PH 110 Quizes
categorical
do you make a certain amount of money and fit into one of the categories
where do most Americans get their insurance
employers 50%
how would you describe the US health system?
expensive, inaccessible, unequal, variable quality of care
All states have expanded Medicaid under the ACA.
false
David Jones' article, "Political Participation in the Least Health Place in America," was primarily focused on understanding why residents of the Mississippi Delta consistently voted against their own interest and against their own health needs.
false
Expanding health insurance is always associated with access to high quality care.
false
Expanding health insurance will likely save money overall by reducing the use of emergency departments.
false
Health spending in the United States, as a percent of GDP, is similar to that of all other wealthy democracies.
false
Medicaid's eligibility is based only on income.
false
On average, Medicaid reimburses providers at a higher price than both Medicare and private insurance.
false
The definition of population health as a "field of research" is NOT concerned with what causes a particular distribution of health outcomes, it is only concerned with the proper measurement of those outcomes.
false
The social determinants of health are entirely concerned with access to health care and the quality of health care an individual receives.
false
Copayment
fixed dollar amount at the point of service; refill is $20 - doesn`t mean it cost $20 dollars the insurance is paying the other portion
means-tested programs
government programs providing benefits only to individuals who qualify based on specific needs: income
In the following causal chain, which factor is considered the most downstream factor? Built Environment --> Housing Quality --> Exposure to toxins/pollutants --> High Asthma Rates
high asthma rates
Deductible
huge barrier to accessing care; money you owe before the insurance kicks in; paid before service
what is the goal of the ACA?
increase access to health care
how do we deal with risk?
insurance
Medicare—Part D Prescription Drug Coverage
is a voluntary program for paying for your prescription drugs. If you earn more, you pay more.
Generally, a PPO offers a beneficiary more flexibility in terms of where they can seek health care services that would be covered by the insurance plan.
true
One of the consequences of "medicalization" is that much of our health policy discourse focuses on access to health care as the primary lever for addressing health vulnerability and health inequity, instead of on social factors that exist beyond the provision of medical care.
true
Premium tax credits can be used to buy a Bronze, Silver, Gold, or Platinum plan.
true
The ACA prohibits insurance companies from placing yearly or lifetime limits on the amount of care an individual can get in a year.
true
The ACA's Medicaid expansion was associated with a significant reduction in mortality
true
population health as a field of research
what are the causes of these outcomes; independent v. dependent
population health as a concept of health
what are the health outcomes? who is healthy v. sick
Medicare Part C (Medicare Advantage)
•Replaces and covers expenses found in Part A and B •Medicare private fee-for-service plans (PFFS) •Medicare managed care plans (HMOs and PPOs) •Medicare specialty plans *Fed gov pays capitated, per member, per month fee
Medicare part B
The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. *mean tested- your premium depends on your income
What 2 objectives should a health care system have?
1. All citizens should have access to HCS (health care syst) 2. Ensure that the cost-effective services meet established standards of quality
Guaranteed issue refers to a requirement in which insurance companies must do what?
Accept all insurance applicants without regard to their health status or previous medical history
Which of the following is true about the ACA's Health Insurance Exchanges?
All of the above
What is a deductible?
The amount of money that a beneficiary must spend out of pocket before their insurance plan starts to pay for covered services
What is "medicalization"?
The expansion of medicine as an institution and the use of a medical lens to view human processes and behaviors
What is a premium?
The expected cost of treatment for everyone in the pool
Federal Medical Assistance Percentage (FMAP)
The statutory term for the federal Medicaid matching rate—i.e., the share of the costs of Medicaid services or administration that the federal government bears. In the case of covered services, FMAP varies from 50 to 76 percent depending upon a state's per capita income; on average, across all states, the federal government pays 57 percent of the costs of Medicaid.
what are the 4 basic components of a health care delivery system?
1. financing 2. insurance 3. delivery 4. payment
how did the ACA expand access to health insurance?
1. medicaid expansion- expand eligibility 2. health insurance exchanges- regulate market 3. protect people who already had insurance: disabilities and preexisting conditions 4. provided premium tax credits and cost sharing reductions 5. enacted individual mandate
what are the 10 MAJOR characteristics of the US health care system?
1. no central agency governs the system 2. Access to HC services is selectively based on insurance coverage 3. HC is delivered under imperfect market conditions 4. Insurers form the 3 party act as intermediaries between the financing and delivery functions 5. The existence of multiple payers makes the system cumbersome 6. The balance of power among various players prevents any single entity from dominating the system 7. Legal risks influence the practice behavior of physicians 8. Development of new tech creates an automatic demand for its use 9. New service settings have evolved along a continuum 10. Quality is no longer accepted as an unachievable goal
What is the urban heat island effect?
A phenomenon in which the built environment of an urban area causes temperatures to be higher than rural and natural surrounding areas
Out-of-pocket maximum
A predetermined amount after which the insurance company will pay 100% of the cost of medical services.
health insurance exchanges
A set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.
Federal Subsidies
A benefit given by the government to groups or individuals usually in the form of a cash payment or tax reduction.
Medicaid
A federal and state assistance program that pays for health care services for people who cannot afford them.
