healthcare systems Chapter 6 - financing &
reimbursement methods UPDATED
ACTUAL Exam Questions and CORRECT
Answers
financing - CORRECT ANSWER - any mechanism that gives people the ability to pay for
health care services
-necessary to access healthcare
2 functions of financing - CORRECT ANSWER - -purchase of health insurance
-payment for the services delivered to insured pts.
primary financiers of health care in the US - CORRECT ANSWER - Private employers
and the govt (also uncompensated or charity care)
****2014 annual premium for an employer health plan for (a) family and (b) single
coverage***** - CORRECT ANSWER - Family - $16834
Single - $6025
moral hazard - CORRECT ANSWER - consumer behavior that leads to a higher
utilization of health care services when the services are covered by insurance
____% of Gdp = healthcare costs - CORRECT ANSWER - 17.9% in 2010
provider-induced demand - CORRECT ANSWER - providers' ability to create demand (by
offering additional and more expensive services when insurance is paying some of it)
supply-side rationing - CORRECT ANSWER - focuses on restricting the availability of
expensive medical technology and specialty care (this helps keep health care expenditures lower)
, demand-side rationing - CORRECT ANSWER - -when utilization of services is curtailed
to an extent because not all americans have health insurance
basic insurance (definition) - CORRECT ANSWER - a mechanism for protection against
risk
-designed to protect people against financial burden when sickness strikes
risk (in the context of insurance) - CORRECT ANSWER - the possibility of a substantial
financial loss from some event
underwriting - CORRECT ANSWER - -a systematic technique for evaluating, selecting
(or rejecting), classifying, and rating risks
-it's the job of the insurer
-how the insurer determines a fair price to insure someone
4 fundamental principles underlying the concept of insurance (about risk) - CORRECT
ANSWER - 1) risk is unpredictable for the individual
2) risk can be predicted for a group or population
3) insurance transfers or shifts risk from the individual to the group thru pooling of resources
4) losses are shared by all members of the insured group- "spreading the risk"
premium - CORRECT ANSWER - the amount charged for insurance coverage
-usually paid every month
average monthly cost of health insurance premiums in 2011 for a SINGLE PLAN and a
FAMILY PLAN - CORRECT ANSWER - SINGLE PLAN - $452
FAMILY PLAN - $1,256
(employer and employee both pay a part-cost sharing)
reimbursement methods UPDATED
ACTUAL Exam Questions and CORRECT
Answers
financing - CORRECT ANSWER - any mechanism that gives people the ability to pay for
health care services
-necessary to access healthcare
2 functions of financing - CORRECT ANSWER - -purchase of health insurance
-payment for the services delivered to insured pts.
primary financiers of health care in the US - CORRECT ANSWER - Private employers
and the govt (also uncompensated or charity care)
****2014 annual premium for an employer health plan for (a) family and (b) single
coverage***** - CORRECT ANSWER - Family - $16834
Single - $6025
moral hazard - CORRECT ANSWER - consumer behavior that leads to a higher
utilization of health care services when the services are covered by insurance
____% of Gdp = healthcare costs - CORRECT ANSWER - 17.9% in 2010
provider-induced demand - CORRECT ANSWER - providers' ability to create demand (by
offering additional and more expensive services when insurance is paying some of it)
supply-side rationing - CORRECT ANSWER - focuses on restricting the availability of
expensive medical technology and specialty care (this helps keep health care expenditures lower)
, demand-side rationing - CORRECT ANSWER - -when utilization of services is curtailed
to an extent because not all americans have health insurance
basic insurance (definition) - CORRECT ANSWER - a mechanism for protection against
risk
-designed to protect people against financial burden when sickness strikes
risk (in the context of insurance) - CORRECT ANSWER - the possibility of a substantial
financial loss from some event
underwriting - CORRECT ANSWER - -a systematic technique for evaluating, selecting
(or rejecting), classifying, and rating risks
-it's the job of the insurer
-how the insurer determines a fair price to insure someone
4 fundamental principles underlying the concept of insurance (about risk) - CORRECT
ANSWER - 1) risk is unpredictable for the individual
2) risk can be predicted for a group or population
3) insurance transfers or shifts risk from the individual to the group thru pooling of resources
4) losses are shared by all members of the insured group- "spreading the risk"
premium - CORRECT ANSWER - the amount charged for insurance coverage
-usually paid every month
average monthly cost of health insurance premiums in 2011 for a SINGLE PLAN and a
FAMILY PLAN - CORRECT ANSWER - SINGLE PLAN - $452
FAMILY PLAN - $1,256
(employer and employee both pay a part-cost sharing)
