Lectures 1-4 Flashcards
United States spend___ % of national gross domestic product on healthcare
United States spend 17% of national gross domestic product on healthcare
List the components of the Triple Aim and apply them to the healthcare system
- Improving experience
- Improving health
- Reducing cost of healthcare
-Iron Triangle of healthcare
- Cost
- Quality
- Access
4 types of cost sharing
Deductible
Copayment
Coinsurance
Out of Pocket Max
Catastrophic Hazard
Problem
Solution
- Problem: Widespread catastrophic event that would exceed ability to pay
- Solutions:avoid insuring large numbers of policy holders in same situation
Adverse Selection
Problem
Solution
- Problem: Individuals purchase insurance because they expect a loss
- Solutions: Group policies, waiting periods, medical underwriting, coverage limitations, coordination of benefits
Incentive to Create Losses
Problem
Solution
- Problems: Individuals gains from apparent loss (doctors who perform shotty ops)
- Solutions: New payment models
Supplier Induced Demand
Problem
Solution
- Problems: Demand for medical services does not come from provider
- Solutions: Prior Authorizations
Primary Agent Problem
Problem
Solution
- Problems: Occurs when one person is able to make decisions on behalf of impact another person
- Solution: Provider education
-Moral Hazard
Problem
Solution
- Problem: Overconsumption
- Solution: Cost Sharing
What are three different sources of healthcare in US
- Employer
- Individual
- Government
Staff Model HMO
Direct ownership of healthcare facilities and employment of physicians
Group Model HMO
Contracts with physician group who offer services exclusively to HMO patients on a capitated basis
Network Model HMO
Contracts with physician group who offer services NON- exclusively to HMO patients on a capitated basis
Independent Practice Association Model HMO:
Physicians team up and contract with HMO to work for negotiated fee
Preferred Provider Organization:
Patients can see anyone but have incentive to see in network
Point of Service:
- Combines characteristics of a HMO and PPO
- HMO: MUST PICK PCP in network
- PPO: PCP can make referrals outside of network
Consumer Driven Health Plan (Indemnity Insurance)
Tax free bank accounts that can be only used for medical expenses
-HSA
-FSA
-HRA
. Law now requires they must enroll in high deductible plan.
