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Health 3050 Final ECU IRONS Exam Questions and Answers
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Health 3050 Final ECU IRONS Exam Questions and Answers
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Health 3050 Final ECU IRONS ExamQuestions and Answers
Determinants of Health - Answer-Factors that contribute to a person's current state of
health.
Effects of Social Determinants - Answer-Example: Low socioeconomic status when
growing up can lead to poor education which leads to low paying jobs and little to no
health care for that person's future
Research shows that health-related behaviors are linked to 3 things; income, education
level and employment
Role that policy and law play on Social Determinants - Answer-The law can be used to
design and perpetuate social conditions that can have terrible physical, mental, and
emotional effects on individuals and populations-- Jim Crow Laws
The law can be utilized as a mechanism through which behaviors and prejudices are
transformed into distributions of well-being among populations.
Laws can be determinative of health through their under-enforcement
Law can be used to structure direct responses to health-harming social needs that
result from things like impoverish, illness, market failure, and individual behavior that
harms others
Benefits - Answer-The list of services covered by the health insurance plan
Examples: blood work, MRI, X-Rays
Beneficiaries - Answer-Individual who buys health insurance
Fee for Service - Answer-Where providers charge a fee for every service they render
Premium - Answer-Annual fee paid by the beneficiary to the health plan
How Premiums are paid - Answer-Paid in monthly installments in 1 of 3 ways:
1. Completely by the individual
2. Completely by the employer
3. Shared between the individual and employer
Your premium means the insurance company will pay for healthcare costs, as long as
the costs are covered with the benefits outlined in your plan
, Setting Premiums - Answer-Insurance companies set premiums to cover most of their
expenses
Experience Premium Rates - Answer-Based on health status and claims in prior year(s)
Community Premium Rates - Answer-Use only geography and family composition to set
rates
Deductible - Answer-The amount of money you pay first, before your health insurance
starts to pay
Cost Sharing - Answer-Costs shared between the insurance company and the individual
seeking health care
2 ways: Co-insurance or Co-payments
Co-Payments - Answer-A set dollar amount the beneficiary must pay at time services
are rendered
Co-insurance - Answer-The amount of the bill that the individual must pay AFTER the
deductible is met.
Out of pocket maximum - Answer-The most money you have to pay out of pocket per
year
Risk and Uncertainty - Answer-Individual: People choose to be insured because of
uncertainty and risk
Insurance Companies:
-they are businesses that need to cover the cost of their expenditures
-uncertainty and risk of customers can lead to adverse selections
-make more money when healthy people buy insurance
Managed Care - Answer-Managed care integrates the provision and payment of health
care services
Ideally, managed care contains costs while providing necessary and high quality health
care services
Why were Managed Care established? - Answer--Rising healthcare costs
-No mechanisms for cost containment under fee for service (FFS)
-FFS does not create incentives to use lowest-cost quality care available
-Insurance companies can't control access and costs in the FFS
Benefits of Managed Care - Answer--Defined package of benefits (premiums and cost
sharing) for a pre-set fee
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