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RMIN4000 EXAM BROWN #4 NOTES FOR THE EXAM with Complete Solutions
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RMIN4000 EXAM BROWN #4 NOTES FOR THE EXAM with Complete Solutions Effects of Third-Party Healthcare Transactions - (1) Patient/Insured/Employee (2) Healthcare Providers (3) End Result of Health transaction Patient/Insured/Employee - - lower "user prices" of healthcares - less incentive to ac...

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  • September 26, 2024
  • 30
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • RMIN4000

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RMIN4000 EXAM BROWN #4 NOTES

FOR THE EXAM with Complete Solutions


Effects of Third-Party Healthcare Transactions - ✔✔(1)

Patient/Insured/Employee

(2) Healthcare Providers

(3) End Result of Health transaction

Patient/Insured/Employee - ✔✔- lower "user prices" of healthcares

- less incentive to act as a traditional consumer

- increases moral hazard

Healthcare Providers - ✔✔- payment system based on fee for service

- for service (x-ray, flu test, etc) a separate fee is paid

End Result of Health Transaction - ✔✔over-utilization of healthcare =

patient with insurance + providers paid by FFS

Global Contributions to High Cost - ✔✔- advances in technology

- aging population

- behavioral factors

- third-party financing

,US Contribution to High Costs - ✔✔- employer-sponsored health insurance

- fee for service providers

- high administration cost

- lack of transparency in cost and quality

- cost-shifting in medicare and Medicaid

- defensive medicine

Major defects in U.S. healthcare system - ✔✔- rising healthcare

expenditures

- large number of uninsured

- considerable waste and inefficiency

- harmful insurer practice

Affordable Care Act (ACA) - ✔✔Federal legislation passed in 2010 that

includes a number of provisions designed to increase access to healthcare,

improve the quality of healthcare, and explore new models of delivering

and paying for healthcare.

Guaranteed Issue (under ACA) - ✔✔Insurers cannot deny coverage due to

preexisting conditions

Community Rating (Under ACA) - ✔✔Insurers may only rate on a few

variables

, Minimum Standards for Health Insurance (under ACA) - ✔✔- cannot drop

policyholders

- dependents can remain on policy until the age of 26

- no annual of lifetime limits

- coverage for essential health benefits

- individual mandates

- health insurance

- subsidies for low income individuals/families

- employee mandate

- increases adverse selection

Individual Mandate - ✔✔Buy health insurance or pay a penalty

Employer Mandate - ✔✔Firms with 50+ employee must provide health

insurance or pay a fine

- requires health insurers to pay 85% of premiums

- example: $10 million premiums, $8.5 million claims

Copayment - ✔✔a flat amount the insured must pay for certain benefits,

such as an office visit or generic drugs

- does not count toward annual deductible

- policies may include individual/family deductibles

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