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Med School Stuff > insurance stuff contd > Flashcards

insurance stuff contd Flashcards

1
Q

Universal Health Care in Different Countries, Pros and Cons of Each:

  • Pros
    • … health care costs for an economy
    • forces hospitals and doctors to provide … at low cost
    • eliminates … by eliminating need to deal with private insurance
    • allows for everyone to have access to … and consequently reduces expensive … usage
A

lowers;

same standard of care;

administrative costs;

primary care physicians;

ER

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2
Q

Universal Health Care in Different Countries, Pros and Cons of Each:

  • cons
    • forces … to pay for others’ medical care
      • apparently this is also true outside of universal systems “as spending on chronic diseases will raise the cost of … as well”
    • without financial incentive, people may not be as … with their health
A

healthy people;

private health insurance plans;

careful

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3
Q

Universal Health Care in Different Countries, Pros and Cons of Each:

  • cons
    • most universal health systems report … for elective procedures
    • can actually reduce availability of care due to …
      • “for example, doctors report Medicare payment cuts will force them to close many in-house blood testing labs”
    • the gov can limit services with a low probability of …
      • e.g. drugs for rare conditions
A

long wait times;

cost-cutting;

success

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4
Q

Universal Health Care in Different Countries, Pros and Cons of Each:

  • most universal health care is funded by … or …
    • i personally think the burden should be higher for those with higher income
A

general income taxes;

payroll taxes

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5
Q

3 universal health care models:

  • …
  • …
  • …
A

single payer;

mandatory insurance;

national health insurance;

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6
Q

3 universal health care models:

  • single payer
    • government provides health care through …
    • services are gov owned, and health care workers are …
    • every citizen has the same …
A

tax money;

gov employees;

access to care

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7
Q

3 universal health care models:

  • single payer
    • … uses this, along with:
      • …
      • …
      • …
    • US offers it to … and …
A

UK;

Spain;

New Zealand;

Cuba;

veterans;

military personnel

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8
Q

3 universal health care models:

  • Mandatory insurance
    • requires everyone to …, typically through …
    • kind of like what Obamacare was reaching for
    • taxes also contribute to a government run … that covers everyone
A

purchase insurance;

employers;

health insurance fund

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9
Q

3 universal health care models:

  • mandatory insurance
    • there are still … doctors and hospitals
    • gov controls health insurance … and can influence that of private providers as well
A

private;

prices;

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10
Q

3 universal health care models:

  • mandatory insurance:
    • … developed this
    • …, …, …, …, and … also use it
A

Germany;

France;
Belgium;

the Netherlands;

Japan;

Switzerland

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11
Q

3 universal health care models:

  • National health insurance
    • uses public insurance to pay for …
    • everyone pays into the …
    • … costs are lower
    • government can help force medical costs down
A

private practice care;

national insurance plan;

administrative costs

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12
Q

3 universal health care models:

  • national health insurance
    • …, … and … use this
A

Canada;

Taiwan;

South Korea

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13
Q

3 universal health care models:

  • national health insurance:
    • …, … and … use this model
A

Medicare;

Medicaid;

Tricare

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14
Q

3 universal health care models:

  • … funded and … delivered
    • visits are billed to …
A

publicly;

privately;

the government

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15
Q

3 universal health care models:

  • countries typically combine universal health care and other systems to allow for … and thus …, … or … care
A

competition;

lower costs;

expand choice;

improve

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16
Q

Australia’s health care:

  • … plan
  • gov provides … health insurance called … and runs …
    • everyone is covered under this
A

mixed health;

public;

Medicare;

public hospitals;

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17
Q

Australia’s health care:

  • people pay … before gov payments are able to be used
  • residents can also purchase … to get higher quality of care if they so choose
  • government regulations protect populations including …, the …, … and … residents
A

deductibles;

private insurance;

seniors;

poor;

children;

rural

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18
Q

Australia’s health care:

  • ​wait times are … but per capita costs are …
  • … rates of similar countries
A

high;

low;

best infant mortality

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19
Q

Canada’s universal health care:

