Matching questions
1-114 of 114
Click a definition to match it with a term
Social determinants of health
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, Social conditions into which people are born and that affect their daily lives
and overall well-being as they move through life
• World Health Organization (WHO) defines SDH as: “the conditions in
which people are born, grow, live, work and age”
• Centers for Disease Control and Prevention (CDC): SDH are shaped by
the distribution of money, power, and resources at both local and national
levels
The Affordable Care Act: private insurance market changes
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• Insurers mandated to enroll young adults until age 26 under parents’
plans
• Illegal to charge more or refuse coverage for preexisting conditions
• All health plans had to include certain “essential health benefits”
• Preventive services without cost sharing, No rescission without fraud
• Fee on insurers for the privilege of selling plans through the exchanges
- This fee could increase the premiums people pay
• Medical loss ratio (MLR): the percentage of premium revenue spent on
medical expenses
- 85 percent for large group insurance plans
- 80 percent of individual or small group plans
• The ACA provisions made health coverage more secure and effective for
people who actually became sick or injured
• Increased premiums
• Deductibles at often-unaffordable levels
Benefits and costs of HMOs and PPOs
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,Law as a social determinant of health
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• The law can be used to design and perpetuate social conditions that can
have terrible physical, mental, and emotional effects on individuals and
populations.
• The law can be utilized as a mechanism through which behaviors and
prejudices are transformed into distributions of well-being among
populations.
• Laws can be determinative of health through under-enforcement.
• The law can be used to structure direct responses to health-harming
social needs that result from things like impoverishment, illness, market
failure, and individual behavior that harms others.
Health Maintenance Organization (HMO)
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, • Pays providers a salary or capitation
• Beneficiaries may only use in-network providers
• HMO coordinates and controls receipt of services
• Focus on medical care and preventive care services
• Require to choose a primary care services → gatekeeper
• Providers commonly receive a capitated fee or salary
• In-network hospitals, physicians, and other health care providers
Why do insurance companies set premiums?
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To cover most of their expenses
Medicaid
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Overview: A federal-state public health insurance program for the indigent
Program administration
• Federal: Center for Medicare and Medicaid Services (CMS) outlines
(mandatory and optional) populations and benefits covered under
Medicaid
• State: State Medicaid agencies run programs, select which optional
populations and benefits to cover in the state program
All states participate in Medicaid
1-114 of 114
Click a definition to match it with a term
Social determinants of health
Give this one a try later!
, Social conditions into which people are born and that affect their daily lives
and overall well-being as they move through life
• World Health Organization (WHO) defines SDH as: “the conditions in
which people are born, grow, live, work and age”
• Centers for Disease Control and Prevention (CDC): SDH are shaped by
the distribution of money, power, and resources at both local and national
levels
The Affordable Care Act: private insurance market changes
Give this one a try later!
• Insurers mandated to enroll young adults until age 26 under parents’
plans
• Illegal to charge more or refuse coverage for preexisting conditions
• All health plans had to include certain “essential health benefits”
• Preventive services without cost sharing, No rescission without fraud
• Fee on insurers for the privilege of selling plans through the exchanges
- This fee could increase the premiums people pay
• Medical loss ratio (MLR): the percentage of premium revenue spent on
medical expenses
- 85 percent for large group insurance plans
- 80 percent of individual or small group plans
• The ACA provisions made health coverage more secure and effective for
people who actually became sick or injured
• Increased premiums
• Deductibles at often-unaffordable levels
Benefits and costs of HMOs and PPOs
Give this one a try later!
,Law as a social determinant of health
Give this one a try later!
• The law can be used to design and perpetuate social conditions that can
have terrible physical, mental, and emotional effects on individuals and
populations.
• The law can be utilized as a mechanism through which behaviors and
prejudices are transformed into distributions of well-being among
populations.
• Laws can be determinative of health through under-enforcement.
• The law can be used to structure direct responses to health-harming
social needs that result from things like impoverishment, illness, market
failure, and individual behavior that harms others.
Health Maintenance Organization (HMO)
Give this one a try later!
, • Pays providers a salary or capitation
• Beneficiaries may only use in-network providers
• HMO coordinates and controls receipt of services
• Focus on medical care and preventive care services
• Require to choose a primary care services → gatekeeper
• Providers commonly receive a capitated fee or salary
• In-network hospitals, physicians, and other health care providers
Why do insurance companies set premiums?
Give this one a try later!
To cover most of their expenses
Medicaid
Give this one a try later!
Overview: A federal-state public health insurance program for the indigent
Program administration
• Federal: Center for Medicare and Medicaid Services (CMS) outlines
(mandatory and optional) populations and benefits covered under
Medicaid
• State: State Medicaid agencies run programs, select which optional
populations and benefits to cover in the state program
All states participate in Medicaid
