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CEBS GBA Exam 2 Updated /305 Questions With Verified Answers 100% Score!!!!
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- CEBS GBA Exam 2 Updated 2023-2024
CEBS GBA Exam 2 Updated /305 Questions With Verified Answers 100% Score!!!!
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CEBS GBA Exam 2 Updated 2023-2024 /305Questions With Verified Answers 100% Score!!!!
Quiz :What is the basic assumption underlying concept of a free market and
how is it challenged by the theory of "bounded rationality?" (Mod 1.1) -
Answer :Assumption that rational customers will make informed decisions
about value, quality and price, while producers who meet consumer's
demands will be rewarded with market share and profit. However this is
challenged by the consumer's "bounded rationality" - rational consumer is only
functional up to a certain point because choices are constrained or bound by
limited knowledge and understanding of their choices.
Quiz :What are economic benefits of a free market? (Mod 1.1) - Answer :If an
individual does not like their provider or health plan, the should be able to
"vote with their feet" and select other options. This choice empowers
customers, regulates producers and drives efficiency.
Quiz :Describe several ways the US Healthcare market does not function like a
normal market. (Mod 1.1) - Answer :Healthcare market has significant
asymmetry in information between consumers, providers and insurers. Moral
hazard is a problem because the marginal cost of covered care is zero, causing
some to overconsume medical care. Many consumers choose doctors initially
by convenience, accessibility or recommendation. Cost has also been shown to
be lower on priority scale for choosing a provider.
Quiz :List several recent initiatives in the US that purport (to claim, often
falsely) to use market forces to increase efficiency in the healthcare system.
(Mod 1.1) - Answer :1) Employers are offering more HDHPs with some as high
as $10,000. These plans, often paired with HSAs, are coupled with the idea of
transparency, or making more info available to consumer on cost and quality.
Idea is that consumers will have more skin in game and be prudent purchasers
of care with their own money.
2) ACA is creating marketplaces that employ a form of managed competition
where standardized health plans compete on cost and quality.
3) Public Medicaid and Medicare programs are moving towards requiring or
making choices available for managed care products that structure care within
provider networks.
Quiz :Indicate the approximate percentages of the population covered by
major health programs. (Mod 1.2) - Answer :Largest portion of Americans
,(48%) receive health insurance through an Employer, 16% through Medicaid,
15% through Medicare, 6% purchase insurance on their own
Quiz :How did ACA change Medicare? (Mod 1.2) - Answer :ACA expanded
Medicare's wellness and prevention benefits, improved prescription drug
coverage and financed experiments to control health care costs by testing
alternative payment methods and delivery systems.
Quiz :How did ACA change eligibility for Medicaid benefits and how is this
change affecting the number of people who are enrolled? (Mod 1.2) -
Answer :ACA shifted program eligibility from category based (ex: single parents
with dependents or people w/disabilities) to an income-based standard.
Medicaid once covered fewer than half of low-income Americans, but now
ACA Medcaid expansion has been steadily increasing enrollment, with largest
increase in the states who are participating.
Quiz :Explain significance of US Supreme Court case National Federation of
Independent Business v Sebelius in 2012 (Mod 1.2) - Answer :ACA sought to
expand Medicaid coverage to all individuals and families with incomes below
138% of the poverty level. US (first time) would have had a solid safety net of
insurance coverage for all lower income citizens. In the case, the court rules
states could choose not to expand (and Medicaid funding would not be
withheld). By Jan 2015, 25 states chose not to expand.
Quiz :How has ACA affected number of uninsured Americans? (Mod 1.2) -
Answer :Prior to ACA, 16.3% or 49.9 million Americans were uninsured. By
2014, this number reduced to 13% and by the first quarter of 2016 to 8.6%.
Quiz :Describe private health insurance coverage with regard to a) size of firm
b) HDHPs with Medical Savings Accounts
c) variability of coverage by states (Mod 1.2) - Answer :a) 98% of employers
with 200+ EE's offer health insurance but fewer than 45% of firms with 3-9 EE's
do so. Larger employers offer more choice of health plans than smaller
employers; small employers tend to offer POS plans that require higher EE cost
sharing to go outside network.
b) In 2006, HDHPs with medical savings accounts accounted for 4% of ER-
sponsored market, but by 2012, accounted for over 20%. In 2016, this rose to
almost 30%.
