Question 17

Packaged pricing

Answer 17

bundled services

Question 18

Resource based relative value scale

Answer 18

Medicare’s scale for reimbursement

Question 19

Capitation

Answer 19

prearranged agreement made between provider and insurer

Question 20

Prospective reimbursement

Answer 20

payments made ahead of need

Question 21

Premiums

Answer 21

regular periodic payments

Question 22

Deductible

Answer 22

amount of money that the beneficiary must pay before the insurance company begins to pay for covered services

Question 23

Co-insurance or co-payment

Answer 23

the portion or % of an insurance company’s approved amounts for covered services that the beneficiary is responsible for paying

Question 24

Fixed indemnity

Answer 24

maximum amount an insurer will pay for a certain service

Question 25

Exclusion

Answer 25

a specified health condition that is excluded from coverage, the Health Insurance Portability and Accountability Act of 1996

Question 26

Pre-existing condition

Answer 26

a medical condition that has been treated six months before starting a health policy

Question 27

Health Insurance Portability and Accountability Act (1996) and ACA (2010)

Answer 27

insurance companies can’t make a pre-existing condition an exclusion for coverage

Question 28

Types of health insurance coverage

Answer 28

hospitalization, surgical, regular medical, major medical, dental, disability

Question 29

The ACA mandates that

Answer 29

employers with 50 or more employees provide insurance coverage or pay a tax

Question 30

Trends due to ACA

Answer 30

employers reducing full-time jobs, increasing part-time jobs, increased worker share of premium, raising deductibles, increasing prescription co-payments, increasing number of exclusions

Question 31

Self-funded insurance programs

Answer 31

created for/by employers rather than using commercial insurance carriers, many benefits to employer, generally for larger companies unless low-risk employees

Question 32

Health insurance provided by the government

Answer 32

medicare, medicaid, CHIP, VA, IHS, federal employees, uniformed services, prisoners

Question 33

Medicare

Answer 33

covers more than 47.5 million people, 65+, permanent kidney failure, certain disabilities, through FICA tax

Question 34

Four parts of medicare

Answer 34

hospital insurance (A), medical insurance (B), managed care plans (C), prescription drug plans (D)

Question 35

Medicare part A

Answer 35

hospital, inpatient, mandatory, 100% coverage for hospital stays, hospice, and some health care, no premium, deductible, some co-pays

Question 36

Medicare part B

Answer 36

medical, voluntary but those with part A automatically enrolled, coverage for doctor services, outpatient hospital care, physical therapy, durable medical supplies, ambulance, diagnostic tests, blood screening, and preventive care, premium, deductible, copays

Question 37

Medicare part C + Choice plans (Medicare Advantage)

Answer 37

alternative to A & B and medigap plans, managed care plan, preferred provider plan, private fee-for-service plan

Question 38

Mediare part D

Answer 38

prescription drug coverage, voluntary, 2 parts: discount card based on income, prescription insurance with premium, deductible

Question 39

Medicaid

Answer 39

for the poor, costly budget item for states, noncontributory

Question 40

Medicaid under ACA

Answer 40

eligibility based solely on income, extended to more low-income people, nearly everyone under 65 with income below 133% of poverty level could qualify, increases burden on states

Question 41

CHIP

Answer 41

joint state-federal program, created in 1997, funding by increase in federal excise tax rate on tobacco, 8 million children enrolled

Question 42

Problems with medicare and medicaid

Answer 42

some providers do not accept, fraud, cost of programs escalating and will become insolvent unless tax revenue increased or benefits reduced, many concerned federal government overextended

Question 43

Supplemental health insurance

Answer 43

helps cover out of pocket costs, medigap, specific disease insurance, long-term care insurance

Question 44

Managed care

Answer 44

goal to control costs by controlling health care utilization, provider panels, limited choice, gatekeeping, risk sharing, quality management, utilization review

Question 45

Types of managed care

Answer 45

PPO, HMO, Independent practice association (IPA), POS, medicare advantage

Question 46

National health care

Answer 46

a system in which the federal government assumes responsibility for health care costs of entire population, primarily paid with tax dollars, US only developed country without

Question 47

National health service model

Answer 47

entire system owned and operated by government, UK, Spain

Question 48

Social insurance model

Answer 48

government is the only 3rd party payer, Canada, Germany

Question 49

Consumer directed health plans

Answer 49

responsibility for health care decisions lies with the individual

Question 50

High deductible health plan

Answer 50

brings down monthly payments, pay more out of pocket, incentive not to seek needed care or preventive care

Question 51

Health savings accounts

Answer 51

individual invests and the account grows tax free, money withdrawn tax free to pay for care

Question 52

Health reimbursement arrangement

Answer 52

employer funded health savings account for employees

Question 53

Flexible spending account

Answer 53

employers allow employees to set aside tax free money for medical expenses in a given year

Question 54

Archer medical savings accounts

Answer 54

account funded by both individual and small business employer

Question 55

Affordable Care Act

Answer 55

1000 pages and passed without any bipartisan support, very controversial, goals to reduce costs and increase number insured, step toward national healthcare, profoundly increases the authority of DHHS

Question 56

President’s 8 principles of reform

Answer 56

protect families’ financial health, make health coverage affordable, aim for universality, provide portability of coverage, guarantee choices, invest in prevention and wellness, improve patient safety and quality care, maintain long-term fiscal sustainability

Question 57

You can’t have everything

Answer 57

pick two: good, fast, cheap

Question 58

Why costs are increasing

Answer 58

increasing population, aging population, increasing technology, changing patient expectations, service/cost detachment

Question 59

For every dollar spent on newer medicines in place of older medicines

Answer 59

total healthcare spending is reduced by $6.17

Question 60

Every additional dollar spent on healthcare in the US over the past 20 years

Answer 60

has produced health gains worth $2.40 to $3.00

Question 61

Medical malpractice suits

Answer 61

encourage defensive medicine

Question 62

Chronic illness

Answer 62

75% of health care spending, receive 56% of all clinically recommended care, substantial share of growth in healthcare spending

Question 63

Nearly 60% of healthcare spending

Answer 63

happens during the last 2 weeks of life