Quiz 3

Question 1

Explain the meaning of the “no-duty-to treat” principle

Answer 1

• Individuals dont have the legal right to receive health services (or insurance)
• For providers, they dont have to legally provide care

Question 2

Explain the key duties that exist under EMTALA

Answer 2

• Provide appropriate “screenings” for individuals who meet the emergency standard
• The second duty is to provide treatment and if you cant provide treatment, you must provide the necessary tools to send that patient to another hospital that can help them. You Must do so in a timely manner.

Question 3

Title VI of the 1964 Civil Rights Act prohibits discrimination based onCHECK

Answer 3

race, ethnicity, origin, and any program or activity that receives or is funded by federal aid (medicaid)

Question 4

Identify the two basic concepts that insurance is intended to address

Answer 4

-risk and uncertainty

Question 5

Define adverse selection as it relates to insurance

Answer 5

Adverse selection is when unhealthy people over select a particular insurance plan because unhealthy people tend to think they need more insurance coverage

Question 6

Distinguish between experience rating and community rating

Answer 6

• Experience rating is based on health status and claims from prior years
• community rating is based on factors unrelated to health such as geography and age

Question 7

identify three utilization control tools used by managed care organization

Answer 7

• case management
• gatekeepers
• utilization review.

Question 8

Describe what is meant by a state’s police powers

Answer 8

capacity of the states to regulate behavior and enforce order

Question 9

Canterbury v. Spence

Answer 9

Boy got surgery bc he was suffering from severe back pain. Dr. Spence did not inform the risks of the surgery . boy was suffering paralysis from waist down

Question 10

Roe v. Wade

Answer 10

unmarried pregnant woman filed a lawsuit bc texas criminal law prohibited her from attempting an abortion at any stage of pregnancy

solution: women have the right to abort but restricts their power as the fetus grows

Question 11

Health insurance comsumer
AKA?
define

Answer 11

• beneficiary/insured

- buys health insurance in advance for an annual fee

Question 12

health insurance carrier or company

define

Answer 12

pays for all or part of the beneficiary’s healthcare costs

Question 13

deductibles

Answer 13

amount of money the beneficiary must pay on her own for her healthcare needs each year before insurance carrier starts to help with costs

Question 14

co-payment or co-insurance

Answer 14

set dollar amount the beneficiary pays when receiving a service from a provider

Question 15

risk and uncertainty

Answer 15

• uncertainty-sick,injured

- risk-consumers buy insurance for the risk that something could happen

Question 16

adverse selection

Answer 16

unhealthy people over select a particular plan