  • … health insurance system
  • gov pays for services provided …
  • … insurance is used to pay for vision, dental care, and prescription drugs
A

national;

privately;

private supplemental;

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20
Q

Canada’s universal health care:

  • hospitals are … funded and provide … care to everyone regardless of ability to pay
  • hospitals are on a … to control costs but doctors are reimbursed at a … rate
  • … wait times
A

publicly;

free;

fixed budget;

fee-for-service;

very high

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21
Q

France’s universal health care:

  • … health insurance system provides care to everyone
    • includes drugs, dental and vision and hospitals
  • it also pays for …, … treatments and …
A

social;

homeopathy;

spa;

nursing home care

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22
Q

France’s universal health care:

  • … fund 16%, … and … fund 12%, and … fund 64%
A

income taxes;

alcohol; tobacco;

payroll taxes;

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23
Q

France’s universal health care:

  • pretty high wait times for …
  • decent …
A

specialists;

infant mortality

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24
Q

Germany universal health care:

  • also … health insurance;
  • people above a certain income can have …
  • state sponsored insurance covers …, except for meals and accommodation
A

social;

private insurance;

hospitalization

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25
Q

Germany’s universal health care:

  • covers … for hospital stays, … and … and also covers …
A

rehab;

mental health;

addiction;

long term care

26
Q

Germany’s universal health care:

  • funding from …
  • wait times aren’t too bad for … and are really low for …
  • again, … infant mortality
A

payroll raxes;

specialists;

general practitioners;

low

27
Q

UK universal health insurance:

  • … system
  • visitors receive care for … and …
  • … runs hospitals and pays doctors as employees
A

single-payer;

emergencies;

infectious diseases;

National Health Service

28
Q

UK universal health insurance:

  • Gov pays 80% of costs through … and …
  • the rest is paid from … and people paying … for NHS services
A

income;

payroll taxes;

copayments;

out of pocket

29
Q

UK universal health insurance:

  • covers some … and … care, … and some …
A

dental;

eye;

hospice;

long-term care

30
Q

UK universal health insurance:

  • … for drugs
  • … wait times to see a specialist
A

copays;

very high

31
Q

… rates in US are pretty high. … also are a huge problem.

WHO declared health care a … in 1948

… is the closest to universal health care that the US has implemented, but it still has a lot of exemptions that make it non-universal

A

infant mortality;

medical errors;

basic human right;

Obamacare

32
Q

Pros and Cons of Obamacare:

  • Pros
    • More Americans have …
    • health insurance is more … for many people
      • prevents insurers from making …
A

health insurance;

affordable;

unreasonable rate increases

33
Q

Pros and Cons of Obamacare:

  • Pros
    • people with … can no longer be denied
    • no … on care
      • Before Obamacare, some people with chronic health problems ran out of coverage - insurers would have limits on the amount of money they would spend on an individual
        • can’t do this anymore
    • more screenings and … services are covered
    • prescriptions …
A

preexisting conditions;

time limits;

preventive;

cost less

34
Q

Pros and Cons of Obamacare:

  • Cons
    • some indications that some people have to pay …
    • … if you don’t have insurance
      • this was eliminated in 2019 by the …
A

higher premiums;

fined;

Trump administration

35
Q

Pros and Cons of Obamacare:

  • Cons:
    • …
    • businesses searching for loopholes like cutting people’s hours to evade the definition of … to avoid covering their employees
A

tax increases;

full-time employee

36
Q

Obamacare:

  • the trump administration cut payments to insurance companies to keep their …, but the law still requires companies to do so
  • with Obamacare, there is an … period where you can shop for new health insurance plans for the next year
A

deductibles low;

open enrollment period;

37
Q

Obamacare:

  • With obamacare, there is an open enrollment period where you can shop for new health insurance plans for next year. If you don’t enroll during this time, you may not be able to purchase ACA-compliant coverage unless you experience a …, including
    • job loss
    • move to a new coverage area
    • birth of a child
    • loss of existing coverage
    • family event, like marriage, divorce, or death
    • there is the possibility of enrolling in a … if you haven’t had a qualifying event and you’re not covered
A

qualifying event;

short-term plan

38
Q

Obamacare:

