Paying for Healthcare Flashcards
paradox of excess and deprivation of health care
some people receive to little care due to inability to pay
others receive unnecessary (and potentially harmful) care because they will/ can pay
pre PPACA (Patient protection and Affordable Care act)
3/4ths of uninsured are employed but have no coverage
what is the publics view of the health care system
least universal, most costly health care system
what are the top 3 modes for paying for health care
- government financing
- employment based private insurance
- out of pocket insurance
define out of pocket
how do providers get paid
pay directly for health care when needed
providers have direct reimbursement for consumer good/service
cons of out of pocket spending
unpredictable expenditures(costs)
makes budgeting hard
what was the original reimbursement model
out of pocket spending
what is insurance
risk sharing
(used to limit the risk of an uncertain loss)-< google def.
individual private insurance
what is it?
individual pays insurance company who pays provider
cons of individual
difficult to collect premiums
premium
what is it
amount of money charged by a company for active coverage
basically like a membership fee
deductable
what is it
amount you must pay before insurance pays anything
rx deductible may be seperate from a medical deductible
out of pocket
what is it and what does it include
amount paid directly by patient to care provider for care.
- payments before deductable is reached
- co-insurance: % of a medical charge that you pay after meeting your deductible.
- copay
- non covered items
what is the dominant payment model in the US
EMPLOYMENT BASED PRIVATE INSURANCE
how did the great depression effect payment models
it decreased health care utilization
the ability to pay OOp decreased
employment-based private insurance
what is it
employer takes money out of your paycheck to pay for premium
community rating
everyone charged same premium
experience rating
healthy groups are able to get better premiums
cons of employer insurance
some ppl unable to work
govt funded model
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)
how do providers get reimbursed under govt funded health care
through payment from idividuals and taxes
Types of medicare
A- basically pays for inpatient stuff
B- basically, medical expenses in outpatient settings
C
D- drugs
Medicare part A
in patient like hospitalizations,skilled nursing facility, home health care, hospice care
who is eligible fo part b
ppl who are eligible for part a and elect to pay premium of $104.50
