Paying for healthcare Flashcards
1
Q
When was health insurance first created?
A
- ancient Greeks and Roman
- modern is in early 20th century
2
Q
What was employer-sponsored healthcare + when was it first created?
A
- first created in 1923
- only covered memebers expsnesed at single hospital- Baylor Hospital
- Provided H for teachers at pre-paid monthly rate
- creation of blue cross/ blue shield
- forerunner of today’s HMOS
3
Q
Why was health insurance offered in WWII?
A
- as an incentive to recruit to workers because they were prohibited from raising wages
4
Q
What is fee-for-service?
A
- became very popular in 1960s
- payment method in which doctors, hospital, and medical practice charge seperately for each service they perform
- pt or insurance company is responsible for the amt the healthcare provider chargers for the service
- not cost effective for most
5
Q
What are the types of hospital?
A
- non-profit: provide healthcare for all, aualify as charities, exempt from most taxes, do pay SS and medicare taxes
- proprietary-for profit: community health systems, community corporiation of America, Tenet Healthcare
- Governmental - VA, Austin State Hospital, Texas Health resources, Baylor Medical System
6
Q
What is direct pay (capitation) ?
A
- type of system where provider don’t participate in any insurance reimbursement
- they fix prices and charge a set monthly fees to pt regardless of the number of visits
7
Q
What is private insurance?
A
- managed care is a type of private insurance
- purchased by paitents
- primarily provided by your employer as part of your benefit package
- purchased in “bulk” by employers to provide to their employees
8
Q
What are government plans?
A
- services paid by government agency
- Medicare and Medicaid
9
Q
What are the challenges of rising costs of healthcare?
A
- US spends more per capita than other countires but does not have the highest success or satisfaction rates
10
Q
What are the causes for the rising costs?
A
- high prices for healthcare services and goods
- significant adminsitrative costs (costs of maintaining buildings and personnel salaries)
- defensive medicince
- cost of technological advances
- overuse of specialists
- waste and fraud
- high price of drugs relative to other products
- high costs to develop
11
Q
What aer future causes for risign costs?
A
- growth of aging population
- decline health in young
- decrease in healthy lifestyle
12
Q
How to lower costs?
A
- bill and code correctly (International Classification of Disease (ICD-10), numbers assigned to diseases and conditions, used to determine and justify charges by providers), Current procedural termin ology (CPT code, used to document and report all types of services)
- DRGs - efforts impsoed by government and managed care to lower healthcare costs
13
Q
What is Veterans Health Administration?
A
- largest integrated health care system in US
- serves veterans who meet certain qualifications
14
Q
What is Medicare?
A
- Federal INSURANCE program
- health insurance for ppl 65 and older and disabled persons
- charges monthly premium
- covers 80% of approved charges
- paid by a trust fund, funded with payroll taxes
- same program nationwide
- pt pay deductibles and for part of coverage
- types:
Part A: Hospitalization
Part B: Outpatient services
Part C: Medicare advantage plans
Part D: Prescription drugs
15
Q
What is medicaid?
A
- Federal and State ASSISTANCE program
- public health insurance program for low-income and disabled persons
- partly funded by federal governments
- administered and differs by states
- funding differs slightly from state to state
- covers large percentage of nursing home costs
- provides medical coverage to needy individuals
- based on income level
- pt pays very little or no part of coverage
- participants receive regular dental and vision exams
16
Q
similarites between medicare and medicaid>
A
- benefits ppl with disabilities
- prescription drug coverage
- outpatient hospital care
- inpatient hospital care
