chapter 6 Flashcards
Why have costs risen?
advances in technology
specialization
aging has put strain on Medicare
Why do we purchase health insurance?
minimize risk (probability of financial loss)
What is the process of being insured?
a subscriber purchases a health insurance plan from an insurer
range of benefits
covered services and those that are reimbursed
Why was insurance developed?
could not assume that patients could afford risk or hospitals would be able to reimbursed
Who finances health care?
individual, employer, or government
first source
individual purchases policy directly from insurance company
cons: expensive (pat premium cost out of pocket)
second source
employment cased arrangement; pay premium using payroll deductions combined with employer contributions
co-insurance
cost sharing obligation under a policy
third source
tax dollars collected from individuals and corporations allocated to finance programs and services
Who is the largest purchaser of health insurance?
Centers for Medicare/Medicaid Services
Who does Medicare cover?
65+
disabled
end stage renal disease
Medicare Part A
inpatient hospital care, skilled nursing facility, some home health, and hospice care
Who finances Medicare Part A?
payroll taxes and federal revenues
Medicare Part B
voluntary
physician services, outpatient hospital, some home health, medical equipment
Who finances Medicare Part B?
beneficiary premium payments
Medicare Advantage
gain greater choice and can choose from an array of private health plan options
Medicare Part D
subsidizes cost of prescriptions and provides more choices in health care coverage
Medicaid
for indigent populations
Who funds Medicaid?
state and federal governments
Retrospective reimbursement methods
providers paid after service in full with no dispute
insurers assume risk for cost and claims
Currently how much of our GDP is going to healtcare?
16%
What are the three parts of a 3rd party system?
patient-provider-payer
What are the 8 areas covered by the CBRR?
- Information disclosure
- Choice of plans and providers
- Access to emergency service
- Participation in HC decision
- Respect and nondiscrimination
- Confidentiality of health infor
- Complaints and appeals
- Consumer responsibilites
