health care

Question 1

is health care unnecessary for healthy young people

Answer 1

• young adults are high risk group for unanticipated medical care
• because people are young and health this group forgoes health insurance because they believe it is unnecessary

Question 2

explain insurance before obama care

Answer 2

almost half of working adults uninsured
-this group has highest rate of emergency medical care and unplanned pregnancies than other age groups

without health insurance these two things cost thousands of dollars

people without health insurance more likely to skip care

Question 3

explain complications of being uninsured

Answer 3

• individual level: dont get preventative care and you wait longer to seek intervention when sick
• community level: more likely to spread contagious disease
• national level: leads to larger burden of disease and increases in taxes, insurance premiums for others

Question 4

what is going on in health insurance now

Answer 4

2010: patient protect and ACA designed to extend health care coverage to 30 million uninsured people
2014: medicaid expansion to increase eligibility implementation of tax penalty for anyone who does not have insurance by march 31st
2017: bill for ACA introduced, then pulled into formal vote

Question 5

explain the uninsured in post obama care

Answer 5

• uninsured rate cute in half with majority of people taking place in employee programs or Medicaid
• only 86% of people uninsured, the lowest ever

Question 6

what are the two main private health care plans

Answer 6

HMO: health maintenance organization

PPO; preferred providers organization

Question 7

what is the HMO

Answer 7

you select primary care physician who coordinates your care among providers in your plans network

lower out of pocket costs and less paperwork

Question 8

what is PPO

Answer 8

no PCP and no referrals needed, can use both providers inside and outside network, but fees higher for the latter

more options and less hassle, but higher deductible and price

Question 9

what are the other two minor health care plans

Answer 9

POS: point of service
EPO: exclusive provider organization

Question 10

what is POS

Answer 10

combination of HMO PPO, PCP has to refer you to specialists, options for in and out network care

Question 11

what is EPO

Answer 11

just like PPO, but you have to pay full cost if you go out of network

Question 12

what are private indemnity plans

Answer 12

allow for unlimited access to and use of medical services, as long as you are willing to pay your premium and co-pays
-health, insurance companies only pay 50-80% of what they believe to be “usual and customary fees” for service

Question 13

what happens when you go out of network

Answer 13

when you go to a place insurance doesnt cover it is expensive
-usually companies will tell you if insurance doesnt cover it

Question 14

why are prices so high

Answer 14

there is no logical reason why one is more expensive, it’s because they can charge more (they can get away with it)

Question 15

what needs to be met to get medicare or medicaid

Answer 15

2012: medicare accounted for 15% of federal budget-usually people over 65 with some exceptions
2012: medicaid accounted for 8% of federal budget- low income, pregnant, young kids, blind, 65, disabled

medicaid used to not cover those without dependent kids, but the ACA expanded this to those below poverty line (w financial needs)

Question 16

benefits of medicaid

Answer 16

1) better self reported mental health
2) less catastrophic medical expenses
3) same access as privately insured to preventative care and PCP (research shows more ER visits and less care from specialists)

Question 17

public opinion of health care

Answer 17

• remain stable

- slight increase in % reporting being dissatisfied with cost of health care

Question 18

health care in US

Answer 18

• US is most costly and least effective compared to other comparable countries
• ranked 37th overall

Question 19

what are the models of health care

Answer 19

beveridge model, bismarck model, national health insurance model and out of pocker

Question 20

what is the beveridge model

Answer 20

health care provided and financed by government through tax, hospitals and clinics owned by government

Question 21

what is the bismarck model

Answer 21

plans have to cover everybody, dont make profit, doctos and hospitals private

Question 22

what is the national health insurance model

Answer 22

uses private sector providers, but payment comes from government run insurance program every citizen pays into

Question 23

what is the out of pocket model

Answer 23

only developed industrialized countries have established health care systems, other nations are too poor

Question 24

what is the US model

Answer 24

hard to understand, we have elements of all in our fragmented health care system

Question 25

explain patient satisfaction

Answer 25

can be determined by comparing expectations of care with the perceived quality of care that is received

1) physician characteristics
2) interpersonal skills
3) overall service

Question 26

what are desirable physician characteristics

Answer 26

those high in openness and awareness are viewed more favorably
(personality, age=experience, and similarity to patient)

Question 27

explain importance of communication

Answer 27

both patient and doctor need to make sure there is effective communication
communication difficulty: one issue might be that patients feel that their physicians dont listen to them-their treatment doesnt feel individualized

-advances health outcomes and leads to more consumer satisfaction and adherence to instructions

Question 28

explain failure to understand

Answer 28

patients discharged from ER indicate they do not understand discharge instructions
-those who think they understand actually dont

Question 29

3 biggest physician errors

Answer 29

1) medspeak: the use of medical jargon- want to look knowledgeable but cant speak beyond patient
2) might assume patients know more than they do
3) nonverbal communication miscues (body language can imply impatience or inattention)