Topic 8 - Health Care in the U.S Flashcards
1
Q
Explain HMOs
A
- paid doctors on salary rather than fee for service insurance system
- “gatekeeper” doctors to prevent unnecessary use of specialists
- emphasis on prevention
- affordable health care
2
Q
Explain the difference between medicare and medicaid
A
Medicare: for people > 65 and disabled
Medicaid: disadvantaged individuals and funded by both the state and the federal government
3
Q
Name the crises in health care
A
- Rising cost
- Access to care
- Quality of care
- Errors
4
Q
Describe the Flexner Report.
A
- highlights inadequate requirements and poor facilities in medical schools
-subsequent legislation resulted in closing many medical schools
5
Q
Explain the fee-for-service model.
A
prior to 1930, people used to be able to pay out of pocket for care - costs were as not prohibitive as they are today
6
Q
What was the Social Security Act of 1965?
A
- Medicare and Medicaid was created
- federal program-funded from social security taxes
7
Q
How were Diagnostic Related Groups established?
A
- increasing costsled the federal gov. to implement this managed care system and because of over-treatments
8
Q
What is Managed Care?
A
- refers to any system that controls costs through closely monitoring and controlling the decisions of health care providers
9
Q
Explain the 1983 Diagnostic Related Groups (DRG).
A
- limits the amount of reimbursement funds for Medicare and Medicaid patients
- logic changed now physicians and hospitals are rewarded for under treatment - increase revenues by restricting care
- shift from inpatient to outpatient surgery
10
Q
What are some key aspects of the Affordable Care Act?
A
- goal to provide health insurance for 32 mil. uninsured Americans
- individual madate
- employer madate
- limits on deductibles and copayments
11
Q
What was Blue Cross Blue Shield designed for?
A
- protect doctors and hospitals
- fee-for-service insurance
- community rating: each person charged based on average risk of entire community
12
Q
Explain actuarial risk rating
A
- insurers maximize their profits by ding whatever they can to avoid signing up individuals who are at high risk
- individual premimum bsed on individual risk
13
Q
Explain the state children’s health insurance program
A
- extended converage for children under 18 through Medicaid
