Module 7 lecture, part 1 Flashcards
What is the central role of HC financing?
To pay health insurance premiums
What does HC financing do?
Increases demand for HC through health insurance
What does HC financing influence, and how?
Supply of HC by affecting the production of HC services, such as capital expenditures, renovations, expansions, and adoption of new svcs and tech.
What does HC financing stimulate?
New models of HC organization
What is also affected by HC financing?
Supply and distribution of HC professionals.
Total HC expenditures
____ increases demand, and supply for HC along with ______ (this is according to the conceptual model of cost control)
Insurance, payment
What determines access, which affects utilization of svcs, according to the conceptual model of cost control?
Insurance and supply of HC svcs
Utilization is also directly controlled by ______
Insurance, what is covered or not, and managed care
Expenditure formula
E = P X Q
Expenditures = price x utiilization
What is quantity of services consumed also affected by?
The changes in and the size of demographic composition
What are HC expenditures increased by?
Expansion of health insurance
Increase in health insurance premiums
What are HC expenditures reduced by?
Restricting insurance (demand-side rationing)
Restricting reimbursement to providers
Having fewer specialists
Spending less on R &D
Direct control over utilization (supply-side rationing)
Designating certain svcs as noncovered (rationing)
Definition of insured (beneficiary)
An individual protected by insurance
Insurer definition
An insurance agency that assumes the risk
Underwriting definition
Evaluation, selection (or rejection), classification, and rating of risk
Four principles of insurance
Risk is unpredictable
Risk can be predicted with some accuracy in a large group
Insurance can transfer risk from the individual to group through pooling of resources
Losses are shared by all members
Definition of premium
Amt charged by insurer to insure against risk
In employment-based insurance, how is a premium subsidized?
Employer-employee cost sharing
What is risk rating?
The actuarial assessment of risk
What are three risk rating methods?
Experience rating
Community rating
Adjusted community rating
Definition of cost-sharing
Insured individuals pay a portion of the actual costs of medical svcs out of pocket
What are 3 forms of cost sharing?
Deductible
Copayment
Co-insurance
Benefits definition
Svcs covered by an insurance plan
Where are benefits usually specified?
A contract
