Social Insurance, Comparative health systems, health reform, pharmaceutical industry. Flashcards
1
Q
There are 5 social insurance programs:
A
- Poverty
- Old age
- Disability
- Health
- Unemployment
2
Q
Some programs, termed ? Are available to all who qualify.
A
Entitlements
3
Q
List examples of entitlements.
A
- Food stamps
2. Medicaid
4
Q
Are housing programs an entitlement?
A
No
5
Q
Common features to characterize health related social insurance programs, 3 related to receipt of care:
A
- Contributions
- Benefits
- Length of coverage
6
Q
Common features to characterize health related social insurance programs, 2 describe the provision of care as well as the political problems involved in initiating plans:
A
- Means
2. Methods of determining payment levels to providers
7
Q
A tax which lower income people pay higher fractions of their incomes to the tax than do the rich.
A
A regressive tax
8
Q
Tax is one which lower income people pay lower fractions than do higher income people.
A
Progressive tax
9
Q
Tax payments in the US into social security have always been somewhat?
A
Regressive
10
Q
Effective tax rate ________ as wage income rises above 106,800$.
A
Falls
11
Q
________ whether it in net causes a transfer of money from the rich to the poor
A
Redistributive
12
Q
PPACA
A
Patient Protection and Affordable Care Act 2010
13
Q
The United Kingdom established their first social health insurance in?
A
1911 leading to establish the British national health service in 1946
14
Q
Medicare and Medicaid passed when?
A
1965
15
Q
This requires most individuals to have health insurance
A
Individual mandate
16
Q
FPL
A
Federal poverty level
17
Q
SHOP
A
Small business health option program
18
Q
_____ is a national program that primarily provides compulsory hospital insurance to the elderly, plus optional medical coverage to which nearly all elderly subscribe
A
Medicare (1965)
19
Q
BBA of 1997
A
Balanced budget act
20
Q
Part A of Medicare is what?
A
Hospital insurance
21
Q
Part B of Medicare is what?
A
Supplementary medical insurance (SMI)
22
Q
Part D of Medicare is?
A
Drug benefit
23
Q
Does Medicare cover everything?
A
No.
24
Q
What services are not covered by Medicare?
A
Long term care, custodial care, dentures, dental care, glasses, and hearing aides
25
Expensive medication have been subject to high copayment rates. This means after initial subsidy, the enrollee would have to pay dollar per dollar. (Part d controversy)
Doughnut hole
26
Levy and Weir evaluate part d benefits, their study is called? It examines the impact of an intervention on a group seen prior to intervention.
Before and after study
27
The before and after study showed what?
1. Enrollment in part d was driven by demand
| 2. Most had no problems with the decision to enroll and were able to navugate the program
28
How is Medicare part A financed?
Primarily financed through the FICA tax, mandatory payroll deduction at 1.45% of earnings.
29
Who pays the FICA tax.
All employees and employers
30
How much is the FICA tax for the self employed?
2.9%
31
How is part b financed in Medicare?
Through premium payments and contributions from the general fund of the US treasury
32
_____ refers to private health insurance that within limits pays most of the health care service charges not covered by parts A and B of Medicare.
Medigap
33
PPS pays a ______ predetermined amount for each inpatient stay based on the DRg classification.
Specific
34
Physicians were payed based on reasonable charge before '92, initially defined as:
1. The md actual charge
2. The md customary charge or
3. The prevailing charge for similar services in that locality.
35
Changes to how charges from physicians were made in '92 were defined as allowed charges as the lesser of...
1. The submitted charges
| 2. Or the amount determined by a fee schedule based on relative value scale
36
Part b reimburses hospitals for outpatient services based on a ____ _____ ______, home health care reimbursed under the same system under part A.
Prospective payment system
37
Payment in full=
Take assignment
38
___ _____ beyond the initial annual deductible and coinsurance
Balance bill
39
What happens if providers do not take the assignment?
They will bill the amount not covered to the beneficiary (patient).
40
_____ is a federal state matching entitlement program that pays for medical Assistance for certain vulnerable and needy individuals and families with low incomes and resources.
MedicAid
41
Gruber describes Medicaid as four public insurance programs in one:
1. Low income women and children families
2. Public insurance for the portions of medical expenditures not covered by Medicare for low income elderly
3. Medical expenses for the low income disabled
4. Pays nursing home expenditures of many of the institutionalize elderly
42
Each state for Medicaid enrolled:
1. Estab their own standards
2. Determine the type, amount, duration, and scope of services
3. Sets the rate of payment for services
4. Administers its own program
43
Medicaid is a _____ ____ partnership between the federal government and the states.
Cost sharing
44
Cost sharing is know as?
FMAP- federal medical assistance program
45
How is the FMAP determined?
Comparing the states average per capital income level with the national average
46
States with higher per capita income levels are reimbursed _______ shares of their costs.
Smaller
47
If providers participate in Medicaid must they accept payment rates as payment in full?
Yes
48
DSH: states must make additional payments to qualified hospitals that provide inpatient services to a disproportionate number of Medicaid beneficiaries and/or to other low income or uninsured persons.
