Pubh 6012 EXAM QUESTIONS WITH
CORRECT ANSWERS
Uncertainty |- |CORRECT |ANSWER✔✔-people |purchase |health |insurance |to |protect |them |from |
medical |costs |associated |with |both |expensive |and |unforeseen |events: |how |to |set |the |
consumers |burden |of |cost |at |the |right |level |that |it |encourages |and |makes |available |the |proper
|use |of |health |care |while |discouraging |imporoper |usage
Risk |- |CORRECT |ANSWER✔✔-Providers: |will |beneficiary |experience |a |covered |medical |event?
Consumer:buy |insurance |to |protect |themselves |against |an |unforseen |event
asymmetric |information |- |CORRECT |ANSWER✔✔-causes |insurance |to |have |difficulty |matching |
health |people |with |low |deductible |plans |and |health |people |with |high |deductible |plans
Unhealthy |consumers |dont |share |all |of |the |information |regarding |their |condition |with |provider
|so |they |dont |get |charged |extra
adverse |selection |- |CORRECT |ANSWER✔✔-unhealthy |people |overselect |a |particular |plan; |this |
happens |because |people |at |risk |all |buy |the |same |plan |because |it |is |more |attractive. |this |leaves
|the |insurer |with |a |disproportionate |number |of |high |risk |individuals. |This |leads |to |increase |in |
premiums
What |are |the |two |main |methods |of |setting |premiums |- |CORRECT |ANSWER✔✔-experience |
rating |and |community |rating
experience |rating |- |CORRECT |ANSWER✔✔-how |much |a |beneficiary |or |group |of |beneficiaries |
spent |on |medical |services |previously |to |determine |the |amount |of |the |premium |for |each |
member |or |group
, community |rating |- |CORRECT |ANSWER✔✔-insurers |use |only |geography |and |family |
composition |to |set |rates; |in |modified |community |rating, |insurers |may |be |allowed |to |consider |
other |characteristics |such |as |age |and |sex
Large |Group |insurance |- |CORRECT |ANSWER✔✔-usually |has |cheaper |rates |than |purchasing |
health |insurance |individually |or |as |part |of |a |small |group |due |to |having |an |average |risk |rate. |
Carriers |also |prefer |to |insure |large |groups |because |most |of |the |admin |costs |associated |with |
insurance |are |the |same |whether |the |carrier |is |covering |a |few |people |or |a |few |thousand
Medical |underwiting |- |CORRECT |ANSWER✔✔-there |are |ways |for |insurers |to |predict |potential |
future |health |expenses: |underwiting |is |whether |companies |are |allowed |to |consider |an |
applicant's |medical |history |or |other |personal |information |to |help |assess |risk |of |healthcare |
needs |in |the |future |(complicated |legal |question)
HIPPA |(Health |Insurance |Protability |and |Accountability |Act |of |1996 |- |CORRECT |ANSWER✔✔-
includes |an |important |protection |for |consumers |by |prohibiting |group |health |plans |from |
excluding |or |limiting |otherwise |qualified |individuals |due |to |preexisting |conditions |(before |
HIPPA |people |with |prexisting |conditions |could |be |denied |health |insurance)
Managed |Care |- |CORRECT |ANSWER✔✔-system |that |create |incentives |to |provide |fewr |services |
and |less |expensive |care |while |still |maintaing |the |appropriate |level |of |healthcare |quality. |MCOs
|also |attempt |to |alter |patients |decision |making |through |cost |sharing |requirements |cost |
containment |tools |utilization |restrictions |and |free |or |low |cost |coverage |for |preventive |care
Cost |containment |strategies |within |Managed |Care |Plans |- |CORRECT |ANSWER✔✔-performance
|based |salary |bonsues |or |witholdings, |discounted |fee |schedules |and |capitated |payments, |
gatekeeping |and |utilization |review
salary |and |bonuses/withholdings |(provider |payment |cost |containment |strategies) |- |CORRECT |
ANSWER✔✔-Provider |receives |a |salary |as |an |employee |of |an |MCO: |Costs |are |controlled |
incentive |for |provider |to |perform |fewer |and/or |less |costly |services. |(MCO |and |provider |
assumes |financial |risk)
CORRECT ANSWERS
Uncertainty |- |CORRECT |ANSWER✔✔-people |purchase |health |insurance |to |protect |them |from |
medical |costs |associated |with |both |expensive |and |unforeseen |events: |how |to |set |the |
consumers |burden |of |cost |at |the |right |level |that |it |encourages |and |makes |available |the |proper
|use |of |health |care |while |discouraging |imporoper |usage
Risk |- |CORRECT |ANSWER✔✔-Providers: |will |beneficiary |experience |a |covered |medical |event?
