Bio 150 exam 1 || A+ GRADED SOLUTIONS!!
Cost, Access, Quality correct answers What three issues make up the "Golden Triad" of
health care?
Five major ongoing challenges in the U.S. healthcare industry correct answers - Limited
access
- Inconsistent quality
- High cost
- Unnecessary and wasteful service
- Repeated test and treatment
Two ways in which insurance is able to pay for large expenses. correct answers 1. Money
should be set aside in small increments over time to spread out the potential cost of an
unexpected large expense.
2. Your money should be pooled with others' money to further spread out large costs
Beneficiary correct answers An individual enrolled in a health insurance plan/policy
Premium correct answers Monthly fee that a subscriber pays
Co-payment correct answers Fixed-dollar amount that the beneficiary must pay for a service
Co-insurance correct answers Percentage of the bill that the beneficiary must pay for a
service
Deductible correct answers Fixed-dollar annual amount of health care cost that the
beneficiary must pay out of pocket
Out of pocket max correct answers Total amount that the beneficiary must pay in a given year
Three basic ways to get insurance correct answers - Employment
- Government program
- On the market
Why did hospitals experiment with insurance after the great depression? correct answers
Because of reduced number of admission
Medicare correct answers - Federally-funded
- Nationwide coverage consistency
- 65 and older
- Participants pay deductibles and part of coverage costs
Medicaid correct answers - Federally and state-funded
- Coverage varies from state to state
- Mostly benefits pregnant women, individuals with disabilities, and people with low incomes
- Participants pay little or nothing for coverage
Block grants correct answers A mechanism to shift the federal government's direct support
and administration of healthcare programs to state and local governments
, Indemnity insurance correct answers - Basic insurance plan
- Beneficiary has a fixed amount of cost-sharing regardless of which physician it hospitals
he/she visits
Ex: Blue Cross/Blue shield
Managed care organizations correct answers Lower cost by establishment of Provider
Network and utilization management (payees evaluate the need and appropriateness of care)
Managed Care Organization (types) correct answers Health Maintenance Organizations,
Preferred Provider Organizations, and Point of Service
Health Maintenance Organization (HMO) correct answers - Least flexible
- Least expensive
- Requires patient to choose primary care physician
- Doesn't cover out of network providers
Preferred Provider Organization (PPO) correct answers - Most flexible
- Most expensive
- Allows out of network providers
Point of Service (POS) correct answers - Between HMO and PPO
- Requires PCP
- Allows out of network provider s
Health Insurance Probabitily and Accountability Act (HIPAA) correct answers - 1996
- Maintain privacy and security of patient health information
- Ensured coverage renewal for workers changing jobs
- Regulated insurers' coverage of preexisting condition
Health Insurance Marketplace (Exchanges) correct answers Where people who want
Obamacare (ACA) can choose their plan
Individual mandate correct answers A government rule that requires everyone to have
insurance coverage or they will have to pay a penalty in the form of a tax
Four major goals of the ACA correct answers - Incorporating preventative care
- Holding insurance companies accountable
- Incressing access to affordable care
- Improving quality and lowering cost
- Providing new customer protection
Medical Underwriting correct answers - The practice of estimating how much medical care
ab individual needs and charging a rate based on that
- ACA prevents
Medical Loss Ratio correct answers - The percentage of premium dollars an insurance
company spends on medical care, as opposed to administrative costs or profits
- ACA raised it
Cost, Access, Quality correct answers What three issues make up the "Golden Triad" of
health care?
Five major ongoing challenges in the U.S. healthcare industry correct answers - Limited
access
- Inconsistent quality
- High cost
- Unnecessary and wasteful service
- Repeated test and treatment
Two ways in which insurance is able to pay for large expenses. correct answers 1. Money
should be set aside in small increments over time to spread out the potential cost of an
unexpected large expense.
2. Your money should be pooled with others' money to further spread out large costs
Beneficiary correct answers An individual enrolled in a health insurance plan/policy
Premium correct answers Monthly fee that a subscriber pays
Co-payment correct answers Fixed-dollar amount that the beneficiary must pay for a service
Co-insurance correct answers Percentage of the bill that the beneficiary must pay for a
service
Deductible correct answers Fixed-dollar annual amount of health care cost that the
beneficiary must pay out of pocket
Out of pocket max correct answers Total amount that the beneficiary must pay in a given year
Three basic ways to get insurance correct answers - Employment
- Government program
- On the market
Why did hospitals experiment with insurance after the great depression? correct answers
Because of reduced number of admission
Medicare correct answers - Federally-funded
- Nationwide coverage consistency
- 65 and older
- Participants pay deductibles and part of coverage costs
Medicaid correct answers - Federally and state-funded
- Coverage varies from state to state
- Mostly benefits pregnant women, individuals with disabilities, and people with low incomes
- Participants pay little or nothing for coverage
Block grants correct answers A mechanism to shift the federal government's direct support
and administration of healthcare programs to state and local governments
, Indemnity insurance correct answers - Basic insurance plan
- Beneficiary has a fixed amount of cost-sharing regardless of which physician it hospitals
he/she visits
Ex: Blue Cross/Blue shield
Managed care organizations correct answers Lower cost by establishment of Provider
Network and utilization management (payees evaluate the need and appropriateness of care)
Managed Care Organization (types) correct answers Health Maintenance Organizations,
Preferred Provider Organizations, and Point of Service
Health Maintenance Organization (HMO) correct answers - Least flexible
- Least expensive
- Requires patient to choose primary care physician
- Doesn't cover out of network providers
Preferred Provider Organization (PPO) correct answers - Most flexible
- Most expensive
- Allows out of network providers
Point of Service (POS) correct answers - Between HMO and PPO
- Requires PCP
- Allows out of network provider s
Health Insurance Probabitily and Accountability Act (HIPAA) correct answers - 1996
- Maintain privacy and security of patient health information
- Ensured coverage renewal for workers changing jobs
- Regulated insurers' coverage of preexisting condition
Health Insurance Marketplace (Exchanges) correct answers Where people who want
Obamacare (ACA) can choose their plan
Individual mandate correct answers A government rule that requires everyone to have
insurance coverage or they will have to pay a penalty in the form of a tax
Four major goals of the ACA correct answers - Incorporating preventative care
- Holding insurance companies accountable
- Incressing access to affordable care
- Improving quality and lowering cost
- Providing new customer protection
Medical Underwriting correct answers - The practice of estimating how much medical care
ab individual needs and charging a rate based on that
- ACA prevents
Medical Loss Ratio correct answers - The percentage of premium dollars an insurance
company spends on medical care, as opposed to administrative costs or profits
- ACA raised it