Disproportionate share hospital adjustment
49
Are pregnant women and children exempt from cost sharing?
Yes, along with those receiving emergency services and family planning services.
50
What are dual eligible?
Those who have Medicare and Medicaid that work jointly for many beneficiaries
51
If one has both Medicare and Medicaid, which service pays first? And what is that term?
Medicare lays first, Medicaid always the "payer of last resort"
52
CHIP:
Children's health insurance program, this was the largest expansion of health insurance coverage for children since the initiation of Medicaid in the 60's
53
What does CHIP target?
Targets low income children... one who resides in a family with income below 200% of the FPL, or whose family has an income 50% higher than the states medicaid eligibility threshold.
54
2 categories that are impediments to program take-up.
1. Program stigma, some people are embarrassed or afraid to apply for programs
2. Individuals face costs of learning about and applying for programs and these costs may deter them from being used
55
What did the Keiki child care program seek to do in Hawaii?
To cover every child from birth to 18, who didn't have insurance- mostly low income families and immigrants
56
What does the implementation of Medicaid and Medicare coincide with?
Considerable increase in health care costs
57
After the implementation of Medicaid and Medicare, what increased?
Hospital care inflation rate?
58
What's the primary reason for growth in Medicaid payments?
Growth in the enrollee population
59
Rehouse, suggested three ways in which insurance programs such as Medicaid and Medicare could affect price and cost, even without growth in population served:
1. Medicare and Medicaid increase insurance coverage for those eligible
2. Coverage may induce technological improvements
3. "Increased insufficiency theory', when insurance covers a substantial portion of the bill, hospitals have less incentives to control costs.
60
What is increased insufficiency theory?
When insurance covers a substantial portion of the bill, institutions have less incentive to control costs
61
What are some of the sources of inflation in regards to Medicare and Medicaid?
1. Changes in population in quantity per capita
| 2. And in the nature of services provided per visit or per admission
62
I infants who are high cost users of insurance?
1. Premies with substantial respiratory or other acute conditions
2. For the elderly, are cardiac or cancer patients
63
Holahan, Wiener, and Wallin noted that " declining Medicaid case loads are matters of concern, while _________ cash welfare caseloads are matters of _______."
Falling, pride
64
Card, Dobkin, and Maestas found that there is a Medicare eligibility ______ death rate of this severely ill patient group by _______%.
Death, 20
65
What did the BBA (balanced budget act) do?
Mandated development of prospective reimbursement systems and ended distaste reimbursement for outpatient services.
66
Did the BBA reduce physician payments?
Yes
67
How do you find the GDP percentage?
%= 100xexpenditures/GDP
68
What is the main criticism of US health care?
Main weakness is the problem of the uninsured
69
Uninsured consume _____ as much as health care as those ______.
Half, insured
70
What impact did the economic downturn of 2000-2003, have on social programs?
1. There was an increase in enrollment to the programs
2. Increased program spending due to growth
3. Few program expansions
4. Some program reductions in eligibility standards
71
Margaret Gordon developed typology of four health benefit systems:
1. Traditional sickness insurance
2. National health insurance
3. National health services
4. Mixed systems
72
Private insurance market with a state subsidy, exists in Germany
Traditional sickness insurance
73
These plans are found in Canada that involve a national level single payer health insurance system
National health insurance
74
This is in the U.K., has the state provide the health care
National health services
75
This is seen in the US, contains elements of both traditional sickness insurance and national health coverage
Mixed systems
76
PPP
Purchasing power parity, figures are adjusted on purchasing powers of local currencies
77
Who has the largest expenditures per capita and how much is spent on GDP?
The US, 17.9%
78
High expenditures have 3 meanings:
1. High average level of services
2. High resource costs for services
3. Inefficient provision of services
79
Cross national studies indicate a substantial responsiveness of health care expenditure to increased income (what does this mean)
Relatively large income elasticity
80
When did Britain establish their national health service?
1946
81
In britains health plan, how are general practitioners paid? And hospital practitioners?
Capitation and salaried
82
______% of prescriptions in Britain are exempt from charges.
90
83
Are patients in Scotland, wales, or Northern Ireland charged for prescriptions?
No
84
In Britain who are the gatekeepers to the health care system?
General practitioners
85
In Britain how is speciality care rationed?
Through wait lists and availability of new technologies
86
In britains NHS, the supply curve is?
Reflects what the government provides irrespective of price, shows a vertical line
87
The que for services with the NHS leads to what?
The wait can lead participants to postpone or simply not purchase certain services
88
What high return services does the NHS devote a lot of resources to?
Prenatal and infant care
89
Even though access was universal, were the results equal?
No
90
Who replaced the centralized hierarchical NHS bureaucracy with a quasi market mechanism?
Margaret thatcher
91
It created a purchaser/provider split
Quasi market mechanism
92
2 major problems with quasi market?
1. Capacity constraints- doctor, nurse, and inpatient bed shortages
2. Incentive problems pervaded the system
93
The experience of the NHS in the area of cost containment seems clear:
Rationed care cuts money costs
94
In China the healthcare system was a doctrinated political system with administered prices to?
