PUP3002 Chapter 7 Health Care Policy

What is the Affordable Care Act?

-Obamacare -law signed to ensure all Americans have access to affordable healthcare -requires most US citizens have health insurance or pay a fine

How much of a state's budget is allocated to Medicaid?

24%

An example of moral hazard

A family does not install a smoke alarm because they have fire insurance.

What is Medicaid?

A health insurance assistance program for some low income people (especially children and pregnant women) sponsored by federal and state governments.

__________ occurs when individuals seek insurance because they are at particularly high risk.

Adverse Selection

What is an information asymmetry in health care?

Asymmetric information exchange between providers and patients contributes to medical errors, customer frustration, over-treatment, and under-treatment in the U.S. healthcare system.

Why do doctors from Canada come to work in the United States?

Because they can make more money than in Canada

What is a moral hazard in healthcare?

Because you have insurance you tend to act more irrational with your health (i.e., smoking)

What is an employer insurance mandate?

Businesses with more than 50 employees must provide insurance to all full time workers (<30 hours a week)

What is a single payer system?

The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance.

what is a community rating?

The price of health insurance is based on the expected health costs of the larger population in which they live.

Why is healthcare innovation higher in the United States than in other countries?

There are more incentives for healthcare innovation because drug companies and doctors can make more money.

True or False? The U.S. spends a larger portion of its income on health than any other country in the world

True

What is a risk profile?

a general assessment of how much an individual will spend on healthcare in a given period of time

Supporters of the _________ such as the Massachusetts Plan (RomneyCare and ObamaCare point to the need for required health insurance coverage.

Health Insurance Mandates

What is HMO?

Healthcare Management Organization: have to stay in the network of their select physicians

What are some failures in the Healthcare system?

Information Asymmetry Moral Hazard Adverse Selection Problem

What is an adverse selection problem in health care?

Information Asymmetry at the selection stage. Ex: Insurers may choose individuals that are high risk.

In a ________ program, recipients must demonstrate evidence of low income as well as other factors in order to be enrolled.

Means-Tested

Is the ACA a single payer system?

No

Some scholars argue that health systems developed by nations are ________, with their current systems resulting from historical circumstances.

Path Dependent

What is PPO?

Private Preferred Options: can go to a doctor outside the network but you will have to pay more (higher premiums, co-pays, and deductibles)

In a single payer system, can providers be public, or private?

Providers may be public, private, or a combination of both

The price of health insurance varies from individual to individual based on characteristics like age, weight, and habits. These characteristics are part of an individual's _________.

Risk Profile

The set of individuals covered by an insurance plan is called a

Risk-Pool

To correct for moral hazard problems, health insurers use:

co-payments

Who runs Medicare?

federal government

What is Medicare?

federal insurance program for elderly persons or persons with permanent disabilities

what has a significant effect on the risk pool and the price of health insurance?

the choice of risk profiles (individual year, individual lifetime, average of individuals in a region)

What is an insurance mandate?

the government requires that all citizens have adequate health insurance (does not matter from which sector)

Moral hazard presents problems for who?

the insurer and ultimately the consumer

what does the riskiness of the pool depend on?

the risk profiles of those in the pool. If risk pool contains an inordinate percentage of less healthy individuals = higher insurance costs

what is the risk pool?

the set of individuals covered by insurance

what does a large part of health spending in the United States cover?

uncompensated care (care that is given to people who do not pay)

Benefits of a single payer system?

universal coverage, some argue it is cheaper than other systems?

What are some examples of single payer systems?

Canada and United Kingdom

What is CHIP?

Children's health insurance program federally and state funded (more federal money) administered by the state to include children who do not qualify for Medicaid

What is it called when the price of health insurance for an individual is based on the expected health costs of the larger population within which they live?

Community Rating

Costs of a single payer system?

Costs a lot of money for the government, standard of care may be lower

What is it called when the consumer pays for some agreed upon proportion of the bill if they use insurance?

Deductible