PI Final

Question 1

5 exemplary leadership practice

Answer 1

1. model the way
2. inspire a shared vision
3. Challenge the process
4. enable other to act
5. encourage the heart

Question 2

PBL definition

Answer 2

this is any learning environment in which the problem drives the learning

Question 3

Financing

Answer 3

payment for service

Question 4

delivery

Answer 4

providing service/care

Question 5

4 types of health care financing in the US

Answer 5

1. out of pocket payment
2. individual private insurance
3. employment based group insurance
4. government - social insurance model

Question 6

individual private insurance consists of

Answer 6

a deductible and a co-payment

Question 7

deductible

Answer 7

amount of medical charge that must be paid by the patient before insurance companies will pay for the remaining charge

Question 8

Co-payment

Answer 8

amount of money patient pays provider directly at each visit

Question 9

public/private insurance

Answer 9

medicare: private delivery, public payment; government pays private deliveries

Question 10

public-public

Answer 10

like the military; the public money and public delivery

Question 11

VA/civilian:

Answer 11

employee of the government or public servant

Question 12

Government financing takes up what percent of all healthcare financing?

Answer 12

43%

this includes medicare, medicaid, CHIP, and other

Question 13

what is the most abundant type of healthcare financing?

Answer 13

A Health insurance plan at 77.3%

Question 14

Voluntary health insurance providers include:

Answer 14

1. Blues (Blue cross and Blue shield)
2. Private/commercial insurance
3. HMOs

Question 15

Blue Cross Blue Shield

Answer 15

Blue cross: hospital coverage; Blue shield: physician coverage

Question 16

Private/commercial insurances

Answer 16

1. UHC
2. Anthem BC
3. Aetna
4. CIGNA
5. Wellpoint
6. Humana

Question 17

HMO’s

Answer 17

1. kaiser
   2, GH
2. HIP
3. Partners healthcare

Question 18

T/F insurance is a state function

Answer 18

True- it is sold/regulated differently in each state

Question 19

Social Health insurance

Answer 19

1. Worker’s comp

2. medicare

Question 20

Worker’s Compensation

Answer 20

• offered in all 50 states
• covers medical costs and cash replacement of lost wages
• only 66% of lost wages replace tax-free and gives incentive to get back to work

Question 21

Medicare

Answer 21

• funded by SHI US trust fund and trust fund from Americans

- has two parts ( A and B)

Question 22

Medicare Part A:

Answer 22

• Hospital Insurance
• funded by social security withholding payroll taxes
• copays: hospital deductable pay the first 1184 per benefit period

Question 23

Medicare Part B

Answer 23

• Clinical services/physicians
• covers supplementary medical insurance (physicians, supplies, tests, out-pt services, health visits, preventative care, paps, mammograms, physicals, no copay, coinsurance
• funded by 64% general federal taxes
• 36% premiums of part A also funded

Question 24

Medicare Modernization act

Answer 24

• Part D provides outpatient drug prescription through private companies
• part C is the Medicare Advantage
• Drugs discount cars preventative benefits

Question 25

Public Welfare Insurance

Answer 25

1. medicaid

2. State child health insurance program

Question 26

Medicaid

Answer 26

• federal/state welfare
• eligible by income or needs
• optional “medically needy”
• federal mandated benefits
• hospital, lab, physician, X-ray, prenatal, preventive, nursing home

Question 27

who is a recipient of medicaid

Answer 27

• low income families with kids
• elderly, disabled, blind who receive SSI
• children

Question 28

state child health insurance program

Answer 28

• federal state program founded in 1997
• under age 19
• not medicaid eligible but up to 200% of poverty line
• result of Clinton reform
• less than half are enrolled in Colorado
• obama expanded coverage

Question 29

Indemnity Benefit

Answer 29

• traditional insurance plan
• to secure from loss or hurt
• fixed cash amount or percentage paid to beneficiary
• may be per day, per procedure, per visit
• relatively easy to administer
• increasingly rare in health care

Question 30

PPO (preferred provider organization)

Answer 30

• Arrangement where a specific group of providers agree to provide services for patients at a negotiated rate in order to gain referrals and see more patients
• retrospective payment

Question 31

EPO

Answer 31

• exclusive provider
• more restrictive
• greater discounts