Market oriented processes
95
China spends more per capita than India or Indonesia but less than?
Japan
96
Three tier network in urban china areas are composed of?
Street clinics, district hospitals, and city hospitals
97
In Chinese rural areas the three tier network consists of?
Village clinics, township health centers (THC), and county hospitals
98
What's the goal of Maoist communist role thru the 70s?
Assure access to care
99
Without government subsidies, providers tend to favor high tech diagnostics at the expense of?
Less profitable basic services
100
How many Chinese rural must pay out of pocket for all health services?
700 million
101
Chinese providers receive payment from three main sources:
1. 60% from out of pocket payments based on regulated fee schedule
2. Social insurance
3. Government subsidies (these are a decreasing share of a providers revenue)
102
Facilities in china remain largely _____, and clinics remain _____ for _____.
Nonprofit, private for profit
103
5 priorities for Chinese health policy reform:
1. Expanded coverage and improved basic health care benefits for rural and urban
2. Full coverage for essential meds
3. Reformed and improved capabilities for primary health care institutions
4. More efficient provision of and access to public health programs
5. Improved capacity and quality of traditional Chinese medicine care and further containment of health care costs
104
Difference between Canadian and US health care systems?
Canada has publicly funded national health insurance and the US has relied on private financing and delivery
105
What's the Canadian system of financing and delivering health known as?
Medicare
106
How is Canadian Medicare supported?
Each of the ten provinces and three territories are partially supported by grants from federal government
107
Canadian criteria for coverage:
Universal
Comprehensive
Portable, meaning ind can transfer their coverage to other provinces as they migrate across the country
108
Are there any financial barriers to access in Canada?
No, and patients have free choice in the selection of their providers
109
Most Canadian physicians have ______ _______ and hospital admitting privileges
Private practice
110
Canadian hospitals are what kind of hospitals?
Private, not for profit
111
Canada health act of 1984 defines criteria and conditions to satisfy in order to qualify for full share of the federal transfers under the Canada health transfer cash contribution:
1. Public administration
2. Comprehensiveness
3. Universality
4. Portability
5. Accessibility
112
2 key provisions of Canadian Medicare
1. No extra billing by medical practitioners or dentists for insured health services under the terms of the health care insurance plan
2. No user charges for insured health services by hospitals or other providers under the terms of health care insurance plan
113
Canada spends less on he's,the care even though their ____ of _____ is longer.
Length of stay
114
Define monopsonies
Single buyers
115
What does the monopsony mean to provincial governments?
They face upward sloping supply curves for physicians , when fees are raised it's raised for all
116
What does monopsony result in?
Lower fees than with competitive buyers and in hiring fewer workers than in a competitive market.
117
What kind of patients are generally found in Canadian hospitals?
Long term care
118
Balance billing means?
Canada gas limits on total spending, means providers cannot evade fee controls by charging extra to patients who can afford it
119
Administrative costs in the US account for how much of health care spending?
31%
120
Canadian system more effective than the US system in several respects:
1. Lower costs
2. More services provided
3. Financial barriers don't exist
4. Health status measured by mortality rate is superior
Canadians have longer life spans and lower infant mortality rates
121
What do critics of Canadian health care system say?
Health care is rationed in a sense that all the care patients demand or would be provided to meet their best interests cannot be supplied on a timely basis
122
WhAt causes Canadians and Americans not to seek care?
Canadians complain of wait time being too long or unavailable
US complain of cost
123
HUI
Health utility index
124
Costs are more easily over come than the?
Absence of services
125
Model of health care expenditures called total expenditures on health care, E. what is the definition of this?
Expenditures equal the price of health care multiplied by the quantity of health care consumed, or:
E=PQ
126
s= the share of national income spent on health care, we calculate s as the ratio of E to national income, Y, or:
s= PQ/Y
127
The share (s) can increase because either the price or quantity has ____, or because the national income has ______.
Increased, decreased
| % change s)= (% change P) + (% change Q) - (% change Y
128
If the price of health care, P, increases by the sane rate as the price of all other goods, so that Y increases at the sane rate, then the health care share of national income?
Does not change
129
Q (quantity) increases when?
Y (national income) increases
130
We find varying degrees of ______ power on the sell side of the mArket and varying degrees of _______ power on the buy side
Monopoly, monopsony
131
Monopolist equate marginal costs to ______ ____, enabling them to raise prices above those they would obtain in a perfectly competitive market
Marginal revenues
132
This is the excess of the prices actually received by sellers above the minimum prices the sellers would have to be paid to sell into the market
Rents
133
A single payer is a?
Pure monopsony
134
Pure monopsonies are constrained by market forces on the supply side, meaning?
If fees are too low, providers will not supply their goods or services
135
Anderson and colleagues proposed two explanations for high US costs:
1. Other countries have constrained the supply of health care resources, partly for elective cases, led to wait lists and lower spending
2. The threat of malpractice litigation and the resulting defensive medicine in the .uS
