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Flashcards in Ch8 Deck (26)
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1

rationing

interest is renewed in rationing bc of increased healthcare spending; implies reduced access to care and decreases in acceptable quality of services offered

2

access to care barriers

insured not approving or covering for care
preexisting conditions
physicians refuse insurance plan
childcare needs hinder ability to go to dr to seek care

3

current trends

Given that economics in general and health care economics in particular are concerned with resource use and decision making, any discussion of the economics of health care must consider past and current health care spending.
Past spending reflects past decision making; likewise, past decisions reflect the values and beliefs held by society and policy makers that undergird policy making at any given point in time.

4

the science concerned with the use of resources (producing, distributing, and consuming resources)

economics

5

concerned with how scarce resources affect health industry

health economics

6

affects resource allocation in healthcare

uninsured

7

provide services to uninsured or under insured

safety net providers

8

who is most likely to be uninsured?

low paying or part-time jobs, small biz, children-medicaid, elderly-medicare, those working for big companies have employer-sponsored health insurance

9

primary determinant to health care

ability to pay for services

10

healthy people 2020 goals

strategies to provide better access for all people

11

teen mom- long term primary prevention measure to break cycle of poverty what do you do?

encourage education to break the cycle

12

What level of prevention are most healthcare dollars spent?

secondary and tertiary care (only 3% is spent on primary care)

13

work with legislators and insurance companies to provide coverage for health promotion to reduce the risk of disease

primary prevention

14

provides hospital insurance and medical insurance to persons aged 65 years and older, permanently disabled persons, and persons with end-stage renal disease

medicare

15

primarily financed by federal payroll tax that is paid by employers and employees. The proceeds for this tax go to the hospital insurance trust fund, which is managed by CMS. Available to ALL persons eligible to receive medicare

part a

16

requires a deductible from recipients for the first 60 days or services with a reduced deductible for 61-90 days of service, based on a rate equal to a 1 day stay at a hospital.

Medicare Part A

17

supplemental (voluntary) program available to all eligible to Medicare, but must pay a monthly premium. Majority of medicare covered persons elect for this coverage. Provides coverage for lab services, ambulation transport, prostheses, equipment, and some supplies

Medicare Part B

18

purpose was to shift const incentives away from providing more care toward more efficient services

prospective payment system that came about in 1983 as hospital and medicare costs rose

19

what is the basis for prospective reimbursement?

Diagnosis-Related Groups (DRGs)

20

provides financial assistance to states and counties to pay for medical services for poor older adults, the blind, the disabled, and families with dependent children

Medicaid

21

jointly sponsored and financed with matching funds from the federal and state govts

medicaid

22

the federal govt finances health services for military and dependent persons through

TRICARE

23

How poor must you be to qualify for Medicaid?

children under 6 and pregnant women under 133% of poverty level

24

major cause of rising health care costs

excessive and inefficient use of services in healthcare delivery

25

is a prescription drug plan that requires you to pay premiums and deductibles, though you're not required to carry it.

Medicare Part D

26

consolidation of A,B, D into __________which is available through a private insurer's Medicare Advantage plan.
Medicare pays the company you choose for part of your coverage each month, but you must also pay premiums.

Medicare Part C