Lectures 1-4

Question 1

United States spend___ % of national gross domestic product on healthcare

Answer 1

United States spend 17% of national gross domestic product on healthcare

Question 2

List the components of the Triple Aim and apply them to the healthcare system

Answer 2

• Improving experience
• Improving health
• Reducing cost of healthcare

Question 3

-Iron Triangle of healthcare

Answer 3

• Cost
• Quality
• Access

Question 4

4 types of cost sharing

Answer 4

Deductible
Copayment
Coinsurance
Out of Pocket Max

Question 5

Catastrophic Hazard
Problem
Solution

Answer 5

• Problem: Widespread catastrophic event that would exceed ability to pay
• Solutions:avoid insuring large numbers of policy holders in same situation

Question 6

Adverse Selection
Problem
Solution

Answer 6

• Problem: Individuals purchase insurance because they expect a loss
• Solutions: Group policies, waiting periods, medical underwriting, coverage limitations, coordination of benefits

Question 7

Incentive to Create Losses
Problem
Solution

Answer 7

• Problems: Individuals gains from apparent loss (doctors who perform shotty ops)
• Solutions: New payment models

Question 8

Supplier Induced Demand
Problem
Solution

Answer 8

• Problems: Demand for medical services does not come from provider
• Solutions: Prior Authorizations

Question 9

Primary Agent Problem
Problem
Solution

Answer 9

• Problems: Occurs when one person is able to make decisions on behalf of impact another person
• Solution: Provider education

Question 10

-Moral Hazard
Problem
Solution

Answer 10

• Problem: Overconsumption

- Solution: Cost Sharing

Question 11

What are three different sources of healthcare in US

Answer 11

• Employer
• Individual
• Government

Question 12

Staff Model HMO

Answer 12

Direct ownership of healthcare facilities and employment of physicians

Question 13

Group Model HMO

Answer 13

Contracts with physician group who offer services exclusively to HMO patients on a capitated basis

Question 14

Network Model HMO

Answer 14

Contracts with physician group who offer services NON- exclusively to HMO patients on a capitated basis

Question 15

Independent Practice Association Model HMO:

Answer 15

Physicians team up and contract with HMO to work for negotiated fee

Question 16

Preferred Provider Organization:

Answer 16

Patients can see anyone but have incentive to see in network

Question 17

Point of Service:

Answer 17

• Combines characteristics of a HMO and PPO
• HMO: MUST PICK PCP in network
• PPO: PCP can make referrals outside of network

Question 18

Consumer Driven Health Plan (Indemnity Insurance)

Answer 18

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.