NURS 312 Exam 2 with !| !| !| !| !|
precise detailed answers !| !|
Economic definition - Correct answer ✔Study of the distribution of resources
!| !| !| !| !| !| !| !| !| !| !|
across a !|
population
Opportunity Cost - Correct answer ✔Value of product/service
!| !| !| !| !| !| !|
foregone, what is given up in choosing one
!| !| !| !| !| !| !|
product, service or technology over another
!| !| !| !| !|
complements in consumption - Correct answer ✔Products/services consumed
!| !| !| !| !| !| !|
jointly so if ↑price of one may
!| !| !| !| !| !|
↓demand for both !| !|
(IV fluid & tubing)
!| !| !|
substitues in consumption - Correct answer ✔Goods/services that satisfy
!| !| !| !| !| !| !| !| !|
same
need
EX: Unlicensed personnel as substitutes for RNs
!| !| !| !| !| !|
,Moral Hazard - Correct answer ✔When a person's behavior changes based
!| !| !| !| !| !| !| !| !| !| !|
on insurance.
!| !|
EX: less incentive to promote health b/c one has good insurance and will be
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
treated
Insurance co-pay - Correct answer ✔Amount to be paid out-of-pocket when
!| !| !| !| !| !| !| !| !| !| !|
care/service is rendered !| !|
ex: $25 for patient first
!| !| !| !|
Insurance deductible - Correct answer ✔-Fixed amount that consumer must
!| !| !| !| !| !| !| !| !| !|
first pay towards
!| !|
medical bill each year before insurance payments are made.
!| !| !| !| !| !| !| !|
-Lower deductible= higher premium or vice versa.
!| !| !| !| !| !|
Risk Pooling - Correct answer ✔>Spread the risk across the group
!| !| !| !| !| !| !| !| !| !|
-money is shifted b/w younger/ healthier people vs. older/sick people who
!| !| !| !| !| !| !| !| !| !| !|
require expensive/ frequent medical care
!| !| !| !|
-sell policies to large groups with predictable or avg risk using formulas (age,
!| !| !| !| !| !| !| !| !| !| !| !| !|
gender, race, employment, geographic location)
!| !| !| !|
>Premium paid by all members cover mgmt of insurance and all losses
!| !| !| !| !| !| !| !| !| !| !| !|
across group; insurance companies profit when fewer services are used.
!| !| !| !| !| !| !| !| !|
Health Savings Accounts (HSAs) - Correct answer ✔-created by congress
!| !| !| !| !| !| !| !| !| !|
2003
-employees pay for selected HC expenses with pre-tax dollars in pre-selected
!| !| !| !| !| !| !| !| !| !| !|
amount held from gross income !| !| !| !|
,Out-of-Pocket Payment - Correct answer ✔Rare today !| !| !| !| !| !|
-Predominate method in 19th century/ early 20th !| !| !| !| !| !|
-Consumers pay provider directly for HC services !| !| !| !| !| !|
-Rare due to tech-driven, expensive care
!| !| !| !| !|
Medicare (MC) - Correct answer ✔-Federally funded national program for
!| !| !| !| !| !| !| !| !| !|
people over 65 (pay int system via social security taxes/ employment)
!| !| !| !| !| !| !| !| !| !|
Medicare part A - Correct answer ✔Covers most inpatient costs after
!| !| !| !| !| !| !| !| !| !| !|
deductible
Medicare part B - Correct answer ✔"supplemental" medical insurance, covers
!| !| !| !| !| !| !| !| !| !|
outpatient care. !|
-voluntary/ purchase on own thru MC or other provider (AARP)
!| !| !| !| !| !| !| !| !|
-pay additional monthly premium for additional coverage
!| !| !| !| !| !|
Medicare part D - Correct answer ✔>Prescription drug plan (2006) thru MC
!| !| !| !| !| !| !| !| !| !| !|
-Must enroll when eligible for MC or pay penalty
!| !| !| !| !| !| !| !|
Medicaid (MA) - Correct answer ✔>Federally funded, state-operated for
!| !| !| !| !| !| !| !| !|
lower-income, unemployed or disabled !| !| !|
-Funded by tax payers !| !| !|
-must meet strict eligibility requirements
!| !| !| !|
, -flawed system, many people fall through cracks (ACA attempts to fill in
!| !| !| !| !| !| !| !| !| !| !| !|
gaps)
Uninsured - Correct answer ✔those without private or public health
!| !| !| !| !| !| !| !| !| !|
insurance coverage !|
How is LTC paid for? - Correct answer ✔-Not covered by most private health
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
insurance plans !|
-only short-term "skilled" care stays approved by MC, otherwise spend-down
!| !| !| !| !| !| !| !| !| !|
of assets to qualify for MA
!| !| !| !| !|
-LTC insurance can be purchased
!| !| !| !|
Prospective Payment Systems (PPS) - Correct answer ✔>established 1983 by
!| !| !| !| !| !| !| !| !| !|
congress
-started w/ MC due to impending financial insolvency
!| !| !| !| !| !| !|
-hospitals no longer automatically reimbursed for all costs inccured
!| !| !| !| !| !| !| !|
-Est. Diagnosis Related Groups (DRGs) System
!| !| !| !| !|
--predetermined fixed amounts of reimbursement regardless of actual length !| !| !| !| !| !| !| !| !|
of stay
!|
--may asjust id documented complication (variance)
!| !| !| !| !|
**STRONG INCENTIVE FOR HOSPITALS TO DECREASED LENGTH OF
!| !| !| !| !| !| !| !|
STAY, INCREASE EFFICIENCY
!| !| !|
-Principles then spread to MA/ private insurers
!| !| !| !| !| !|
precise detailed answers !| !|
Economic definition - Correct answer ✔Study of the distribution of resources
!| !| !| !| !| !| !| !| !| !| !|
across a !|
population
Opportunity Cost - Correct answer ✔Value of product/service
!| !| !| !| !| !| !|
foregone, what is given up in choosing one
!| !| !| !| !| !| !|
product, service or technology over another
!| !| !| !| !|
complements in consumption - Correct answer ✔Products/services consumed
!| !| !| !| !| !| !|
jointly so if ↑price of one may
!| !| !| !| !| !|
↓demand for both !| !|
(IV fluid & tubing)
!| !| !|
substitues in consumption - Correct answer ✔Goods/services that satisfy
!| !| !| !| !| !| !| !| !|
same
need
EX: Unlicensed personnel as substitutes for RNs
!| !| !| !| !| !|
,Moral Hazard - Correct answer ✔When a person's behavior changes based
!| !| !| !| !| !| !| !| !| !| !|
on insurance.