Medicare
A federal program of health insurance for persons 65 years of age and older
What is a copayment?
A fixed dollar amount that is paid by the beneficiary at the point of service for covered services
What is a 'death spiral'?
A phenomenon in which high premiums cause healthy beneficiaries to drop their insurance, which in turn causes premiums to increase, which in turn drives more healthy people from the insurance market, leading to market collapse
On what plan is the ACA's tax credits based?
The Second Cheapest Silver Plan
Affordable Care Act
An expansion of medicaid, most of employers must provide health insurance, have insurance or face surtax, prevents rejection based on pre-existing condition. Also referred to as "Obamacare", signed into law in 2010.
What was the population under study in the White Hall Study?
British civil servants
Which is TRUE about Medicare and Medicaid
Each contains some means-tested aspects
What are the primary mechanisms by which the ACA expanded access to health insurance?
Health Insurance Exchanges and Medicaid
Who is covered by medicaid ?
Initial required pops: single headed families receiving cash assistance, elderly, blind, disabled Current pop: pregnant women, children, parents, elderly, disabled, people below the minimum threshold
Which of the following is TRUE about Medicare
It includes private insurance companies in its operations and benefit delivery
Which of the following is TRUE about Medicaid
It is jointly financed by the states and the federal government
Which of the following provides an example of population health as a "concept of health"?
Life expectancy in California i 81 year, with Black Californians having a life expectancy of 75.1 years, Asians 86.3 years, Latino 83.2, and White 79.8
Moral Hazard
Overuse. Collectively brings up spending and bring up people`s insurance who don`t use it premium up
Which population was initially eligible for premium tax credits under the ACA?
People between 100-400% of FPL
Death Spiral
Process that begins by attempting to increase price to meet reported product costs, losing market, reporting still higher costs, and so on, until the firm is out of business.
Medicare Part A (aka Hospital Insurance or HI)
Provides hospital insurance automatically at age 65 (if FICA qualified) at no fee but may have deductible & co-pay.
cost sharing
Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost-control mechanism.
individual mandate
Requirement that individuals get health insurance or pay a tax penalty to the federal government.
What does the figure below illustrate?
Social gradient
social justice
When the outcome is the result of health inequity or we could make a change through health policy when we don`t do that
Coinsurance
a percentage of that coinsurance; less known than copay; depends on the hospital price for service
Coinsurance
a provision under which both the insured and the insurer share the covered losses
What terms is used to describe a phenomenon in which less healthy people disproportionately enroll in a given risk pool?
adverse selection
Upon what is Medicare's eligibility primarily based?
age
Medicare
age based or long term disabilities; universal for those over 65; purely federal program; entitlement program (no wait list) you get the benefits
According to the WHO report, "Closing the Gap in a Generation," the social determinants of health are shaped by which of the following factor(s)?
all of the above
Which of the following factors can be used to determine the price of a monthly premium for a plan sold in the health insurance exchanges?
all of the above
entitlement programs
benefits; no matter how many people are eligible or what the needs are the gov cannot put a cap on it. The money flows
Risk Pooling
combines the medical costs of a group to calculate premiums and average out the costs
subsidy clip
cuts off middle class in terms of affordability; made it expensive because they are covering more
HMO (Health Maintenance Organization)
less flexible, care is in-network, emphasis on prevention, gate-keeper- have to go through primary
what is the problem the ACA was trying to solve?
making health care affordable and covering the people left uninsured
Actuarial Value (AV)
measure of the plans cost sharing. the lower the AV, the higher the cost share for the enrollee. e.g. if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.
Premium
membership fee regardless if you use it
PPO (Preferred Provider Organization)
more flexible and network is more broad; higher fees when out of network, can call specialized doctor
Moral Hazard
once enrollees have Health insurance they may use more HCS than if they paid for these out of pocket
How does Medicaid get its funding?
open-ended funding stream (entitlement) makes them flexible with events and emergencies, FMAP fed medical assistance program: depends on the income of the state, CA maybe 50/50 whereas Alabama may be 30/70
capitated system
per member, per month fee
In the following causal chain, which factor is the most upstream factor? Policies subsidizing highway construction --> Destruction of neighborhoods to build highways --> High traffic congestion through dense neighborhoods --> Increased pollution rates --> higher asthma rates
policies subsidizing highway construction
What is the primary strategy by which an insurance company can ensure a reasonably predictable and stable expected health care costs?
pool risking
health disparities
preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations
Medigap
private supplemental insurance plans; people can buy this; fill in the gaps of you insurance
Copayment (copay)
provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each visit or medical service received
What did the ACA of 2010 do?
reduce the # of uninsured, all US residents had to have public or private insurance, uninsured were taxed, federal subsidies helped low-income people with the cost of health insurance
intergovernmental program
shared responsibility between state and fed gov
how are Medicaid expenses covered?
shared responsibility between state and fed; it is optional to participate. Fed gov sets the minimum for the states; splits the costs of additional individuals
need
the amount of medical care and experts believe a person should have to remain or become healthy
Premium
the expected cost of treatment for everyone in the pool
As initially enacted, the ACA's Medicaid expansion was required, but is now an optional population
true
Both Medicare and Medicaid are entitlement programs.
true