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HTH 354: EXAM 1 WITH QUESTIONS AND 100% ALL SURE ANSWERS
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JACKLINEHTH 354: EXAM 1 WITH QUESTIONS AND 100% ALL SURE ANSWERS
Terms in this set (174)
1. financing (employers, government, individual self funding)
Quad Function Model -- Basic Components of 2. insurance (Insurance companies, blue cross/shield, self insurance)
Health Services Delivery System (4) : 3. delivery (providers)
4. payment (Insurance companies, blue cross/shield, third party claim processors)
Private Insurance 194.5 million
Medicare 43.4 million
Insurance & Health Care Reform in 2009
Medicaid 47.8 million
Uninsured 50.7 million
- passed March 23, 2010
- one of the main objectives: reduce the # of uninsured
- Most of the provisions were implemented Jan 1, 2014
Affordable Care Act (ACA) - Mandate for employers to provide health insurance postponed until 2015
- Predictive model said that ACA at best would reduce the number of uninsured to 20 million
- ACA is significant & large health care reform
- NOT universal coverage
HTH 354: EXAM 1
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, 1. no central agencies - lots of key players but no one in charge
2. partial access - uninsured gap
3. imperfect market - economic based (more money -> better healthcare)
4. third party insurers & payers
Major Characteristics of the US Healthcare 5. multiple payers - cumbersome (INEFFICIENT)
system: 6. power balance
7. litigation risk
8. high technology - raises cost
9. continuum of service
10. quest for equality
there are many key players ( i.e. president, CBC, FDA, legislative branches, president, AMA,
no central agencies (expand)
medicaid & medicare, insurance companies) BUT there are NO MAIN LEADERS
partial access access to health care services is selectively based on insurance coverage
imperfect market health care is delivered under imperfect market conditions
third party insurers & payers third party insurers act intermediaries between the financing and delivery functions
multiple players existence of multiple payers make the system cumbersome
partial access (expand) gaps in coverage
the balance of power among various players prevents any single entity from dominating the
power balance
system
legal risks influence practice behavior of physicians
litigation risks (expand)
ex. if something went wrong we could sue the doctors ( we have that right), in result, the doctors
also have coverage & require extra tests
high technology Development of new technology creates an automatic demand for its use
quest for quality Quality is no longer accepted as an unachievable goal(pay for good quality)
Social Security Tax pays for medicare at 65
illness => wellness
acute care => Primary care
inpatient => outpatient
HTH 354: EXAM 1
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