IHOP EXAM 3 UPDATED ACTUAL Questions and CORRECT Answers
effectiveness of healthcare delivery system evaluated in
cost, access, quality
terms of:
proportion of a country's national income spend on
healthcare -- national expenditures for healthcare (GDP)
costs referred to as: - gross domestic product that a country spends on the
delivery of healthcare services (micro level - the out of
pocket costs someone pays for healthcare)
1) consumer perspective: referring to the price of health
care such as the physician's bill or premiums that both
employers and employees pay for purchasing insurance
2) national perspective: health care costs refer to how
cost from 3 different perspectives much a nation spends on healthcare (health care perspec-
tive) - consumption of economic resources in the delivery
of healthcare(E=PxQ)
3) provider perspective: notion of cost refers to staff
salaries, capital costs, rental space, costs of production
medicare and medicaid in 1965 (by 1970 healthcare ex-
health care costs grew largely due to access to what?
penditures had grown 140%)
true or false: on average other wealthy countries spend
about half as much per person on health than the U.S. True
spends
since 1980 the gap has widened between U.S. health
True
spending and that of other countries
federal increase in spending has slowed in recent years
facts
but is expected to grow again
third-party payers, growth in tech, epidemiological shift
why are healthcare costs so high
with growing elderly population, medical model of health-
, care delivery, multipayer system +administrative costs, de-
fensive medicine, waste+abuse, variation in practice
third party (not the consumer) pays for most of the ser-
vices used - whether the government or a private company
foots the bill individual patients pay a price far lower than
the actual cost of the service and as a result the propensity
reasons for high cost: third-party payment
to utilizes greater qualities of care is HIGH because exces-
sive utilization and the moral hazard
-- both patient and provider have little incentive to be cost
conscious
new tech is expensive and the US likes it, so costs incurred
reasons for high cost: growth in tech in R&D figure into the price of healthcare and once the tech
is developed there is a demand for use
life expectancy increasing = increase in elderly population
reasons for high cost: growing elderly population and the elderly consume more healthcare than average
person == more expenses
medical model emphasizes medical intervention after a
person has become sick -- which means prevention is
reasons for high cost: medical model of health care deliv-
not a focus -- == health resources are spent curing these
ery
people when it would be less expensive to prevent the
sickness alltogether
administrative costs include costs for health insurance,
marketing and enrollment, contact with providers, claims
processing etc. because of these additional steps they
reason for high cost: multi-payer system with administra-
account for as much as 25% o the cost of total healthcare
tive costs
expenditures
-- commonly believed that single payer systems have low-
er costs
because the US medical system includes many legal risks,
defensive medicine requires many tests and services that
, are not medically justified but rather used to protect physi-
reason for high costs: defensive medicine
cians from malpractice lawsuits
healthcare fraud has been identified as a major problem
in medicare and medicaid programs -- also occur when
reason for high costs: waste and abuse more services provided than necessary or when services
not provided are billed to a third party -- this includes
billing for higher-priced service than was given
small-area variation -- fact that observed differences in
practice patterns have been associated with certain geo-
reason for high costs: practice variations graphic areas of the country -- these signal ineflciencies
in the healthcare system because they increase costs with
no better outcomes
false 36% of people who are insure report having used
true or false: no one who is insured and suffers a serious most of their savings to pay for medical bills and 57%
illness will have financial distress of uninsured people say they encounter financial dis-
tress/bankruptcy after this kind of illness
in 2016 the US had the lowest insured rate of all compa-
true
rable countries at 86% -- the average was 98%
efforts to contain cost must be done in a piecemeal fash-
ion -- also cost shifting has plagued the US because it
cost containment refers to the ability of providers to make up for lost rev-
enues in one area by increasing utilization or charging
higher prices in other areas free of controls
Refers to an undertaking by the government to align and
distribute health care resources in a manner that, in the
eyes of the government, would achieve desired health
health planning
outcomes for all people.-- this is supply side rationing
- -and doesnt really work well in the US because it is
centralized and would need an admin agency to watch it
Economic Stabilization Program - price controls
, made by Nixon and placed limits on the amount that
hospitals could raise their prices from year to year --
generated moderating influence on price increased for
most medical services but placed no limit on the quantity
of services or costs of production
most important price control was switching medicare re-
social security amendments of 1983 imbursement from retrospective to prospective, but had
little effect on overall spending as proportion of GDP
established a national medicare fee schedule -- known as
the resource-based relative value scale - Federal law that
Omnibus Budget Reconciliation Act (OBRA)
regulates physician paid according to relative value units
established for more than 7000 covered services
true or false: 1/10 adults report that they delayed or did
True
not get care because of its cost
peer review
competitive approaches (Reagan)
cost containment approaches chronic disease prevention+management
health planning
price controls
-Demand-side Incentives (cost sharing mechanisms that
place larger cost burden on consumers encouraging con-
sumers to be more cost conscious)
-Supply-side Regulation (refers to antitrust laws passed in
the US which prohibit business practices that stifle com-
cost containment competitive approaches petition among providers- fixed pricing - price discrimi-
nation )
-Payer-driven Price Competition (when employers shop
for the best value in terms of premiums and benefits
package)
-Utilization Controls (used in managed care and elimi-
effectiveness of healthcare delivery system evaluated in
cost, access, quality
terms of:
proportion of a country's national income spend on
healthcare -- national expenditures for healthcare (GDP)
costs referred to as: - gross domestic product that a country spends on the
delivery of healthcare services (micro level - the out of
pocket costs someone pays for healthcare)
1) consumer perspective: referring to the price of health
care such as the physician's bill or premiums that both
employers and employees pay for purchasing insurance
2) national perspective: health care costs refer to how
cost from 3 different perspectives much a nation spends on healthcare (health care perspec-
tive) - consumption of economic resources in the delivery
of healthcare(E=PxQ)
3) provider perspective: notion of cost refers to staff
salaries, capital costs, rental space, costs of production
medicare and medicaid in 1965 (by 1970 healthcare ex-
health care costs grew largely due to access to what?
