PBH 400 FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTION!!
True or False?
The U.S. does not have a single national health insurance program that covers
the entire population. Answer - True
Approximately _____ of the non-elderly U.S. population is uninsured. Answer -
10%
Of those with insurance, most obtain coverage through ____________.
Answer - their employer
______ and ______ are government health insurance programs that cover
millions of people in the U.S. Answer - Medicaid, Medicare
Health insurance really began as __________, in Europe in the late _____ /
early ____ Centuries
Some of these truly started as _____, and still are. Answer - "sickness"
insurance (hospital coverage, etc), 19th, 20th, government-run programs
Coverage in the U.S. started as, and is still largely, a ___________ Answer - a
private sector base
,_________ and _________ began the commercialized insurance business (1929
and 1939) Answer - Blue Cross (hospital plans), Blue Shield (physician plans)
______ were instrumental in starting this type of private plan, so they could
guarantee payment during the _______ Answer - Hospitals, Depression
WWII saw the start of ___________
There was a national wage-freeze during War, so employers began offering
________
Rise of labor unions, leading to _________ Answer - employer sponsored
plans, "benefits", bargaining of benefits
1954: The IRS allows Answer - employers to pay for health coverage with pre-
tax dollars...and we are on our way to employer sponsored insurance being the
norm....
Federal Gov't didn't really enter the game until ____ (____ and ______), to fill
the gaps for non-working Answer - 1965, Medicare, Medicaid
Our healthcare system is a ______, which basically ...spending SKYROCKETS in
1970's.... Answer - fee-for-service system (FFS), rewards providers for
performing more, and more costly, services
Beneficiary Answer - Consumer, individual who is covered by the plan
Premium Answer - An annual fee paid by the beneficiary to the health plan,
usually in monthly installments, to secure health insurance coverage
, Deductible Answer - An amount of money a beneficiary must pay out-of-
pocket before the insurance company assists with paying for services. (some
plans have $0 deductible.)
Cost-sharing Answer - Co-payment or co-insurance, an amount the beneficiary
pays per service after the deductible is met (80/20; 70/30)
People choose to be insured because of Answer - uncertainty and risk
There is uncertainty whether Answer - an expensive and unforeseen event that
impacts their health status will occur
There is risk of Answer - financial exposure due to the unexpected event
Insurance companies are concerned about uncertainty and risk because
Answer - they are businesses that need to cover the cost of their expenditures.
Uncertainty and risk may lead to Answer - adverse selection
Adverse Selection examples Answer - Unhealthy people over-select a
particular plan, making the plan more expensive.
Too many sick people, not enough healthy, to balance out
Health Maintenance Organization Act of 1973: Answer - Trying to move away
from FFS and integrating payment and delivery into one place...try to control
rising costs.
ANSWERS WITH COMPLETE SOLUTION!!
True or False?
The U.S. does not have a single national health insurance program that covers
the entire population. Answer - True
Approximately _____ of the non-elderly U.S. population is uninsured. Answer -
10%
Of those with insurance, most obtain coverage through ____________.
Answer - their employer
______ and ______ are government health insurance programs that cover
millions of people in the U.S. Answer - Medicaid, Medicare
Health insurance really began as __________, in Europe in the late _____ /
early ____ Centuries
Some of these truly started as _____, and still are. Answer - "sickness"
insurance (hospital coverage, etc), 19th, 20th, government-run programs
Coverage in the U.S. started as, and is still largely, a ___________ Answer - a
private sector base
,_________ and _________ began the commercialized insurance business (1929
and 1939) Answer - Blue Cross (hospital plans), Blue Shield (physician plans)
______ were instrumental in starting this type of private plan, so they could
guarantee payment during the _______ Answer - Hospitals, Depression
WWII saw the start of ___________
There was a national wage-freeze during War, so employers began offering
________
Rise of labor unions, leading to _________ Answer - employer sponsored
plans, "benefits", bargaining of benefits
1954: The IRS allows Answer - employers to pay for health coverage with pre-
tax dollars...and we are on our way to employer sponsored insurance being the
norm....
Federal Gov't didn't really enter the game until ____ (____ and ______), to fill
the gaps for non-working Answer - 1965, Medicare, Medicaid
Our healthcare system is a ______, which basically ...spending SKYROCKETS in
1970's.... Answer - fee-for-service system (FFS), rewards providers for
performing more, and more costly, services
Beneficiary Answer - Consumer, individual who is covered by the plan
Premium Answer - An annual fee paid by the beneficiary to the health plan,
usually in monthly installments, to secure health insurance coverage
, Deductible Answer - An amount of money a beneficiary must pay out-of-
pocket before the insurance company assists with paying for services. (some
plans have $0 deductible.)
Cost-sharing Answer - Co-payment or co-insurance, an amount the beneficiary
pays per service after the deductible is met (80/20; 70/30)
People choose to be insured because of Answer - uncertainty and risk
There is uncertainty whether Answer - an expensive and unforeseen event that
impacts their health status will occur
There is risk of Answer - financial exposure due to the unexpected event
Insurance companies are concerned about uncertainty and risk because
Answer - they are businesses that need to cover the cost of their expenditures.
Uncertainty and risk may lead to Answer - adverse selection
Adverse Selection examples Answer - Unhealthy people over-select a
particular plan, making the plan more expensive.
Too many sick people, not enough healthy, to balance out
Health Maintenance Organization Act of 1973: Answer - Trying to move away
from FFS and integrating payment and delivery into one place...try to control
rising costs.
