Essentials of the U.S. Health Care System Ch. 6 2024 Distinction

Financing - Correct Answer refers to any mechanism that gives people the ability to pay for health care services. Moral Hazard - Correct Answer consumer behavior that leads to a higher utilization of health care services when the services are covered by insurance. Provider-induced Demand - Correct Answer the providers' ability to create demand. Risk - Correct Answer refers to the possibility of a substantial financial loss from some event. Insured - Correct Answer an individual who is protected by insurance against the possible risk of financial loss. Underwriting - Correct Answer is a systematic technique for evaluating, selecting (or rejecting), classifying, and rating risks. Deductible - Correct Answer the amount the insured must first pay before any benefits by the plan are payable. Copayment - Correct Answer the amount that the insured has to pay out of pocket each time health services are received after the deductible amount has been paid. Coinsurance - Correct Answer cost sharing in the form of a percent amount. Insurance pays 80%, you pay 20%. Stoploss Provision - Correct Answer the maximum out of pocket liability an insured would incur in a given year. Third Party Payers - Correct Answer insurance companies, MCOs, Blue Cross/Blue Shield, and the government. Reimbursement - Correct Answer payment made by third party payers to the providers of the services. Balance Bill - Correct Answer providers ask the patient to pay the difference between the actual charges and the payments received from insurers. Capitation - Correct Answer a provider is paid a set monthly fee per enrollee, regardless of whether an enrollee sees the provider, and regardless of how often an enrollee sees the provider. (PMPM)