dynamics 3 Flashcards
(25 cards)
What is the difference between an HMO and an EPO?
An EPO doesn’t require primary care providers to make referrals to specialist
What is the main con of an HMO?
You can only use physicians within the HMO group
What is distributive health care?
Advances in medical technology such as mobile units and telemedicine
What is capitation?
Paying the practitioner or hospital a fixed amount for a specific service
What has changed the healthcare system and created new ways of paying for healthcare?
Distributive health care
What is Medicaid?
The federal-state health insurance for the low-income
What is a “Fee for service”
The provider is financially rewarded for volume rather than quality and cost
What did medicare benefit payments do in 2014?
Totaled 597 billion, 25% covered inpatient services, and the other 25% covered private insurance
What is the difference between the benefits of Medicare and private insurance?
The government pays the healthcare bills instead of the individual or private insurance
What do PPOs cover?
Cover care provided both inside and outside the plan’s provider network
What are examples of capitation for private insurance?
Health Maintenance Organizations(HMOs)
What is the largest public health insurance program?
Medicaid
What was the first pre-payment plan to cover physicians?
Blue cross-Blue Shield
What bill was passed where hospitals are paid a set amount for each patient in any of the established DRGs?
Prospective payment bill
The first managed care insurance programs were started with ____
HMOs
What is managed care?
HMOs, PPOs, and EPOs
What was the traditional method of reimbursement for health services before the ACA?
Fee for service and payment for each service at the time of service
What is a PPO?
a group of providers who have voluntarily joined together to render healthcare or a group of providers whom a payer for an arrangement has organized
What is an HMO?
The first managed care insurance program/can not see out-of-network providers
What is Blue Cross?
The first private hospital insurance plan
What is an EPO?
A program that doesn’t require that the primary care provider make a referral to a specialist
What is CHIP?
Healthcare coverage for low-income children
What is a preferred provider?
An organization of a group of providers who join together on a contract to deliver medical services
What is the ACA?
Individuals without access to private insurance through an employer can purchase health insurance through an exchange and receive government subsidies
