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Flashcards in cost and cost control Deck (29):
1

Kissicks triangle?

cost
quality
access

2

annual spending?

3.2 trillion

3

Half of health care used to treat

5% of population

4

Why is cost a burden on business?

if insurance goes up everything goes up.

costing more for employers

5

what does increasing health care cost do?

care and insurance cost both go up/

6

Why is cost so high?

moral hazard
demographic shift (ppl live longer)
reduced consumer ownership(not responsible for it.)
unnecessary spending.

7

using insurance when they don't need it

moral hazard.

8

What are the 2 factors increasing cost?

price and quantity

9

factors of price?

market power
administrative costs

10

how is price controlled?

decrease quality
increase utilization
cost-shifting
mandatory uniform fee schedule.

11

Volume and intensity aspects that increase cost?

fee for service
fragmented care
technology
malpractice
chronic condition
demographics

12

What is a better cost control strategy?

-controll fees and provider incomes.
-cutting price on supplies

13

insurance model used to manage cost, also quality and access

Managed Care

14

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

15

How does managed care work?

provider makes up network. plans pay depends on network rules.

16

what are the 3 types of managed care?

HMO
PPO
POS

17

only pay for care within network, care coordinated by PCP

HMO

18

pay more if care is in network, but pay a portion of outside network care

PPO

19

plan allows HMO or PPO each time care is needed

POS

20

What are early strategies of managed care cost control?

selective providers
provider risk contracting
primary gatekeeping
utilization review
invest in disease management.

21

Advantages of managed care benefit who?

employer not consumer

22

Since HMO is less strict, what increased?

hospital market power due to consolidation.

23

When was peak enrollment in HMO?

1999

24

Why Did HMO cost continue to increase after peak?

reintroduce authorization requirement
concurrent review of care
disease management
tiered provider network
quality care incentive.
cost sharing
benefit design

25

what is the proposal to contain cost HMO?

gov regulation
adjust compensation
invest in IT
improve quality
Prevention
Increase consumer involvement
Alter tax preference for EB insurance.

26

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

27

What does policy data say about PT?

Payer tracking
MEDPAC
Gov accounting office
Office of inspector general
Part B national summary Data file

28

What happened to medic between 200-2004

spending doubled

more beneficiaries used service

29

What were limitations in claims data MEDPAC?

no outcomes
limited Dx
Provider identifiers .