insurance stuff Flashcards
1
Q
Healthcare Quality Improvement Act:
- meant to reduce … and protect the public
- this would be done by allowing physicians who made mistakes to be on … to be able to communicate honestly without fear of …
A
medical errors;
peer review committees;
retaliation
2
Q
…:
- meant to reduce medical errors and protect the public
- this would be done by allowing physicians who made mistakes to be on peer review committees to be able to communicate honestly without fear of retaliation
- “however, the consequences of the Act have instead helped promote an environment that protects those physicians on a peer review committee when they … for their own gain, by maliciously disciplining those physicians that may be in … or …”
A
healthcare quality improvement act;
distort the review process;
political; economic competition
3
Q
Healthcare Quality Improvement Act:
- “legislators enacted the law to protect medical professionals from … and to encourage physicians to … after encountering unprofessional and dangerous peer conduct”
A
peer review-related lawsuits;
file official complaints
4
Q
Children’s Health Insurance Program:
- health insurance for kids from …
- originated with the …
- … makes this accessible to the largest number of these low income kids in US history
A
low-income households;
Children’s Health Insurance Authorization Act of 2009;
Affordable Care Act
5
Q
….:
- health insurance for kids from low-income households
- originated with the Children’s Health Insurance Authorization Act of 2009
- Affordable Care Act makes this accessible to the largest number of these low income kids in US history
A
Children’s Health Insurance Program
6
Q
Hospital Readmissions Reduction Program:
- … initiative
- Requires the Centers for Medicare and Medicaid Services to reduce payouts to care facilities that experience …
A
Affordable Care Act;
excessive patient readmissions
7
Q
…:
- Affordable Care Act initiative
- Requires the Centers for Medicare and Medicaid Services to reduce payouts to care facilities that experience excessive patient readmissions
A
8
Q
Patient Safety and Quality Improvement Act of 2005:
- protects health care workers who …
- meant to encourage reports of … and maintain … by having fines for …
A
report unsafe conditions;
errors;
patient confidentiality;
confidentiality breaches
9
Q
…:
- protects health care workers who report unsafe conditions
- meant to encourage reports of errors and maintain patient confidentiality by having fines for confidentiality breaches
- allows the Agency for Healthcare Research and Quality to publish a list of patient safety organizations that record and analyze …
A
Patient Safety and Quality Improvement Act of 2005;
patient safety data
10
Q
US healthcare system:
- primarily … pays for services (aka insurance)
- mix of public and private insurance
- two major public ones: … and …
A
third;
Medicaid;
medicare
11
Q
US healthcare system:
- Approximately … of Americans have private health insurance through their employer
- Medicare and Medicaid established through …
A
half (48%);
their employer
12
Q
US healthcare system:
- Health Maintenance Organization Act of 1973:
- promoted … service plans known as … as an alternative to … plans
A
prepaid group practice;
health maintenance organizations (HMOs);
fee-for-service
13
Q
US healthcare system:
- Obamacare = ….
- required almost all citizens to have …
- During economic downturns, employers may reduce insurance coverage for employees, while those who are laid off may … altogether
A
Patient Protection and Affordable Care Act of 2010 (PPACA)
health insurance;
lose coverage
14
Q
US healthcare system:
- … were main source of insurance coverage since late 1940s and 1950s
- due to … that employers get for doing this
- second major sources of health insurance are … and …
A
employers;
tax exemption;
Medicaid; Medicare
15
Q
… payments: funds given to hospitals that tend to serve more low income and uninsured patients than other hospitals
A
disproportionate share hospital payments
16
Q
The debate over health care centers on whether the federal gov should … and … This debate has been going on for a very long time
- In the 1910s, many European nations began legalizing healthcare for everyone. Teddy Roosevelt tried to do the same thing here but politicians on both sides didn’t want it
A
provide health care;
how much
17
Q
Arguments for universal health care in the US;
- the federal gov is the only institution that can ensure that …
- the money the gov already pays to cover emergency care for … is so much that it would just be better to insure everyone
- insuring everyone would allow for more effective … with pharmaceutical companies, hospitals, etc. to reduce costs of health care
A
all citizens are covered;
uninsured people;
bargaining
18
Q
Arguments against universal health care:
- if health care is run by the federal gov it would …
- … care being provided to patients
- costs … and results in …
A
take the choice away from patients;
less individualized;
a lot of money;
higher taxes
