MHA 707 Exam C | 89 Questions with 100% Correct Answers | Verified | Latest Updated 2024 | Already Passed Nonmarketability of risks - ✔✔Inherent I medicine and medical practice health insurance. Moral hazard - ✔✔behaving differently when you know someone else is taking the risk (induced demand) Adverse selection - ✔✔The sicker people like ly want more insurance (the healthier, less) Pooling of risk - ✔✔Sharing risk proportionately among many is a basic insurance concept Financing health care in U.S. - ✔✔•Workarounds •Redundancies •Contradictions (NHEA) - ✔✔National Health Expenditure Accounts National health expenditures (NHE) - ✔✔All health care consumption and investments in medical structures and equipment and non commercial health services and biomedical research. Health Consumption Expendit ures (HCE) - ✔✔•A subset of (NHE) National health Expenditures •Includes all medical goods and services that are used to diagnose, treat, and prevent health problems in a specific person. In 2017, the National Health Expenditures (NHE) were approximately - ✔✔• $3.49 trillion • 17.9% of GDP • $10,739 per capita Most of HCE are for personal health care (PHC) - ✔✔•Hospitalization •Physician Services •Prescription drugs •Other health care goods and services Chronic diseases - ✔✔90% of the NHE are for 85% chronic and 5% mental health diseases - ✔✔Value -based purchasing, bundled payments, and P4P (pay for performance) currently used by CMS ( Centers for Medicare & Medicaid Systems) too performers make extra money that is taken from poorer performers Manag ed Care Plans - ✔✔• Health Maintenance Organizations (HMO) • Preferred Provider Organization (PPO) • Point -of-Service (POS) plans • Exclusive Provider Organizations (EPO) • Other Permutation Managed Care Organization (MCO) - ✔✔United health group is the largest in 2017 About 66% - ✔✔of people under the age of 65 are covered through Private Insurance About 11% - ✔✔of people under the age of 65 were uninsured in 2017. (Self -pay or self -
insured ) (unassigned, no doctor) About 8% - ✔✔of people under the age of 65 were uninsured in 2019 Out of pocket health care payments for insured patients are - ✔✔• Copayments • Coinsurance • Deductibles Copayments - ✔✔• Tend to decrease utilization - "First d ollars" spent if present • Tiered copayment amounts tend to steer patients towards lower cost products and services. Coinsurance - ✔✔Intended to steer patients toward providers with lower rates and / or less intense treatment (encouraging a patient to se ek treatments with lower cost rather than just fewer visits). This strategy relies on the sophistication level of the patient. Deductibles - ✔✔• Common in casualty insurance to minimize claims for minor incidents where the expecting is that adverse events are rare and transaction cost are high
insured ) (unassigned, no doctor) About 8% - ✔✔of people under the age of 65 were uninsured in 2019 Out of pocket health care payments for insured patients are - ✔✔• Copayments • Coinsurance • Deductibles Copayments - ✔✔• Tend to decrease utilization - "First d ollars" spent if present • Tiered copayment amounts tend to steer patients towards lower cost products and services. Coinsurance - ✔✔Intended to steer patients toward providers with lower rates and / or less intense treatment (encouraging a patient to se ek treatments with lower cost rather than just fewer visits). This strategy relies on the sophistication level of the patient. Deductibles - ✔✔• Common in casualty insurance to minimize claims for minor incidents where the expecting is that adverse events are rare and transaction cost are high