penditures had grown 140%)
true or false: on average other wealthy countries spend
about half as much per person on health than the U.S. True
spends
since 1980 the gap has widened between U.S. health
True
spending and that of other countries
federal increase in spending has slowed in recent years
facts
but is expected to grow again
third-party payers, growth in tech, epidemiological shift
why are healthcare costs so high
with growing elderly population, medical model of health-
, care delivery, multipayer system +administrative costs, de-
fensive medicine, waste+abuse, variation in practice
third party (not the consumer) pays for most of the ser-
vices used - whether the government or a private company
foots the bill individual patients pay a price far lower than
the actual cost of the service and as a result the propensity
reasons for high cost: third-party payment
to utilizes greater qualities of care is HIGH because exces-
sive utilization and the moral hazard
-- both patient and provider have little incentive to be cost
conscious
new tech is expensive and the US likes it, so costs incurred
reasons for high cost: growth in tech in R&D figure into the price of healthcare and once the tech
is developed there is a demand for use
life expectancy increasing = increase in elderly population
reasons for high cost: growing elderly population and the elderly consume more healthcare than average
person == more expenses
medical model emphasizes medical intervention after a
person has become sick -- which means prevention is
reasons for high cost: medical model of health care deliv-
not a focus -- == health resources are spent curing these
ery
people when it would be less expensive to prevent the
sickness alltogether
administrative costs include costs for health insurance,
marketing and enrollment, contact with providers, claims
processing etc. because of these additional steps they
reason for high cost: multi-payer system with administra-
account for as much as 25% o the cost of total healthcare
tive costs
expenditures
-- commonly believed that single payer systems have low-
er costs
because the US medical system includes many legal risks,
defensive medicine requires many tests and services that
, are not medically justified but rather used to protect physi-
reason for high costs: defensive medicine
cians from malpractice lawsuits
healthcare fraud has been identified as a major problem
in medicare and medicaid programs -- also occur when
reason for high costs: waste and abuse more services provided than necessary or when services
not provided are billed to a third party -- this includes
billing for higher-priced service than was given
small-area variation -- fact that observed differences in
practice patterns have been associated with certain geo-
reason for high costs: practice variations graphic areas of the country -- these signal ineflciencies
in the healthcare system because they increase costs with
no better outcomes
false 36% of people who are insure report having used
true or false: no one who is insured and suffers a serious most of their savings to pay for medical bills and 57%
illness will have financial distress of uninsured people say they encounter financial dis-
tress/bankruptcy after this kind of illness
in 2016 the US had the lowest insured rate of all compa-
true
rable countries at 86% -- the average was 98%
efforts to contain cost must be done in a piecemeal fash-
ion -- also cost shifting has plagued the US because it
cost containment refers to the ability of providers to make up for lost rev-
enues in one area by increasing utilization or charging
higher prices in other areas free of controls
Refers to an undertaking by the government to align and
distribute health care resources in a manner that, in the
eyes of the government, would achieve desired health
health planning
outcomes for all people.-- this is supply side rationing
- -and doesnt really work well in the US because it is
centralized and would need an admin agency to watch it
Economic Stabilization Program - price controls
, made by Nixon and placed limits on the amount that
hospitals could raise their prices from year to year --
generated moderating influence on price increased for
most medical services but placed no limit on the quantity
of services or costs of production
most important price control was switching medicare re-
social security amendments of 1983 imbursement from retrospective to prospective, but had
little effect on overall spending as proportion of GDP
established a national medicare fee schedule -- known as
the resource-based relative value scale - Federal law that
Omnibus Budget Reconciliation Act (OBRA)
regulates physician paid according to relative value units
established for more than 7000 covered services
true or false: 1/10 adults report that they delayed or did
True
not get care because of its cost
peer review
competitive approaches (Reagan)
cost containment approaches chronic disease prevention+management
health planning
price controls
-Demand-side Incentives (cost sharing mechanisms that
place larger cost burden on consumers encouraging con-
sumers to be more cost conscious)
-Supply-side Regulation (refers to antitrust laws passed in
the US which prohibit business practices that stifle com-
cost containment competitive approaches petition among providers- fixed pricing - price discrimi-
nation )
-Payer-driven Price Competition (when employers shop
for the best value in terms of premiums and benefits
package)
-Utilization Controls (used in managed care and elimi-
