Paying for Healthcare

Question 1

paradox of excess and deprivation of health care

Answer 1

some people receive to little care due to inability to pay

others receive unnecessary (and potentially harmful) care because they will/ can pay

Question 2

pre PPACA (Patient protection and Affordable Care act)

Answer 2

3/4ths of uninsured are employed but have no coverage

Question 3

what is the publics view of the health care system

Answer 3

least universal, most costly health care system

Question 4

what are the top 3 modes for paying for health care

Answer 4

1. government financing
2. employment based private insurance
3. out of pocket insurance

Question 5

define out of pocket

how do providers get paid

Answer 5

pay directly for health care when needed

providers have direct reimbursement for consumer good/service

Question 6

cons of out of pocket spending

Answer 6

unpredictable expenditures(costs)

makes budgeting hard

Question 7

what was the original reimbursement model

Answer 7

out of pocket spending

Question 8

what is insurance

Answer 8

risk sharing

(used to limit the risk of an uncertain loss)-< google def.

Question 9

individual private insurance

what is it?

Answer 9

individual pays insurance company who pays provider

Question 10

cons of individual

Answer 10

difficult to collect premiums

Question 11

premium

what is it

Answer 11

amount of money charged by a company for active coverage

basically like a membership fee

Question 12

deductable

what is it

Answer 12

amount you must pay before insurance pays anything

rx deductible may be seperate from a medical deductible

Question 13

out of pocket

what is it and what does it include

Answer 13

amount paid directly by patient to care provider for care.

1. payments before deductable is reached
2. co-insurance: % of a medical charge that you pay after meeting your deductible.
3. copay
4. non covered items

Question 14

what is the dominant payment model in the US

Answer 14

EMPLOYMENT BASED PRIVATE INSURANCE

Question 15

how did the great depression effect payment models

Answer 15

it decreased health care utilization

the ability to pay OOp decreased

Question 16

employment-based private insurance

what is it

Answer 16

employer takes money out of your paycheck to pay for premium

Question 17

community rating

Answer 17

everyone charged same premium

Question 18

experience rating

Answer 18

healthy groups are able to get better premiums

Question 19

cons of employer insurance

Answer 19

some ppl unable to work

Question 20

govt funded model

Answer 20

Medicare and medicaid, SCHIP
medicare for elderly (same across all states)
medicaid for poor (diff across states)
SCHIP for uninsured children (fed and state partnership)

Question 21

how do providers get reimbursed under govt funded health care

Answer 21

through payment from idividuals and taxes

Question 22

Types of medicare

Answer 22

A- basically pays for inpatient stuff
B- basically, medical expenses in outpatient settings
C
D- drugs

Question 23

Medicare part A

Answer 23

in patient like hospitalizations,skilled nursing facility, home health care, hospice care

Question 24

who is eligible fo part b

Answer 24

ppl who are eligible for part a and elect to pay premium of $104.50

Question 25

medicare part b:

Answer 25

outpatient stuff
medical expenses, physician services
physical, occupational, speech therapy, medical equipment, diagnostic tests (no coinsurance for lab services), preventative care

Question 26

media gap

Answer 26

private insurance that helps pay for large medicare deducatbles

medical is not apart of medicare

Question 27

medicare part D

Answer 27

1. deductible phase: max deductible $405
2. coverage phase: copay or 25% co insurance
3. “coverage gap phase: (donut hole )
4. catastrophic phase:

Question 28

what does not count toward donut whole

Answer 28

premiums
dispensing fee
non covered drug expense

Question 29

cons of part d

Answer 29

major gaps in coverage
managed by private insurance companies
govt not allowed to negotiate drug prices

Question 30

medicare part C:

Answer 30

advantage plan to reduce OOP costs. includes med coverage

Question 31

medicaid

Answer 31

poor and disabled

Question 32

SCHIP

Answer 32

STATE CHILDRENS HEALTH INSURANCE PROGRAM

Question 33

progressive health care plan

Answer 33

rising % of income taken as income increases

Question 34

regressive models

Answer 34

decrease % of income as income increases

Question 35

is us health care spending progressive or regressive

Answer 35

regressive. decrease 5 taken the more you make