Flashcards in cost and cost control Deck (29):
Half of health care used to treat
5% of population
Why is cost a burden on business?
if insurance goes up everything goes up.
costing more for employers
what does increasing health care cost do?
care and insurance cost both go up/
Why is cost so high?
demographic shift (ppl live longer)
reduced consumer ownership(not responsible for it.)
using insurance when they don't need it
What are the 2 factors increasing cost?
price and quantity
factors of price?
how is price controlled?
mandatory uniform fee schedule.
Volume and intensity aspects that increase cost?
fee for service
What is a better cost control strategy?
-controll fees and provider incomes.
-cutting price on supplies
insurance model used to manage cost, also quality and access
Integrates financing and management + HCD to an enrolled population
employs/contracts with system of providers which deliver service and shares financial risk
Managed health care Plan
How does managed care work?
provider makes up network. plans pay depends on network rules.
what are the 3 types of managed care?
only pay for care within network, care coordinated by PCP
pay more if care is in network, but pay a portion of outside network care
plan allows HMO or PPO each time care is needed
What are early strategies of managed care cost control?
provider risk contracting
invest in disease management.
Advantages of managed care benefit who?
employer not consumer
Since HMO is less strict, what increased?
hospital market power due to consolidation.
When was peak enrollment in HMO?
Why Did HMO cost continue to increase after peak?
reintroduce authorization requirement
concurrent review of care
tiered provider network
quality care incentive.
what is the proposal to contain cost HMO?
invest in IT
Increase consumer involvement
Alter tax preference for EB insurance.
helping patients choose care that’s supported by evidence, not the same tests already done, free from harm, and actually needed *consumer involvement*
Choosing wisely ABIM
What does policy data say about PT?
Gov accounting office
Office of inspector general
Part B national summary Data file
What happened to medic between 200-2004
more beneficiaries used service