  • those who get tax credits to pay for health insurance are those that have an income that is between … and … times the federal poverty level
    • below that - you apply for Medicaid or other gov assistance
  • plans are divided into 4 tiers that run from … to …
    • the former is the cheapest but only pays 60% of your costs
    • the latter is the most expensive but pays 90% of costs
A

1; 4;

bronze;

platinum

39
Q

HMOs:

  • health maintenance org
  • type of plan that costs less but you have fewer choices of …
  • have to choose a primary care doctor when you choose an HMO. You must go to this doctor before you can see other doctors when you’re sick
  • will have to make a … every time you see your primary care physician or see another specialist
  • HMOs often offer lower … but limit flexibility to see ..
A

doctors;

copay;

monthly premiums;

specialists

40
Q

HMOs:

  • HMOs have their own network of doctors, hospitals and other providers that have agreed to accept payment at a certain level for services they provide
  • tend not to cover … care
  • HMOs are a good option for people who don’t normally need anything more than …
  • HMOs tend to offer …
A

out-of-network;

basic medical care;

managed care

41
Q

HMOs:

  • some argue that HMOs provide an … level of care to patients
  • under HMOs physicians have to make recommendations based on …
  • HMOs are … driven
A

inferior;

HMO guidelines;

profit

42
Q

HMOs:

  • “Often decisions that affect a patient […] are made at corporate headquarters hundreds of miles away by board members with no medical background and no knowledge of local treatment facilities. (Physician advisers do help HMOs in setting standards, but those physicians are paid by and working in the best interest of the …, not of the …)”
  • HMOs set up standards that are not …
  • HMOs can refuse treatments by questioning its …
    • all treatment and all surgeries need to be pre-approved by HMOs
A

HMO;

patient;

patient-specific;

necessity

43
Q

HMOs:

  • “elderly patients are routinely denied expensive and even basic surgeries, solely on the basis of their …”
  • primary care providers are encouraged to limit …
    • HMOs provide money to pay for these, and if there is excess money left over, the primary care provider gets to keep it
    • PCPs who exceed standard costs for this or authorize too many expensive treatments can be …
A

age;

referrals to specialists;

tossed out of the network

44
Q

HMOs:

  • if a specialist requires more tests, permission still needs to be obtained from the …
  • “in effect, the specialist’s hands are tied by …, while the primary physician’s hands are tied by … - and the patient is caught in the middle.”
  • any doctor that speaks out against HMO can be kicked out of the network
  • doctors are still blamed for any negative outcomes that occur due to the HMOs guidelines
A

pcp;

primary physicians;

HMO guidelines;

45
Q

Trump’s impact:

  • cut open enrollment period by … and decreased the budget for promoting plans and paying people to help others navigate the …
  • “By promulgating new federal rules related to short term and also employer association health plans, the Trump administration strove to expand access to cheaper coverage that did not meet these quality standards and would siphon off healthier enrollees from the exchanges”
  • allowed for work requirements and administrative burdens from those benefitting from …
A

half;

sign up process;

Medicaid expansion

46
Q

Biden’s healthcare plans:

  • Wants to … ACA
  • wants … for gold plans for ACA as well, where enrollees pay 20% of the cost. Rn subsidies are focused on the silver plan, where consumers pay 30% of the costs for covered benefits
  • he also wants to increase subsidies by capping what people pay for their coverage at 8.5% of their income
    • currently, we have this cap, but it doesn’t apply to those who make over 400% of the poverty line, though
  • Biden wants a … option for health insurance
A

strengthen;

subsidies;

Medicare-like public;

47
Q

Biden’s healthcare plans:

  • Biden wants to … drug costs
  • wants to expand the …
  • wants to eliminate … for physicals, vaccines, vision and hearing screenings and preventative dental checkups for ,,, of all income levels
A

reduce;

state children’s health insurance rogram;

copayments; ‘

children

48
Q

Biden’s healthcare plans:

