US Model Of Healthcare

Question 1

Why is the government unable to agree on costs in US Healthcare Model

Answer 1

Because of lobbying power from different parties

Question 2

What parts of US Healthcare Model come from the Bismarck Model

Answer 2

Insurance for individuals under 65

Question 3

What parts of US Healthcare Model come from Beveridge Model

Answer 3

Government provision and insurance/payment to provide free healthcare to Native Americans, military veterans, and active military

Question 4

What parts of US Healthcare Model come from National Health Insurance Model

Answer 4

Medicare for those over 65

Question 5

What parts of the US Healthcare Model come from the Out-of-Pocket Model

Answer 5

Many uninsured or insured who are responsible for high healthcare costs

Question 6

What is Medicare

Answer 6

Federal health insurance for anyone over 65 and those under 65 with disabilities or specific conditions

Question 7

What conditions could qualify someone for Medicare

Answer 7

End stage renal disease, cancer, COPD, etc.

Question 8

What was Medicare designed to do

Answer 8

To cover hospital services and doctors’ services but not it also covers drugs, most preventative services, or nursing home care

Question 9

What is not covered by Medicare

Answer 9

Hearing aids and eyeglasses

Question 10

How is Medicare funded

Answer 10

By payroll tax from employees and employers

Question 11

What does Part A of Medicare cover

Answer 11

Hospital care, skilled nursing care, and home health care after hospitalization-hospice care

Question 12

What does Part B of Medicare cover

Answer 12

Wide range of diagnostic and therapeutic services provided by physicians, emergency departments, and outpatient services

Question 13

How does Part B of Medicare work

Answer 13

It is a voluntary supplementary insurance from private insurers where patients must pay 20% of copayments with a $150/year deductible

Question 14

What is Part C of Medicare

Answer 14

A special program to encourage Medicare beneficiaries to enroll in prepaid health plans

Question 15

What is Part D of Medicare

Answer 15

Prescription drug coverage plan (requires patients to pay monthly premiums and annual deductibles)

Question 16

What % of GDP does the US spend on their healthcare per year

Answer 16

18% ($9000/person/year)

Question 17

What is Medicaid

Answer 17

A joint federal/state program designed to pay for health services for people with limited income and resources, etc.

Question 18

How does coverage for Medicaid work

Answer 18

It is comprehensive but physician reimbursement is relatively low (not every physician chooses to participate)

Question 19

What kinds of physicians often choose not to participate in Medicaid

Answer 19

Mental health, dental, dermatology, etc.

Question 20

How many people does Medicaid currently cover

Answer 20

75 million (half of who are children)

Question 21

How is Medicaid financed

Answer 21

Jointly by federal governments and states

Question 22

How is Medicaid administered

Answer 22

By states within broad federal guidelines

Question 23

How much does the Federal government pay for Medicaid

Answer 23

Variable amount from 5%-83% depending on the state’s per capita income

Question 24

What is the Federal poverty level for a family of four

Answer 24

$25,000

Question 25

What does employment-based health insurance look like in the US Healthcare Model

Answer 25

50% of all Americans hav option to purchase some form of insurance through employers

Question 26

How did employment-based health insurance begin in the US

Answer 26

During WWII employers couldn’t raise wages so they offered healthcare benefits instead (fee for service payments/HMOs and capitation)

Question 27

What are fee for service payments

Answer 27

Charges paid for specific services provided which encourages provision of many services (only works with “preferred providers”

Question 28

What is capitation

Answer 28

Fixed number of dollars/month paid to physician to provide services to a patient regardless of the number of services provided

Question 29

What does the health insurance exchange do

Answer 29

Provides way to get health insurance for those ineligible for other forms of comprehensive health insurance (like online marketplace for individuals, families, and small businesses)

Question 30

What is the Affordable Care Act

Answer 30

Requires insurance to cover essential health benefits (dramatically reduced number of uninsured Americans to <10%)

Question 31

What does the Affordable Care Act cover

Answer 31

Ambulatory patient services (outpatient services), emergency services, hospitalization, maternity and newborn care, mental health/SUD services, prescription drugs, rehab services, laboratory services, etc.

Question 32

What are 4 programs to provide additional assistance to people injured or uninsured on the job under the Affordable Care Act

Answer 32

Worker’s compensation and federal programs for workers, social security disability insurance, and social security income

Question 33

What are 6 reasons why being uninsured in the US is so problematic

Answer 33

They receive less preventative care, are diagnosed at more advanced stages of disease, receive less treatment once diagnosed, less likely to have usual source of healthcare, more likely to use emergency department for routine care, and increased mortality rate (~20,000 excess deaths/year)