Consumer:buy |insurance |to |protect |themselves |against |an |unforseen |event
asymmetric |information |- |CORRECT |ANSWER✔✔-causes |insurance |to |have |difficulty |matching |
health |people |with |low |deductible |plans |and |health |people |with |high |deductible |plans
Unhealthy |consumers |dont |share |all |of |the |information |regarding |their |condition |with |provider
|so |they |dont |get |charged |extra
adverse |selection |- |CORRECT |ANSWER✔✔-unhealthy |people |overselect |a |particular |plan; |this |
happens |because |people |at |risk |all |buy |the |same |plan |because |it |is |more |attractive. |this |leaves
|the |insurer |with |a |disproportionate |number |of |high |risk |individuals. |This |leads |to |increase |in |
premiums
What |are |the |two |main |methods |of |setting |premiums |- |CORRECT |ANSWER✔✔-experience |
rating |and |community |rating
experience |rating |- |CORRECT |ANSWER✔✔-how |much |a |beneficiary |or |group |of |beneficiaries |
spent |on |medical |services |previously |to |determine |the |amount |of |the |premium |for |each |
member |or |group
, community |rating |- |CORRECT |ANSWER✔✔-insurers |use |only |geography |and |family |
composition |to |set |rates; |in |modified |community |rating, |insurers |may |be |allowed |to |consider |
other |characteristics |such |as |age |and |sex
Large |Group |insurance |- |CORRECT |ANSWER✔✔-usually |has |cheaper |rates |than |purchasing |
health |insurance |individually |or |as |part |of |a |small |group |due |to |having |an |average |risk |rate. |
Carriers |also |prefer |to |insure |large |groups |because |most |of |the |admin |costs |associated |with |
insurance |are |the |same |whether |the |carrier |is |covering |a |few |people |or |a |few |thousand
Medical |underwiting |- |CORRECT |ANSWER✔✔-there |are |ways |for |insurers |to |predict |potential |
future |health |expenses: |underwiting |is |whether |companies |are |allowed |to |consider |an |
applicant's |medical |history |or |other |personal |information |to |help |assess |risk |of |healthcare |
needs |in |the |future |(complicated |legal |question)
HIPPA |(Health |Insurance |Protability |and |Accountability |Act |of |1996 |- |CORRECT |ANSWER✔✔-
includes |an |important |protection |for |consumers |by |prohibiting |group |health |plans |from |
excluding |or |limiting |otherwise |qualified |individuals |due |to |preexisting |conditions |(before |
HIPPA |people |with |prexisting |conditions |could |be |denied |health |insurance)
Managed |Care |- |CORRECT |ANSWER✔✔-system |that |create |incentives |to |provide |fewr |services |
and |less |expensive |care |while |still |maintaing |the |appropriate |level |of |healthcare |quality. |MCOs
|also |attempt |to |alter |patients |decision |making |through |cost |sharing |requirements |cost |
containment |tools |utilization |restrictions |and |free |or |low |cost |coverage |for |preventive |care
Cost |containment |strategies |within |Managed |Care |Plans |- |CORRECT |ANSWER✔✔-performance
|based |salary |bonsues |or |witholdings, |discounted |fee |schedules |and |capitated |payments, |
gatekeeping |and |utilization |review
salary |and |bonuses/withholdings |(provider |payment |cost |containment |strategies) |- |CORRECT |
ANSWER✔✔-Provider |receives |a |salary |as |an |employee |of |an |MCO: |Costs |are |controlled |
incentive |for |provider |to |perform |fewer |and/or |less |costly |services. |(MCO |and |provider |
assumes |financial |risk)