  • wants to stop employees and insurers from using … when making decisions about hiring/coverage
  • wants to continue movement to …
  • wants to establish scholarship and loan repayment programs to encourage people to join the …
A

genetic discrimination;

electronic health records;

public health workforce

49
Q

What Biden has done so far:

  • Assembled COVID …
  • pushed for immediate covid legislation - this was the … plan
    • did not include increase in minimum wage that biden wanted
  • released a vaccine … plan
  • rejoin … and kept Fauci as close advisor
A

task force;

relief;

distribution;

WHO

50
Q

Biden’s healthcare plans:

  • organized a …
    • basically a meeting among international leaders about reducing contributions to global warming
  • introduced legislation for pathway to … for immigrants in US illegally
  • established a task force to reunite children and parents that were … at the border
A

“climate world summit”;

citizenship;

separated

51
Q

Biden’s healthcare plans:

  • End Trump executive order banning travelers from some … countries
  • increase gov supervision over … and … agencies
  • signed an executive order that strengthened …
A

Muslim-majority;

US border;

immigration;

DACA

52
Q

Biden’s healthcare plans:

  • signed an executive order condemning … at US-Mexico border
  • executive order banning discrimination on the basis of … or …
A

separation of families;

gender identity;

sexual orientation

53
Q

Biden’s healthcare plans:

  • executive order expanding … programs
  • executive order assisting …
  • executive order guaranteeing … for workers who refuse work due to covid
  • executive order reversing … military ban
A

food assistance;

veterans with debt;

unemployment insurance;

transgender

54
Q

…: the belief that your culture is better than everyone else’s

A

ethnocentrism

55
Q

Difference between NP and doctor:

  • NP ed:
    • bachelor’s in nursing
      • includes clinical
    • … work experience
    • then nurse practitioner program
      • focused on a specific …
      • masters or doctorate
    • no formal residency
  • NP begin working with experienced NPs or physicians
  • NPs collaborate with … that they can call if needed
A

RN;

patient population;

physicians

56
Q

Difference between NP and doctor:

  • Both MDs and NPs:
    • obtain …
    • perform …
    • order and interpret …
    • order … and …
    • consult appropriate specialists
A

health histories;

physical exams;

diagnositcs;

treatments;

therapies

57
Q

Difference between NP and doctor:

  • NPs may need a collaborative agreement with a … depending on the state
    • can’t be completely autonomous depending on the state and institution
  • NPs do a lot of … of care
  • In general, physicians do more … than NPs do
A

physician;

transitioning;

advanced procedures

58
Q

Medicare vs. Medicaid:

  • Medicare is for people who are …, Medicaid is for people of my age who meet the state’s income requirements
  • no … for Medicare
  • Medicare, unlike Medicaid is not …
A

65+;

income requirements;

free

59
Q

Medicare A and B have premiums, but a lot of people do qualify for premium free part A:

  • part A = .. insurance
  • part B = … insurance
  • part C = …
  • part D = … insurance
A

hospital;

medical;

Medicare advantage;

prescription drug

60
Q

Medicare vs. Medicaid:

  • Medicaid:
    • who administers it:
      • each … manages its own Medicaid program
    • who is eligible:
      • anyone who meets … requirements, regardless of age
  • Medicare
    • who administers i:
      • the … establishes uniform rules for Medicare at the national level
    • who is eligible:
      • anyone who meets … or … requirements, regardless of income
A

state;

income;

federal government;

age;

disability

61
Q

Medicare vs. Medicaid:

  • Medicaid
    • how much does it cost
      • generally …
    • what does it cover
      • basic health care and prescription drug costs, as well as long-term care, medical equipment, eyeglasses, dental care, and other related health services
  • Medicare
    • how much does it cost
      • … are set at the federal level for Original Medicare, and there are annual deductibles and coinsurance amounts
    • what does it cover
      • medically necessary medical services and hospital care, certain medical equipment, and prescription drugs (under Part D)
A

free;

premiums

Med School Stuff (8 decks)

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