19
Q
With the current healthcare system, patients pay money monthly to maintain their health insurance coverage. insurance companies try to … and as a result, they have … of health care professionals that they have agreements with. Patients are covered when they visit doctors that are in their insurance company’s …
A
negotiate lower prices;
networks;
network
20
Q
Insurance companies cover … services, but if it’s considered “…,” they generally don’t cover it
A
essential;
elective
21
Q
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
- was attempting to address the fact that many patients are …
- major provisions of this act:
- insurers can’t refuse patients due to …
- … for health insurance policies were created
A
uninsured;
pre-existing conditions;
minimum standards
22
Q
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
- major provisions of this act:
- … expanded
- making Medicare more … through reforms
- individuals that aren’t covered through their employers have to …
A
Medicaid eligibility;
efficient;
buy healthcare
23
Q
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
- Major provisions of this act:
- … established to help people find good health insurance and provide …. for those who needed it
A
Health Exchanges;
subsidies (funds)
24
Q
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
- resulted in … more Americans becoming insured
- minimum requirements of … established for people and employers
- lack of adherence to mandates was enforced by …
A
11 million;
coverage;
tax penalties
25
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
* funds and tax credits were given to individual buyers based on ... and ...
* Medicaid expanded to cover ...
* ... given tax credits based on level of insurance offered to employees
income;
number of dependents;
low-income childless adults;
small businesses
26
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
* specified 10 essential benefits that plans created after the law's passage were required to include:
* ...
* ...
* ...
* ... and ...
ambulatory patient services;
emergency services;
hospitalization;
maternity; newborn care
27
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
* specified 10 essential benefits that plans created after the law's passage were required to include
* ambulatory patient services
* emergency services
* hospitalization
* maternity and newborn care
* ... and ... services, including ... treatment
* ...
mental health;
substance abuse disorder;
behavioral health;
prescription drugs
28
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
* specified 10 essential benefits that plans created after the law's passage were required to include
* ambulatory patient services
* emergency services
* hospitalization
* maternity and newborn care
* mental health and substance abuse disorder services, including behavioral health treatment
* prescription drugs
* ... and ... services and devices
* ... services
Rehab; habilitative;
lab;
29
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
* specified 10 essential benefits that plans created after the law's passage were required to include
* ambulatory patient services
* emergency services
* hospitalization
* maternity and newborn care
* mental health and substance abuse disorder services, including behavioral health treatment
* prescription drugs
* rehab and rehabilitative services and devices
* lab services
* ... and ... services and ...
* ... services, including ... and ...
preventive; wellness;
chronic disease management;
pediatric;
oral;
vision care
30
Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:
* between 2013 and 2014, the number of uninsured people declined by ...%
18.8 (about 20)
31
History of healthcare policy in the US:
* ... and ... are forms of health insurance
* Medicare and Medicaid established by social security act by president ... in 1965
fee for service;
managed care
32
History of healthcare policy in the US:
* The Medicare law made up of Part A and Part B:
* part A: for anyone receiving ..., covered ...
* funded by taxes on ... and ...
social security benefits;
hospitalization;
workers;
employers
33
History of healthcare policy in the US:
* The medicare law made up of Part A and Part B
* Part A - for anyone receiving SS benefits, covered hospitalization
* funded by taxes on workers and emloyers
* recipient would pay a ... amounting to one day in the hospital. Medicare then covered hospital stay for next 60 days. After that, it would cover part of the costs for put o 150 days. After 150 days, Medicare wouldn't pay anything
* Medicare would pay costs for 20 days in a nursing home for 20 days after a hospital stay, then part of the costs for up to 100 days
* Part B - covers ... and ... services (doctors visits, x-rays, lab tests, etc)
deductible;
physicians';
outpatient
34
History of healthcare policy in the US:
* Medicare Part B - covers physicians' and outpatient services
* person would pay small ...
* 25% of the funds came from ... paid by the recipient. The rest of the money was funded by ...
