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LSUS MHA 707 Exam D with Solutions
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LSUS MHA 707 Exam D with SolutionsBCBS developed nationwide due to
· U.S. entering WW2 w/ caps on wages
BCBS unified
1940s
BCBS together served
· 24M, 81 hospital plans, 44 med plans
By 1960s BC had
· 52M
By 1960s BS had
· 40M
BCBS covered what percent Fed employees
· 33%
BCBS offered by
· Voluntary, nonprofit companies
· Estab. As charitable & benevolent organizations
BCBS used what to set prices for their products
· Community Rating
Why did BCBS use Community Rating?
· Data too poor to do anything else
,Community Rating refers to
· Insurance pricing whereby everyone in same geographic area pays same premium
· Regardless of health status, age, gender, family composition, occupation, health
behaviors such as smoking, or claims hx
Experience Rating
· Tailors policies & premiums to particular group or individual
· Premiums based on person's claims, health status, & risk of future claims as indicated
by their age, gender, health behaviors, & so forth
Congress passed legislation for 3 groups not covered by employer-based insurance
· Medicare (65+)
· Medicaid (uninsured, low-income)
· CHIP (uninsured, moderate income)
· Between 1965 - 1999
2 Fed health policies enacted to solve problems related to health care coverage
· EMTALA
· HIPAA
· 1986
,Emergency Medical Treatment & Labor Act (EMTALA)
· Prohibited "dumping" by Medicare participating hospitals w/ active ERs
Health Insurance Portability & Accountability Act (HIPAA)
· 1996
· Brought about # of significant improvements in access to health coverage by
mandating
o Continuity or "portability" of coverage in private health insurance markets
o Health insurance coverage for @least 2-day hospital stay for women who gave birth
vaginally & 4 days for C section deliveries
o Sponsored by Texas senator Phil Gramm
o Mental health was given same status a physical health by HIPAA legislation
HIPPA & Privacy
· Data w/in med rec belongs to pt.
· Pts have right to ensure info contained in rec is accurate
· Pts can petition provider to change incorrect info
Hospital developed as heart of HC delivery system
20th century
Community hospitals built with
· Fed funds through Hill-Burton Act
Voluntary, nonprofit hospitals built by
, · Private Sector
Hospital built by
· Military for members, vets, & family
Public hospitals built by
· Gov entities for poor (usually local gov)
1900-1930
· 0.3% of Growth Domestic Product (GDP)
1960
· 1.3% GDP = 4x, four-fold, 400%
1980
· 4.1% GDP = 3x since 1960, 13.6x since 1930
Incremental Changes
· Expansion of capitation & rise of managed care
· Growth of vertical & horizontal integration of HC orgs & integrated delivery systems
· Increase in for-profit HC orgs
2 contrasting ways to pay HC providers for services
· Capitation
· Indemnity Health Insurance (difference is in who takes risk)
Capitation
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