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Med School Stuff > insurance stuff > Flashcards

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

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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

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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

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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

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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

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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

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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
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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20
Q

Insurance companies cover … services, but if it’s considered “…,” they generally don’t cover it

A

essential;

elective

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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

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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

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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)

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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

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25
Q

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
A

income;

number of dependents;

low-income childless adults;

small businesses

26
Q

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 …
A

ambulatory patient services;

emergency services;

hospitalization;

maternity; newborn care

27
Q

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
    • …
A

mental health;

substance abuse disorder;

behavioral health;

prescription drugs

28
Q

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
A

Rehab; habilitative;

lab;

29
Q

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 …
A

preventive; wellness;

chronic disease management;

pediatric;

oral;

vision care

30
Q

Obamacare instituted in 2010 - Patient Protection and Affordable Care Act:

  • between 2013 and 2014, the number of uninsured people declined by …%
A

18.8 (about 20)

31
Q

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
A

fee for service;

managed care

32
Q

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 …
A

social security benefits;

hospitalization;

workers;

employers

33
Q

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)
A

deductible;

physicians’;

outpatient

34
Q

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 …
A

annual deductible;

premiums;

federal gov;

voluntary

35
Q

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 …
A

fee-for-service;

fees they charged;

service;

networks

36
Q

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
A

fiscal intermediaries;

eligibility;

funds;

dual-eligible

37
Q

Social Security Amendments of 1972:

  • Nixon expanded Medicare coverage to … people who were receiving benefits for at least 2 years to people with significant …
A

disabled;

renal disease

38
Q

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
A

prepaid group practice;

health maintenance organizations;

subsidies

39
Q

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 …
A

nonprofit;

same premium;

HMO option;

organizational structures

40
Q

…

  • aka COBRA
  • signed by Ronald Reagan in 1986
  • denied tax deductions to employers whose health plans did not allow employees to …
A

Consolidated Omnibus Budget Reconciliation Act of 1985;

continue coverage

41
Q

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
A

losing;

death; divorce;

reduction;

medical leave

42
Q

… (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
A

Health Security Act of 1993;

full time employees;

small businesses

43
Q

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 …
A

state-based cooperatives;

obtain health insurance;

enrolled automatically;

pay twice the premium

44
Q

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
A

minimum standards;

pre-existing conditions;

National Health Board

45
Q

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 …
A

Health Insurance Portability and Accountability Act;

preexisting conditions;

pregnancy;

genetic predispositions

46
Q

HIPAA:

  • allowed workers to retain their health insurance after …/..
    • basically expanded on COBRA
  • established national standards for … and … of electronic health information
A

losing/changing jobs;

privacy;

security

47
Q

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
A

Security Rule;

Privacy Rule;

disclosure

48
Q

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
A

State Children’s Health Insurance Program;

Medicaid;

expand Medicaid;

new program

49
Q

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
A

Tax Equity and Fiscal Responsibility Act;

medicare Part C;

Medicare Advantage;

federal government

50
Q

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
A

geographic regions;

preventive services;

controlling costs

51
Q

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
A

higher payments;

HMO options

52
Q

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
A

prescription costs;

Medicare part d;

no coverage

53
Q

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
A

separate drug plan;

private;

retirement benefit

54
Q

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 …
A

premiums;

income;

paid higher premiums

55
Q

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
A

tax exemption;

health savings accounts

56
Q

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
A

coverage;

cost;

taxpayers;

eligibility

57
Q

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
A

premium;

how many;

prices paid

58
Q

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)
A

valuable services;

overall costs;

low-value services

59
Q

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 …
A

competitive;

public insurance programs;

public;

single payer system

60
Q

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 …
A

directly;

limited monpology;

new drug development;

61
Q

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
A

scope;

length;

putting a cap;

discouraging

62
Q
A

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