SYS Final 100% VERIFIED 2024/2025 CORRECT ANSWERS, Exams of Health sciences

Download SYS Final 100% VERIFIED 2024/2025 CORRECT ANSWERS and more Exams Health sciences in PDF only on Docsity! SYS Final 100% VERIFIED 2024/2025 CORRECT ANSWERS This model of health insurance is the traditional model that employs a fee-for-service method and can result in overutilization because physician's income depends on the number of service provided to a patient. Indemnity insurance A ________ is used to predict the number of services an individual/group will use annually and is based on health status and demographic characteristics of the individual/group. Typically penalizes the sick. Experience rating What process involves the insurance company trying to reduce the financial risk by determining the appropriate price for its policies to cover the medical expenses of the entire insured group; typically the larger group can be estimated using population estimates. Medical underwriting True or false? Blue Cross Blue Shield was the first health insurance company formed in the United States? True Annual amount of money that the insured individual must pay before the health insurance plan pays anything Deductible Insured individual pays a percentage of the cost of the medical care received co insurance Annual cost each individual pays for their health insurance coverage Premium Set fees that must be paid every time an individual uses a service Copayments A network of physicians who are reimbursed under one insurance rate in return for more predictable volume of patients. This model is considered the most restrictive in terms of consumer choice, but the simplest in terms of financing. Health Maintenance Organizations (HMOs) A network of physicians who are reimbursed at a discounted rate depending on the volume of patients. Patients who receive care outside of the network are charged higher coinsurance rates. Preferred Provider Organizations (PPOs) True or False? The United States health insurance industry is considered a 'third party payer' that primarily operates in the free market; the TPP acts as the financier of health care goods and services. True Define Health Insurance Health insurance is a mechanism by which consumers have some financial protection from unexpected and expensive medical care services. Health insurance is a collective pool of financial resources from a group of people in which those financial resources are allocated across the whole group to ensure access to health care. Describe two implications that occur when the pool of resources paying into the health insurer begins to diminish. When the pool of resources of the health insurer begins to diminish (i.e., individuals dropping out/dies and/or individuals become more costly due to decreased health status) an increase in costsharing methods occurs. This is typically expressed in the form of an increased fluctuating premium. In addition, the benefits of the insurance policy may decrease - diminishing the type of care available under the insurance policy. provider Health care goods and services are said to be _________; there are not enough resources to meet the demands of products. scarce ______________ occurs when the free market does not work fairly or equitably to allocate goods and services using money. market failure Identify and explain two reasons why health care goods and services are not considered to be a public good. The two primary characteristics of a public good is nonrival and nonexclusive. Nonrival implies that is one person using the good it will not diminish another person's use of the same good. In health care, goods and services are scarce and one person's use does diminish another person's use - health care is rival. Nonexclusive implies that the good is too difficult to restrict use to only those who pay for it. A good example of a public good is a lighthouse or the radio. Health care is restrictive and is often only accessible if an individual has health insurance. The scarcity principle is applicable here as well, consider an organ transplant - organ transplants are limited to those who need organ transplant not caused by behavior-related disease and illness (i.e., chronic smoking resulting in lung transplant; liver transplant from alcoholism) - Health care is exclusive. Identify at least one main reason why there is no true separation of supply and demand in the U.S. health care system. Looking to the first characteristic, the ability to interact freely, one can see that the health care system is very different regarding this. This is because in a normal free market the consumers have the ability of choice, which further advocates for a competitive market; as compared to the health care system, consumers do not have the luxury of choice. This is due to health care providers assuming this ability via their prescription & referral powers. Still, it is important to realize that this may be necessary in a system that has uneducated consumers. The function of health policy and regulation is what component of the U.S. health care 'system'? feedback and control mechanism Identify and explain two reasons why the 2010 Patient Protection & Affordable Care Act (ACA) was able to pass under the 44th President Barack Obama. (1) President Obama worked with the key lobbyists (2) President Obama made health care reform his 1 st priority on his presidential agenda. Policies that establish new programs primarily to fund research to increase scientific evidence to support health care interventions. Distributive Policies Policies that are regulatory in nature impacting all parts of the system and all consumers often passed at the state level. Normative Policies Policies that have an impact on one specific targeted group that lacks access to health care (i.e., Medicaid; Indian Health Service; Veterans Administration) Redistributive Policies This office provides independent, non-partisan advice and analysis to both Congress and the President of the United States on economic and budgetary matters; influential in the health policy making process. Congressional Budget Office (CBO) These two countries have a health care system based off social security. Their health care system is publically funded with private insurance companies supplementing health care provided by a tax supported system. Germany and France This country has the most centralized health care system across all comparative countries. The government is responsible for financing and delivering health care. Under this system, hospitals are owned by the government and most physicians are employees of the government. United Kingdom The United States, Netherlands, and Switzerland are based off a health care system that involves government subsidizes and a private insurance market. This system can best be described as: Shared responsibility Switzerland regulates their health insurance industry by the LaMal system. Based off 'Sick Around the World, in-class lecture, and the course readings - explain the main purpose of LaMal LaMal eliminated health insurers from the ability to compete as well as make a profit. LaMal also achieved universal coverage by mandating health insurance for all citizens. True or False? Efforts to reform the U.S. health care system started with the 44th President Barack Obama who proposed and passed the 2010 Patient Protection & Affordable Care Act. False The 1963 assassination of President John F. Kennedy (D) contributed to a democratic super- majority in the 1964 elections; two majors health care programs were passed through Congress and made into law in 1965. What are these two programs? Medicare and Medicaid When comparing countries health care systems, select the key resource indicators used: -Physicans/ population -Average tax burden -% GPD percent for healthcare -Per capita expenditures When comparing countries health care systems, identify the utilization indicators used: -Wait 2+ months to see a specialist - problems paying medical bills in past year -owe more than $1000 in medical bills -wait 6+ days for primary care True or False? Similar to Frances multi-payer system finances through taxes on alcohol and tobacco, the 2010 Patient Protection and Affordable Care Act (ACA) placed a tax on all tanning salons to subsidize the health care plan.