* This part of Medicare was ...
annual deductible;
premiums;
federal gov;
voluntary
35
History of healthcare policy in the US:
* Medicare followed the ... model - gov reimbursed hospitals and doctors for the ... for each ... and didn't manage hospitals or provider ...
fee-for-service;
fees they charged;
service;
networks
36
History of healthcare policy in the US:
* Medicare followed fee-for-service model
* reimbursement occurred through ... - private companies that wrote checks on behalf of the gov
* Medicaid provided health coverage for poor families receiving Aid to Families with Dependent Children
* each state would determine ... for the program
* federal and state govs would provide ...
* Some people can be ... for Medicaid and medicare and can be covered by both
fiscal intermediaries;
eligibility;
funds;
dual-eligible
37
Social Security Amendments of 1972:
* Nixon expanded Medicare coverage to ... people who were receiving benefits for at least 2 years to people with significant ...
disabled;
renal disease
38
Health Maintenance Organization Act of 1973:
* Nixon signed this
* promoted a type of health insurance called ... service plans, aka ... (HMOs). It did this through:
* removing state laws that prohibited HMOs
* offering ... to establish federally qualified HMOs
prepaid group practice;
health maintenance organizations;
subsidies
39
Health Maintenance Organization Act of 1973:
* promoted a type of health insurance called prepaid group practice service plans, aka HMOs. It did this through:
* created standards for federally qualified HMOs
* must be ... orgs
* cover a certain level of care
* charge all members the ...
* required employers who offered health insurance to provide ...
* allowed HMOs to adopt a variety of ...
nonprofit;
same premium;
HMO option;
organizational structures
40
...
* aka COBRA
* signed by Ronald Reagan in 1986
* denied tax deductions to employers whose health plans did not allow employees to ...
Consolidated Omnibus Budget Reconciliation Act of 1985;
continue coverage
41
Consolidated Omnibus Budget Reconciliation Act of 1985 - COBRA:
* employees could choose to continue their health coverage after ... their job, .../... of a family member, ... in work hours, or ...
* this could continue for 18-36
losing;
death; divorce;
reduction;
medical leave
42
... (aka "Hillarycare"):
* didn't pass Congress
* the following regulations were proposed:
* employers had to provide health insurance for ...
* ... would receive funds to help provide insurance
Health Security Act of 1993;
full time employees;
small businesses
43
Hillarycare/Health Security Act of 1993:
* the following regulations were proposed:
* state-based cooperatives would sell approved health insurance plans to consumers and regulate insurance companies
* unemployed, self-employed, and part-time employees would receive funds to help them pay for insurance through those ...
* all Americans would be required to ...
* anyone who refused to enroll could be ... and would have to ...
state-based cooperatives;
obtain health insurance;
enrolled automatically;
pay twice the premium
44
Hillarycare/Health Security Act of 1993:
* the following regulations were proposed:
* the gov would set ... all health insurance plans would have to cover
* insurance companies would not be able to discriminate against ...
* ... would be created to control healthcare spending, oversee cooperatives and establish new regulations
minimum standards;
pre-existing conditions;
National Health Board
45
HIPAA: ...
* limited the extent to which insurance companies could exclude people with ...
* ... could no longer be considered a pre-existing condition
* employer based plans also couldn't exclude employees or increase premiums for those who had pre-existing conditions or ...
Health Insurance Portability and Accountability Act;
preexisting conditions;
pregnancy;
genetic predispositions
46
HIPAA:
* allowed workers to retain their health insurance after .../..
* basically expanded on COBRA
* established national standards for ... and ... of electronic health information
losing/changing jobs;
privacy;
security
47
HIPAA:
* ...: electronic health info has to be kept as confidential as possible and providers are legally responsible for protecting this info
* ...: patients retain full access to their records and can restrict their ... and use
Security Rule;
Privacy Rule;
disclosure
48
Balanced Budget Act of 1997:
* signed by President Clinton
* Created the ... to cover children who weren't eligible for ... and whose families earned below 200% of the poverty line
* states could ..., create a ... to cover these children, or combine these two methods
State Children's Health Insurance Program;
Medicaid;
expand Medicaid;
new program
49
Balanced Budget Act of 1997:
* brought about changes to Medicare
* ... of 1982 allowed medicare recipients to enroll in medicare through private plans rather than regular fee-for-service plan. Balanced Budget Act formalized this, creating ... (...)
