Questions from Text with Keys Check Your Understanding Questions Check Your Understanding 1.1 1. True or false? The national health service (Beveridge) model is different from the social insurance (Bismarck) model because the Beveridge model is financed by general revenue funds from fiscal taxes, whereas the Bismarck model is financed by workers’ and employers’ compulsory payroll contributions into sickness funds. True 2. What are four characteristics of the US healthcare sector? Four characteristics of the United States are its large size, complexity, intricate payment methods and rules, and programs’ broad scopes. 3. True or false? The federal role in the healthcare sector is limited to paying providers for the healthcare costs of senior citizens. False 4. What do insurers receive in return for assuming the insureds’ exposure to risk or loss? Insurers receive premiums in return for assuming the insureds’ exposure to risk or loss. 5. Insurers pool premium payments for all the insureds in a group, then use actuarial data to calculate the group’s premiums so that: a. Premium payments are lowered for insurance plan payers b. The pool is large enough to pay losses of the entire group c. Accounting for the group’s plan is simplified d. All of the above are reasons for using the data Check Your Understanding 1.2 1. Where and when did health insurance become established in the United States? In Texas, in 1929, when Blue Cross first created a plan for school teachers 2. What is the term for health insurance that only covers the employee? Individual or single coverage 3. What is the term in healthcare that means compensation or repayment for rendering healthcare services? Reimbursement Principles of Healthcare Reimbursement: Instructor’s Manual Chapter 1 7 4. Who is the third party in healthcare situations? a. Patient b. Provider c. Payer d. Cannot be determined 5. All of the following are types of episode-of-care reimbursement except: a. Global payment b. Prospective payment c. Capitation d. Self-insured plan 6. What discounted fee schedule does Medicare use to reimburse physicians? Resource-based relative value scale (RBRVS)
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