question

What is the central role of health services financing in the US

answer

Fund health insurance

question

What is the primary mechanism that enables people to obtain health services

answer

health insurance

question

the phenomenon called moral hazard results directly from

answer

health insurance coverage

question

liberal reimbursement for a given technology will ____ innovation/diffusion of that technology

answer

increase

question

controlling total health care expenditures by restricting financing for health insurance

answer

Demand side rationing

question

in national health care systems total expenditures are controlled mainly by

answer

supply side rationing

question

national health expenditures E =

answer

E = P x Q

question

in general sense what is primary purpose of insurance

answer

protection against risk

question

private health insurance is also called

answer

voluntary insurance

question

under community rating

answer

both high and low risk people are charged the same premium

question

which method of risk assessment is required by ACA for individual and small group health insurance

answer

adjusted community rating

question

under experience rating

answer

favorable risk groups pay a lower premium than high risk

question

what is the main advantage of group insurance

answer

risk is spread out among a large number of insured

question

self insurance was spurred by

answer

government policy

question

the employee retirement income security act

answer

exempts self insured plans from certain mandatory benefits

question

cost is shifted from people in poor health to the healthy when

answer

premiums are based on community rating

question

health insurance pays for medical care after insured pays first 1000

answer

deductible

question

copayment is generally paied

answer

each time the insured revives health care services

question

what was the main conclusion of the rand health insurance experiment

answer

cost sharing lowered health care utilization without any significant health consequences

question

medical policies are sold by

answer

private insurance companies

question

the ACA specifies that ____ can be covered under parents insurance plans

answer

children under 26

question

how are preexisting medical conditions covered under the ACA

answer

private insurance plans have to cover them starting 2014

question

under ACA what purpose do the exchanges serve

answer

they allow individuals and small businesses to purchase health plans

question

in general how do bronze, silver and gold health plans differ

answer

they differ according to cost sharing

question

what criterion does ACA use to classify an employer as a large employer

answer

50 or more full time employees

question

to purchase private insurance through an exchange premium subsidies are made available to people with incomes up to

answer

400% federal poverty line

question

majority of beneficiaries reviving health care through medicare are

answer

elderly

question

main function of Medicare payment advisory commission MedPAC

answer

advise the US congress on carious issues affecting the medicare program

question

to finance medicare part A

answer

all income earned by a working person is subject to medicare tax

question

skilled nursing care is covered under _____ of medicare

answer

part A

question

the HI portion of medicare is financed through

answer

payroll taxes

question

for medicare beneficiaries the max stay in an SNF during a benefit period cannot exceed

answer

100 days

question

for hospitalizations medicare beneficiaries must pay a deductible

answer

once per benefit period

question

Medicare part B premiums are

answer

income-based

question

SMI provides

answer

physicians services

question

Part C of medicare specifially covers

answer

--> NONE OF THE FOLLOWING rehab services; preventative care; prescription drugs

question

why was medicare part C created

answer

to channel beneficiaries into managed care programs

question

the donut hole in medicare prescription drug coverage

answer

provides no benefits until the beneficiary qualifies for the catastrophic level

question

the SMI trust fund is for

answer

parts B an D

question

the primary criterion to become eligible for medicaid

answer

financial status

question

by law federal matching funds to the states for medicaid cannot be less than

answer

50%

question

the insurance arm of military health care is called

answer

tricare

question

to receive payment for services delivered providers must file a ___ with third party payers

answer

claim

question

the use of fee for service reimbursement

answer

has been greatly reduced

question

_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of service

answer

fee for servce

question

what is the incentive under fee for service reimbursement

answer

providers have an incentive to deliver nonessential services

question

in general prospective payment systems establish reimbursement for

answer

bundled services

question

RVU's reflect

answer

resource inputs

question

preferred providers are paid

answer

negotiated discounted fees

question

when a fixed monthly fee per enrollee is paid to a provider its called

answer

capitation

question

capitation removes the incentive to

answer

provide unnecessary services

question

under retrospective reimbursement a health care organization is paid according to

answer

the costs incurred in operating the institution

question

wheat perverse incentive is present in retrospective reimbursement

answer

providers can increase their profits by increasing costs

question

the amount of reimbursement is determined before the services are delivered

answer

prospective reimbursement

question

what is not a type of prospective reimbursement methodology

answer

cost-plus

question

a DRG represents

answer

a group of principal diagnoses

question

an MS-DRG method of reimbursement an acute care hospital is paied

answer

a fixed amount for a particular DRG classification

question

under the DRG method of reimbursement a psychiatric hospital is paid

answer

a per diem rate based on psychiatric DRG's

question

how is case mix determined for an inpatient facility

answer

a comprehensive assessment of each patient is done

question

what is the minimum data set (MDS)

answer

a patient assessment instrument for skilled nursing facilities

question

if national health expenditures amount to 18% of the GDP

answer

health care consumes 18% of the total economic production

question

the largest share of national health expenditures is attributed to

answer

personal health care

question

public/government share of the total health care spending in the US is approximately

answer

45%

question

adverse selection makes health insurance less affordable for

answer

those in good health

question

Medicaid recipients are classified as medically uninsured t/f

answer

FALSE

question

Health insurance increases the demand for heath care services t/f

answer

true

question

tax policy in the us provides an incentive to obtain employer based health insurance t/f

answer

true

question

people in older age groups represent a higher risk than those in lower age groups t/f

answer

true

question

under community rating people are charged in the same regardless of health risk t/f

answer

true

question

today the majority of health insurance exists in the form of managed care plans t/f

answer

true

question

by law a health insurance plan must cover work related injuries t/f

answer

false

question

the government plays a significant role in financing health care services in the united states t/f

answer

true

question

it is illegal for an insurance company to sell a medical plan to someone who is covered by medicaid t/f

answer

true

question

under the ACA private health insurance will no longer be the main source of coverage t/f

answer

false

question

the ACA requires that employers provide health insurance to part time workers if the employer has 50+ woerks

answer

false

question

health insurance plans are prohibited from having lifetime dollar limits on medical benefits t/f

answer

true

question

health insurance plans are allowed to have annual dollar limits on a persons medical benefit t/f

answer

false

question

undr medicare program, eligibility criteria and benefits are consistent throughout the US t/f

answer

true

question

part D of medicare does not require the payment of a premium t/f

answer

false

question

long term care services for the elderly are covered under medicare

answer

false

question

under the medicaid program eligibility criteria and benefits are consistent throughout the us t/f

answer

false

question

state governments are required to partially finance the medicaid program t/f

answer

true

question

according to a US supreme court decision individual states can decide whether or not to expand their medicaid programs to comply with ACA

answer

true

question

research shows that prospectively set bundled payment methods are effective in reducing health care t/f

answer

true

Ch 6 Health Care Systems – Flashcards

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