answers
Insurance Function Four fundamental principles - Answer 1) risk is unpredictable
2) risk can be predicted with some accuracy in a large group
3) insurance can transfer risk from the individual to group through pooling of
resources
4) losses are shared by all members
outpatient care - Answer Doesn't require overnight stay incurring room and board
costs
Ambulatory care similar to community medicine because it serves around the
community, convenience, accessibility.
The most basic outpatient services are physical and minor treatments and position
offices
Scope of Outpatient Services - Answer • Growth in outpatient services
• Decline in hospital inpatient
• Essential services line for hospitals
• Competition from home health agencies, ambulatory care, urgent care, outpatient
surgery
**Hospital survival can depend heavily on ambulatory care**
Role and Scope of Health Services Financing - Answer Financing pays health
insurance premiums
,Charity plays a noteworthy role for uninsured
Insurance increases demand for HC
Insurance lowers out of pocket costs
- patients consume more
- leads to higher utilization or moral hazard
Financing influences on supply side factors
New models of organizations may form
Demand side factors
Financing influences the supply and distribution of health professionals
Resource based relative value scale
- determining physicians fees
E = P x Q - Answer Insurance extension to uninsured increases health care
expenditures (E)
Incurable with payment (price=P) influences supply
, Insurance and supply of services determine access and service utilization (quantity
of services consumed = Q)
Private Health Insurance - Answer health insurance that can be purchased from
private insurance companies to provide coverage for health care expenses
"Voluntary health insurance"
Many businesses are self insured
Workers are not mandated to buy it
Deductible - Answer Amount you must pay before you begin receiving any
benefits from your insurance company
Copayment - Answer Flat amount paid nee service
Coinsurance - Answer a set proportion of the medical costs that the insured must
pay out of pocket
Premiums - Answer Items offered free or at a minimal cost as a bonus for
purchasing a product
Why cost sharing? - Answer Cost sharing reduces moral hazard
Rand Health Insurance Experiment
Cost sharing had a material impact on lowering utilization, without any significant
negative health consequences