,c) Range of ER-based options and quality of options available vary widely by
state. The percentage of the population covered by private insurance varies as
well as the options for different types of coverage.
Quiz :What are the basic differences between the four medal categories of
ACA health plans? (Mod 1.3) - Answer :Bronze, Silver, Gold and Platinum plans
all have same actuarial value. However, they differ in regard to amount of
deductibles, coinsurance, other out of pocket costs and premiums. Bronze plan
has lowest premium but most out of pocket costs. Platinum plan has lowest
out of pocket cost, but highest premium.
Quiz :Why is the Silver Plan the most popular choice among ACA plans? (Mod
1.3) - Answer :Majority who enroll are eligible for federal tax credit subsidies
tied to a Silver level plan. People may still select a higher cost Gold or Platinum
plan, but will have to pay higher premiums. Cost-sharing subsidies to lower out
of pocket costs are only available to Silver plans.
Quiz :Do users of ACA marketplace exchanges have many choices and does
evidence indicate they choose the most cost-effective plans? (Mod 1.3) -
Answer :Ton of choices and options (ex: in TX, 15 carriers offered an average of
31 plans per county). A consumer comparing plans may see different
premiums, coinsurance and deductibles, but plans also may differ on every
measure of out of pocket costs including physician copays, ER payments,
hospital stay payments. Studies have found despite wide range of benefits,
people are not choosing most cost-effective plans....people on average choose
plan 10% more expensive than what would be optimal. Other studies suggest
limiting variation in plan designs would be choices more comprehensible (able
to understand).
Quiz :What is the provision in Part D Medicare law that gives a significant
benefit to pharmaceutical companies? (Mod 1.4) - Answer :Part D Medicare
Law prohibits the government from using its purchasing power to negotiate
widespread discounts with drug plans.
Quiz :Do Medicare Part D beneficiaries have many choices and does the
evidence suggest they choose the most cost-effective plans? (Mod 1.4) -
Answer :Provide numerous choices (ex MA has 27 standalone, TX has 32). Most
people do not select the optimal plan or take advantage of open enrollment
periods to obtain a more cost-effective plan. Few people switch plans even
when it would be in their advantage to do so.
, Quiz :Define each part of Medicare (A,B,C,D) and the services provided under
each (Mod 1.4 - Reading) - Answer :Part A = Hospital Services
Part B = Physician & Diagnostic Services
Part C = Medicare Advantage - Alternative Managed Care Option
Part D = Prescription Drugs
-Greatest choices in Part D and the Medicare Advantage Plan, which is where
most of analysis is focused on.
-C and D are paid out of pocket by recipients; A & B are funded by payroll
deductions (taxes)
Quiz :What is Medicare Part C and why do some people select it? (Mod 1.4) -
Answer :AKA Medicare Advantage:
-Recipients have the option to enroll in a health plan with a narrowed network
of hospitals and providers that covers Part A and B but with lower out of
pocket costs. These plans often include their own prescription drug coverage.
Unlike Part D, this is a voluntary choice and beneficiaries always have the
option of going back to the traditional plan. It is a choice to restrict options and
consolidate the different elements of Medicare, including cost sharing.
People select these plans because of lower costs and greater care
coordination. Like Part D, Part C has significant state variation.
Quiz :What have researchers found with regard to consumer benefits and
efficiency of Medicare Part C? (Mod 1.4) - Answer :45 studies - in general that
Part C's HMO and PPO programs have a better record than traditional fee for
service plans in the provision of preventive services and the more efficient use
of resources. Despite high performance, a sub-group of sick beneficiaries in
traditional Medicare tends to rate their care more favorably than beneficiaries
in Part C - due to easier access to specialists. Compared to Part D (which
provides a separate, uncoordinated prescription drug benefit), choice here is
less complex and could lead to greater consumer benefits and efficiency.
Quiz :Discuss consumer choices for Physicians and Hospitals in the Medicaid
Program (Mod 1.4) - Answer :Federal government mandates open choice to
both Phys & Hospitals; however, in the 90s, states could obtain waivers for this
provision and require Medicaid recipients to enroll in a limited-network
managed care plan (most states did).
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