Financing of Health Srvices Flashcards
insurance
all about managing certain types of anticipated risks. risk is probability of incurring loss. loss is unpredictable eg car crash
Risk exchange
i give up small certain loss eg monthly premium
Risk transfer
risk is now on the group
Risk pooling
more people we have part of group and better we are able to spread risk
Adverse selection
only the sick people sign up for insurance or sick people know more about their risk than the insurance does
Underwriting is used to prevent adverse selection. Define underwriting:
Underwriting = accessing how much risk you have eg based on pre existing conditions
Enrollment penalties
enroll in medicare part d or get penalized; federal penalty gone but states have it
Moral hazard
if person has insurance, then they are more likely to use it.
How do you minimize moral hazard?
Cost sharing
Cost sharing
copayments (flat rate), coverage limitations, co insurance%, deductible (youre paying for full cost of that service until a certain amount is met.
Private insurance examples
Through employer through exchanges eg Covered California
Public insurance eg government funded Medicare, Medicaid, and VA
Types of insurance
Indemnity (old school)
Indemnity
fee for service, benefit is have more freedom, challenge is over utilization of services and this can increase costs.
Now have Managed Care
managed care came in to manage costs and keep quality
HMO
yes PCP
yes Referral
no PA
no Out of Network Coverage
POS (hybrid)
yes pcp, yes referral, no PA, yes ONC
EPO (exclusive)
no PCP, no referral, yes PA, no ONC
PPO (highest premium)
no pcp, no referral, yes PA, Yes ONC
