Exam 2 HS4300 Bowman
She is responsible for paying $1,500 of her medical expenses before her insurance policy starts to pay
A 30-year-old woman broke her arm and went to the emergency room for treatment. Her health insurance plan has a $1,500 deductible. What does this mean?
Has no gatekeeper
A PPO is a type of insurance that
Joint venture
A new corporation created by two partnering organizations that remains independent is called a (n).
Groups of people
Risk is generally predictable for what group?
Fee for Service, Package pricing, DRGs and Paying for services before they are provided
There are many ways to pay for health care services according to your readings. They are
False
There is a family coverage option for Medicare.
False
Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US.
Be used by service members for non-war related health issues and be used by service members for war related issues
VHA services can
Health care services transported to patients
What are mobile health care services?
Hospital costs
What does Medicare Part A help cover?
Doctor visits, ER visits, Ambulance , renal dialysis, organ transplants
What does Medicare Part B help cover?
True
Primary care may play an important role in lessening the adverse health effects of income inequality.
Categorical programs are designed to benefit only a certain set of people and A certain set of criteria must be met to be eligible for the programs
Public programs such as Medicare and Medicaid are called categorical programs. What are categorical programs?
True
State governments are required to partially finance the Medicaid program.
To provide a seamless array of services, to diversify, to gain market share and because it makes economic sense,
The Primary purpose to utilize integration strategies in health care is
Indian Health Services, Veterans Health Administration, and Health Care for the Military
The federal government is responsible for providing health insurance for other programs. These programs include
False
The increase of health care delivery through managed care created a decreased demand for primary care physicians
Tricare
The insurance arm of military health care is called
Is highly specialized
Typically, tertiary care:
Prescription drugs
What does Medicare Part D help cover?
Medicare Part C is also called Medicare Advantage, Medicare Part C offers additional choices of insurance plans, and Medicare Part C offers managed care plans
What is Medicare Part C?
The process by which primary care physicians refer patients to specialists
What is gatekeeping?
It controls the utilization of health care
What is the main purpose of cost sharing?
Moral Hazard
What is the term for the consumer behavior that leads to a higher utilization of health care services when the services are covered by insurance?
It is a process of determining how appropriate health care services are for a given health care situation and Its main objective is to provide care that is deemed appropriate and cost effective.
What is utilization review?
Dental and Vision : Dental and Hearing aids
What services are not paid for under Medicare?
Increase
What was considered the likely impact of the ACA on primary care?
Acquisition
When an organization ceases to exist as a separate entity and is absorbed into the purchasing corporation is called a(n)
Alliance
When there is a sharing of existing resources without joint ownership of assets is called a(n).
Merger
When two organizations cease to exist, and a new corporation is formed is called a(n).
UK
Which country's health care system is founded on the principles of gatekeeping?
A specific dollar amount you pay when you receive a specific health care service
Which of the following best describes a copay?
The amount you pay before your insurance company pays benefits
Which of the following best describes a deductible?
It is the set amount you pay for your health insurance plan, usually paid every month, regardless if you don't receive medical care that month.
Which of the following best describes a premium?
The percent of the cost of medical services that the insurer pays
Which of the following describes coinsurance?
Increased morbidity
Which of the following is NOT an effect of increased primary care within a population?
Managed care, new technology and Patient preference
Which of the following is a reason for the growth in outpatient services?
Rehabilitation, Surgery and Consultation
Which of the following is an example of a secondary care service?
Increase in hospital technology budget has increased outpatient services
Which of the following is one of the reasons why outpatient services have increased in popularity over the past 20 years?
A gatekeeper is a primary care physician who delivers primary care services, A gatekeeper is the provider who has first contact with the patient and decides if a referral to a specialist is necessary, and A gatekeeper is employed by HMO plans
Who is a gatekeeper?
False
Medicare is only for the elderly.
Maintain people in the least restrictive environment as possible
Home health's basic philosophy is
Terminal illnesses
Hospice services are primarily for people with:
A primary care physician.
In the gatekeeping method, who makes referrals to specialists?
Prospective
Pre-certification(pre-authorization) is associated with which type of utilization review?
Restricts use of specialty services
An HMO is a type of insurance that
False
Anyone who claims to be an Indian can receive health care services from the IHS.
Is an insurance program for children, Is an insurance program covered under Title 21 of the Social Security act, and Is an acronym for Children's Health Insurance Program
CHIP
A fixed monthly payment per enrollee
Capitation is
Populations which are medically underserved
Community health centers serve primarily:
Copayments, Premiums and Deductibles
Cost sharing means that insured individuals will pay a portion of their health care costs. Forms of cost-sharing are
Higher satisfaction with health services among their populations
Countries whose health systems are oriented more toward primary care achieve:
Services covered by an insurance plan that are deemed medically necessary and Services covered by an insurance plan that are considered medically necessary such as hospitalization, prescriptions, maternity care and delivery of a baby
Covered services are
True
Delivery of health care with a central focus on specialization cannot maximize health.
Secondary and Tertiary
Emergency departments, in most cases, are equipped to provide:
False
Higher primary care physician supply has been associated with lower low-birth weight percentages but higher infant mortality
Point-of-service plans
It is a plan that is a hybrid between an HMO and a PPO.
Telephone triage
It is a type of outpatient service where expert opinion and advice are typically provided to a patient when a physician's office is closed
False
Long-term care services for the elderly are covered under Medicare.
Case management
MCOs use various methods to control costs. One of those methods is ___________ which is mainly recommended for patients who need secondary and tertiary care more often than primary care.
Disease Management
MCOs use various methods to control costs. One of those methods is ______________ which is focused on providing care to high-risk people with chronic illnesses which tend to be illnesses that more complicated and require more intense follow-up. This method is used to ensure that people are complying with their detailed and difficult medical regiment.
Choice restriction
MCOs use various methods to control costs. One of those methods is ______________ which means if the patient receives services from providers who are outside of the plan, they will not be covered
Practice Profiling
MCOs use various methods to control costs. One of those methods is _________________ which refers to profiling how a provider practices. It is primarily used to decide if providers have the "right fit" with the plan's managed care philosophy and goals.
True
Managed care is a way of providing health care services by a single organization that manages financing, insurance, delivery, capitation and discounted fees.
Is a means-tested program, is jointly financed by the federal and state governments, and is primarily run by the state government
Medicaid
True
Medicare and Medicaid are both financed by the government but most health care services are obtained in the private sector.
False
Medicare beneficiaries must pay a premium for Part A.
People who are eligible for Medicare have worked for at least 10 years and People who are eligible for Medicare have contributed to Medicare through the payment of taxes
Medicare is considered an entitlement program. Why is Medicare considered an entitlement program?
Women seek care more often than men
One reason women's health centers were created is:
This utilization review determines the appropriateness of care DURING the course of treatments.
Pick the statement that is true concerning Concurrent review
