Shared Flashcard Set

Details

HSC3102 Module 8
n/a
30
Health Care
Undergraduate 3
10/20/2012

Additional Health Care Flashcards

 


 

Cards

Term
What are the five main topics of Healthcare and consumerism?
Definition
Consumer perceptions of health care

How consumers gain access to quality healthcare services

how health care services are paid for and who is paying for them

Instruments for shift towards healthcare consumerism in healthcare

Recent passage of health insurance reform
Term
What percent of Americans are confused about how the health care system works?
Definition
75%
Term
What is most important factor to consumers selecting a hospital?
Definition
Insurance
Term
What fraction of people would consider switching from physician rec med to cheaper if one was available?
Definition
8/10
Term
What are the five major conclusions of healthcare and consumerism?
Definition
Health care is a consumer market

Cost changes care-seeking behaviors

Consumers want holistic care and resources to pursue wellness and healthy living

Consumers embrace innovations that enhance self-care, convenience, and personalization

Represented in Kissick’s cost containment, access, & quality triangle
Term
How many Americans were uninsured in 2009?
Definition
45.7 million
Term
What groups are more likely to be uninsured?
Definition
the young, less educated, poor, non-caucasian and non US citizens as well as men
Term
Define Deductible
Definition
amt of money that beneficiary must pay before the insurance company begins to pay for covered services
Term
Define insurance
Definition
written agreement bet company (or gov) and ppl to pay for certain health care costs during a certain period in return for regular payments called premiums
Term
Define Co-insurances
Definition
portion of an insurance company’s approved amounts for covered services that the beneficiary is responsible for paying
Term
Define Co-payment
Definition
type of co-insurance, a negotiated set fee
Term
ID: found mostly in managed care plans; set price on per-member, per-month basis
Definition
Prepaid health care
Term
ID: max amt an insurer will pay for a certain service
Definition
Fixed indemnity
Term
ID: condition present 6 months before the policy began
Definition
Pre-existing condition
Term
What are the two most important factors that effect the cost of health insurance?
Definition
risk of the group and amount of coverage provided
Term
ID: provider panels, limited choice, gatekeeping, risk sharing, quality management, and utilization review
Definition
managed care organizations (MCOs)
Term
ID: closest to fee-for-service; contractual agreement bet provider and org to give service to members for discount rate
Definition
Preferred provider organizations (PPOs)
Term
ID: oldest form; combo of insurance and med care; uses primary care physicians and prepaid health care arrangement
Definition
Health Maintenance Org (HMOs)
Term
What are the advantages of managed care?
Definition
Comprehensive benefits

Evidence-based high quality care

Well-documented services provided through integrated delivery systems

Accountability for quality improvement
Term
What are three concerns of managed care?
Definition
Reducing inpatient stays

Delays in receiving care

Cannot understand bills
Term
Describe consumer-directed care
Definition
ives individuals better access to info and more control over their own health care

ncrease consumer involvement and raise awareness about the real cost of health care

Could be more affordable for employers to offer coverage and for ppl to purchase it

Consumer-directed products encourage healthy behavior
Term
What are three Key Building Blocks of Healthcare Consumerism?
Definition
Disease management and case management programs
Information and decision support programs
Incentive and compliance reward programs
HRAs and HSAs
Term
Describe HRAs
Definition
Health Reimbursement Accounts

Members receive annual employer defined allocation of HRA funds they can use for med services

Unused funds rolled over to future years for allowing accumulation over time
Term
Define/describe Health Savings Accounts
Definition
Similar to 401k plans; Triple tax advantaged plan req to be paired with high deductible policies; bring down monthly premiums; pay more out of pocket and some may skip needed care
Term
What two types of insurance plans are usually paired?
Definition
HSAa and HRAs
Term
Describe the Health Care/Insurance Reform for 2010
Definition
Subsidies begin for small businesses to provide coverage to employees
Insurance companies barred from denying coverage to children with pre-existing illness
Children can stay on parents’ plan till age 26
Term
Describe the Health Care/Insurance Reform for 2013
Definition
NEw medicare taxes on ppl earning more than 200k/year and couples filing jointly earning more than 250K a year
Tax on wages rises 2.35% from 1.45%
New 3.8% tax on unearned income such as dividends and interest
Term
Describe the Health Care/Insurance Reform for 2014
Definition
Create exchanges where people without employer coverage can shot for health coverage; Subsidies begin for lower and middle income families; Medicaid expands to all americans with income up to 133% of fed pov level
Term
Describe the Health Care/Insurance Reform for 2016
Definition
Penalty for those who don’t have coverage rises to 2.5% of taxable income or $695
Term
Describe the Health Care/Insurance Reform for 2018
Definition
xcise tax of 40% imposed on health plans valued more than $10,200 for individuals and $27.500 for family coverage
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