!| !|
EX: less incentive to promote health b/c one has good insurance and will be
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
treated
Insurance co-pay - Correct answer ✔Amount to be paid out-of-pocket when
!| !| !| !| !| !| !| !| !| !| !|
care/service is rendered !| !|
ex: $25 for patient first
!| !| !| !|
Insurance deductible - Correct answer ✔-Fixed amount that consumer must
!| !| !| !| !| !| !| !| !| !|
first pay towards
!| !|
medical bill each year before insurance payments are made.
!| !| !| !| !| !| !| !|
-Lower deductible= higher premium or vice versa.
!| !| !| !| !| !|
Risk Pooling - Correct answer ✔>Spread the risk across the group
!| !| !| !| !| !| !| !| !| !|
-money is shifted b/w younger/ healthier people vs. older/sick people who
!| !| !| !| !| !| !| !| !| !| !|
require expensive/ frequent medical care
!| !| !| !|
-sell policies to large groups with predictable or avg risk using formulas (age,
!| !| !| !| !| !| !| !| !| !| !| !| !|
gender, race, employment, geographic location)
!| !| !| !|
>Premium paid by all members cover mgmt of insurance and all losses
!| !| !| !| !| !| !| !| !| !| !| !|
across group; insurance companies profit when fewer services are used.
!| !| !| !| !| !| !| !| !|
Health Savings Accounts (HSAs) - Correct answer ✔-created by congress
!| !| !| !| !| !| !| !| !| !|
2003
-employees pay for selected HC expenses with pre-tax dollars in pre-selected
!| !| !| !| !| !| !| !| !| !| !|
amount held from gross income !| !| !| !|
,Out-of-Pocket Payment - Correct answer ✔Rare today !| !| !| !| !| !|
-Predominate method in 19th century/ early 20th !| !| !| !| !| !|
-Consumers pay provider directly for HC services !| !| !| !| !| !|
-Rare due to tech-driven, expensive care
!| !| !| !| !|
Medicare (MC) - Correct answer ✔-Federally funded national program for
!| !| !| !| !| !| !| !| !| !|
people over 65 (pay int system via social security taxes/ employment)
!| !| !| !| !| !| !| !| !| !|
Medicare part A - Correct answer ✔Covers most inpatient costs after
!| !| !| !| !| !| !| !| !| !| !|
deductible
Medicare part B - Correct answer ✔"supplemental" medical insurance, covers
!| !| !| !| !| !| !| !| !| !|
outpatient care. !|
-voluntary/ purchase on own thru MC or other provider (AARP)
!| !| !| !| !| !| !| !| !|
-pay additional monthly premium for additional coverage
!| !| !| !| !| !|
Medicare part D - Correct answer ✔>Prescription drug plan (2006) thru MC
!| !| !| !| !| !| !| !| !| !| !|
-Must enroll when eligible for MC or pay penalty
!| !| !| !| !| !| !| !|
Medicaid (MA) - Correct answer ✔>Federally funded, state-operated for
!| !| !| !| !| !| !| !| !|
lower-income, unemployed or disabled !| !| !|
-Funded by tax payers !| !| !|
-must meet strict eligibility requirements
!| !| !| !|
, -flawed system, many people fall through cracks (ACA attempts to fill in
!| !| !| !| !| !| !| !| !| !| !| !|
gaps)
Uninsured - Correct answer ✔those without private or public health
!| !| !| !| !| !| !| !| !| !|
insurance coverage !|
How is LTC paid for? - Correct answer ✔-Not covered by most private health
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
insurance plans !|
-only short-term "skilled" care stays approved by MC, otherwise spend-down
!| !| !| !| !| !| !| !| !| !|
of assets to qualify for MA
!| !| !| !| !|
-LTC insurance can be purchased
!| !| !| !|
Prospective Payment Systems (PPS) - Correct answer ✔>established 1983 by
!| !| !| !| !| !| !| !| !| !|
congress
-started w/ MC due to impending financial insolvency
!| !| !| !| !| !| !|
-hospitals no longer automatically reimbursed for all costs inccured
!| !| !| !| !| !| !| !|
-Est. Diagnosis Related Groups (DRGs) System
!| !| !| !| !|
--predetermined fixed amounts of reimbursement regardless of actual length !| !| !| !| !| !| !| !| !|
of stay
!|
--may asjust id documented complication (variance)
!| !| !| !| !|
**STRONG INCENTIVE FOR HOSPITALS TO DECREASED LENGTH OF
!| !| !| !| !| !| !| !|
STAY, INCREASE EFFICIENCY
!| !| !|
-Principles then spread to MA/ private insurers
!| !| !| !| !| !|
