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Prev Med Finals > National Health Insurance Program > Flashcards

National Health Insurance Program Flashcards

1
Q

1997

A

Medicare fxns for govt workers from GSIS

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2
Q

1998

A

Private sectors from the SSS

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3
Q

1998

A

Indigent program

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4
Q

1999

A

Self employed

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5
Q

2005

A

OWFs

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6
Q

2014

A

14.7 M families are enrolled thru full Natl Govt subsidy by RA 10606
Kalusugan Pangkalahatan
“Bawat Pilipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin Sigurado”

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7
Q

RA 10606

A

National Health Insurance Act of 2013

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8
Q

Attainment of coverage for the entire population, with at least a basic minimum package of health insurance benefits

A

Universality

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9
Q

Uniform acces to health care and benefits based on need, not on ability to pay

A

Equity

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10
Q

Adequately meeting the needs for personal health services at various stages of a member’s life

A

Responsiveness

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11
Q

Balance between economical use of resources and quality care

A

Effectiveness

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12
Q

All citizens shall be required to enroll in the NHIP in order to avoid adverse selection & social inequality

A

Compulsory coverage

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13
Q

Adaptation to changes in medical technology, health service organizations, payment system, professional practice and other trends, both in private and public sectors

A

Innovation

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14
Q

Accountable in all their dealings wt the PhilHealth & its members

A

Professional resp of health care providers

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15
Q

Promotes the quality & improvement of health services thru the instituionalization of quality assurance program at all levels of the health service delivey system.

A

Quality of services

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16
Q

Satisfaction of the community & individual beneficiaries shall be a determinant of the quality for service delivery

A

Quality of service

17
Q

Govt shall provide basic package of needed personal health services thru premium subsidy, or thru direct service provision until such time that the program is fully implemented

A

Care for the indigent

18
Q

Any person entitled to health care benefits under this Act

A

Beneficiary

19
Q

Services that the NHIP offers to its members

A

Benefit Package

20
Q

Paid amt for coverage

A

Contribution

21
Q

Dependents

A
  • The legitimate spouse who is not a member
  • Unmarried and unemployed legitimate, legitimated, illegitimate, acknowledged children as appearing in the birth cert; legally adopted or stepchildren below 21
  • children 21yo above suffefring from congenital disb, or any disab that renders them totally dependent
  • parents 60yo above, mo income is below amt to be determined by Corporation
  • parents wt permanent disabilities
22
Q

NHIP in 1995

A

RA 7875

23
Q

A person who has no visible means of income, or whose income is insufficient for the subsistence of his family

A

Indigent

24
Q

Childredn who have no known family willing & capable to twke care of them

A

Abandoned children

25
Q

Hospital payment method that reimburses to hospitals a predetermined fixed rate for each treated case or disease;
Aka per case payment

A

Cash-based payment

26
Q

A former member who has reached the age of retirement under the law and has paid atleast 120 monthly premium contributions

A

Lifetime member

27
Q

Workers wt formal contracts & fixed terms of employment including workers in the govt & private sector; whose premium contribution payments are equally shared by the employee and employer

A

Members in the formal economy

28
Q

Workers who are not covered wt formal contracts or agreements & whose premium contributions are self-paid or subsidized by another individual thru a defined criteria set by the corporation

A

Members in the informal economy

29
Q

Documented or undocumented Filipinos who are engaged in remunerated activity in another country of whc they are not citizens

A

Migrant workers

30
Q

Member whose contribution os being paid by another individual, govt agency, or private entity accrdg to the rules as may be prescribed by the corporation

A

Sponsored member

31
Q

A member of the Program who has reached the afe of retirement as provided for by la or who was retird on acct of permanent disability as certified by the employer & the Corporation

A

Retiree

32
Q

Benefit package:

inpx hospital care

A
  1. Room n board
  2. Services of health care profs
  3. Diagnostic, lab & pther medical examination services
  4. Use of surgical/medical equipment & facilities
  5. Prescription drugs & biologicals
  6. Inpatient education packages
33
Q

Benefit package:

Outpx hospital care

A
  1. Services of health care profs
  2. Diagnostic, lab & other medical exam services
  3. Personal preventive services
  4. Pres drugs & biologicals
34
Q

Members confined abroad are eligible to avail benefit package provided:

A
  1. Official receipt/ any proof of payment/ statement of acct
  2. Cert of the attending physician as to final diagnosis, period of confinement & services rendered
    * submitted wtn 180 cal days from date of discharge
35
Q

Health care insts must give indigent members preferential access to their social welfare funds, whc may be used to augment the benefit package provided, in case of insufficiency to fully cover all confinement charges

A

No balance billing

36
Q

A field of science that investigates the value of health technology such as procedure, process, products or devices, specifically on their quailty,, relative cost effectiveness & safety

A

Health technology assessment

Prev Med Finals (3 decks)

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