Health care u.s. Flashcards
Why is the U.S. health care market referred to as “imperfect”? a
Flashcards
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Chapter 1. An Overview of U.S. Health Care Delivery
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Definition
(a) The health plans acting as intermediaries for the patients typically function as buyers of healthcare services.
Why is the U.S. health care market referred to as “imperfect”? b
(b) Patients lack the information necessary to make prudent decisions. Patients generally do not know which new diagnostic methods, intervention techniques, and drugs are available. Information on price and quality is also extremely difficult to obtain.
Why is the U.S. health care market referred to as “imperfect”? c
(c) Prices are often set by the health plans. They are not determined by the interaction of the forces of supply and demand.
Why is the U.S. health care market referred to as “imperfect”? d
(d) The consolidation of buying power into the hands of private health plans is forcing providers to form alliances and integrated delivery systems on the supply side, thus restricting competition at the individual level.
Why is the U.S. health care market referred to as “imperfect”? e
(e) Health insurance shields patients against the cost of health care. Health insurance does not always serve the purpose of true insurance, which is to protect against catastrophic risks. For basic and routine care, health insurance acts as prepayment for health services. There is a moral hazard that once enrollees have purchased health insurance, they will utilize healthcare services.
Why is the U.S. health care market referred to as “imperfect”? F
(f) The utilization of health care is generally determined by need rather than price-based demand. Providers can often induce demand for their own financial benefit.
What are the two main objectives of a healthcare delivery system?
- Enable all citizens to obtain needed health care services. 2. Ensure that services are cost- effective and meet established standards of quality.
Why does cost containment remain an elusive goal in u.s. health service delivery?
The US healthcare system is not subject to standard methods of cost control through global budgets. In a system that is not centrally controlled, each individual and corporate entity seeks to manipulate financial incentives within the system to its own advantage, without regard for its impact on the system as a whole. Cost containment therefore remains an elusive goal.
Name the 4 basic functional components of the u.s. health care delivery system. which roles does each play in the delivery of healthcare?
Financial
Insurance
Delivery
Payment
what primary reason for employers to purchase insurance plans to provide health benefit to their employees?
The primary reason for employers to purchase insurance plans to provide health benefits to their employees is that employees get group rates through their employer that are generally lower than what the rates would be if the employees were to purchase health insurance on their own.
Why is it that, despite public and private health insurance programs, some U.S. citizens are without healthcare coverage?
Some employers, especially small businesses, cannot afford to provide health insurance to their employees. The unemployed generally cannot participate in an employer-sponsored program.
What is managed care?
Managed care is a system of healthcare delivery that seeks to achieve efficiencies by integrating the basic functions of health care delivery, and employs mechanisms to control utilization of medical services and the price at which the services are purchased.
Financing
health insurance is employment based, a dependent spouse or child may be covered by the working spouse’s employer. Employers purchase healthcare from an MCO. Small employers may not be able to do so.
- Insurance
protects insured people financial catastrophe. The insurance function determines the package of health services, and how and where healthcare may be received.
Delivery
refers to the provision of health care services by various providers.
Payment
The insurer determines how much is paid for a certain service. A patient pays out-of-pocket, and the remainder is covered by the MCO. Tax revenues are used to pay providers.
Discuss the intermediary role of insurance in the delivery of healthcare.
The insurance function introduces a third party into the transaction between the patient and the provider. Health insurance insulates the consumer from the cost of health care. Providers are sometimes restricted from delivering services that are non covered.
Who are the major players in the U.S. health services system? What are the positive and negative effects of the often conflicting self-interests of these players?
The key players in the system are the physicians, administrators of health service institutions, insurance executives, large employers, and the government. One positive effect of these opposing forces is that they prevent any single entity from dominating the system. On the other hand, they also make it difficult to achieve system wide reforms.
Why is it important for healthcare managers and policymakers to understand the intricacies of the health care delivery system?
The federal and state governments play an important role in health care delivery.
An understanding of the health care delivery system can attune health professionals to their relationship with the rest of the health care environment. It can help them understand changes and the impact of those changes on their own practice. Adaptation and relearning are strategies that can prepare health professionals to cope with an environment that will see ongoing change long into the future.
Which main roles doe the government play in the u.s. health services system?
The government is a major financier of health care delivery through the Medicare and Medicaid programs. The government determines eligibility criteria as to who can receive services under these programs; it also determines the reimbursement rates that providers will receive for rendering services to Medicaid and Medicare patients. In order to render services to Medicare and Medicaid, these organizations must comply with the standards of participation formulated by the government.
What is the difference between national health insurance (NHI) and a national health system (NHS)?
(NHS) In Great Britain, in addition to financing a tax-supported NHI program, the government manages the infrastructure for the delivery of medical care. Under such a system, the government operates most of the medical institutions. Most health care providers, such as physicians, are either government employees or are tightly organized in a publicly managed infrastructure. In the context of the quad-function model, NHS requires a tighter consolidation of all four functions.
What is socialized health insurance (SHI)?
In Germany, government-mandated contributions by employers and employees finance health care. Private providers deliver health care services. Private not-for- profit insurance companies, called sickness funds, are responsible for collecting the contributions and paying physicians and hospitals. In a socialized health insurance system, insurance and payment functions are closely integrated, and the financing function is better coordinated with the insurance and payment functions than in the United States. Delivery is characterized by independent private arrangements.The government exercises overall control .
The main goal of the ACA is to increase access to healthcare and make it more affordable, mainly for those who were previously uninsured.