* ... would pay for the private plans
Tax Equity and Fiscal Responsibility Act;
medicare Part C;
Medicare Advantage;
federal government
50
Balanced Budget Act of 1997:
* brought about changes to Medicare
* insurance plans couldn't choose who could enroll but they could choose which ... to serve. they had to offer all the same traditional medicare benefits, but could offer more benefits if they chose
* studies found that Medicare HMO plans did a better job than traditional medicare in providing ... and ..., but beneficiaries (Medicare recipients) perceived traditional Medicare more favorably and therefore still tended to enroll in traditional Medicare
geographic regions;
preventive services;
controlling costs
51
Balanced Budget Act of 1997:
* brought about changes to Medicare:
* Studies found that Medicare HMO plans did a better job than traditional Medicare in providing preventive services and controlling costs, but beneficiaries (Medicare recipients) perceived traditional Medicare more favorably and therefore still tended to enroll in traditional Medicare.
* Result is that private plans received ... than they needed for their enrollees
* The act also encouraged states to offer ... to Medicaid recipients
higher payments;
HMO options
52
Medicare Prescription Drug, Improvement and Modernization Act of 2003:
* initially, Medicare didn't cover ...
* signed by George Bush
* sometimes known as ...
* established 4 tiers of coverage
* 'donut hole' of Medicare coverage between tiers 3 and 4 - a period of ... between two coverage levels
prescription costs;
Medicare part d;
no coverage
53
Medicare Prescription Drug, Improvement and Modernization Act of 2003:
* enrollment in this was voluntary and could occur in the following ways
* patients already covered by plans A or B could enroll in a ...
* patients could enroll in a ... Medicare plan
* patients could enroll through former employer's ... program
separate drug plan;
private;
retirement benefit
54
Medicare Prescription Drug, Improvement and Modernization Act of 2003:
* beneficiaries had to pay ... to enroll in this, and these increased based on ...
* the law also amended Medicare part B such that people with higher incomes ...
premiums;
income;
paid higher premiums
55
Medicare Prescription Drug, Improvement and Modernization Act of 2003:
* Medicare and non-Medicare recipients were also given a ... through this law for ... - allowed people to save money for out-of-pocket medical expenses
tax exemption;
health savings accounts
56
Current debates in health care policy: brief overview:
* center on ... and ...
* some people prefer to limit how much the federal gov helps people get coverage
* they think it burdens ...
* support proposals that reduce ... or "generosity" of programs like Medicaid
* these types of policies would reduce number of people that would have coverage and the amount of coverage people would have
coverage;
cost;
taxpayers;
eligibility
57
Current debates in health care policy: brief overview:
* some people are focused on reducing ... and the number of uninsured citizens
* promote policies that expand programs like Medicaid
* support things like Medicare for All
* two factors determine health spending in the US: ... health care services patients receive and the ... for these services
premium;
how many;
prices paid
58
Current debates in health care policy: brief overview:
* "starting with the volume of services patients receive, the main challenge policymakers face is discouraging delivery of services that provide little health benefit without discouraging delivery of ...:
* potentially provide providers with incentives to stop using unnecessary services by paying them based on the ... patients incur rather than on number of services they provide
* another approach is to have consumers pay more so that they will stop using ... (doesn't this assume the consumers have the knowledge to know what's a low-value service? wth)
valuable services;
overall costs;
low-value services
59
Current debates in health care policy: brief overview:
* addressing high prices:
* make the market more ... - encourage new entrants, block mergers and police anti-competitive behavior
* second option is to take advantage of the fact that ... tend to pay lower prices and introduce a ... option by transitioning to a ...
competitive;
public insurance programs;
public;
single payer system
60
current debates in health care: brief overview:
* addressing high prices:
* or policymakers could just regulate prices ...
* regardless of the approach, quality of care must be conserved
* prescription drug prices raise other issues
* tend to be expensive bc gov gives new drug inventors a ... which allows prices to be set high to encourage ...
directly;
limited monpology;
new drug development;
61
current debates in health care: brief overview:
* addressing high prices
* prescription drug prices raise other issues
* current approaches focus on reducing the .../... of the monopoly or ... on prices manufacturers can set
* the risk is ... drug development
scope;
length;
putting a cap;
discouraging
62
