Term
| What are the five main topics of Healthcare and consumerism? |
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Definition
Consumer perceptions of health care
How consumers gain access to quality healthcare services
how health care services are paid for and who is paying for them
Instruments for shift towards healthcare consumerism in healthcare
Recent passage of health insurance reform |
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Term
| What percent of Americans are confused about how the health care system works? |
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Definition
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Term
| What is most important factor to consumers selecting a hospital? |
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Definition
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Term
| What fraction of people would consider switching from physician rec med to cheaper if one was available? |
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Definition
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Term
| What are the five major conclusions of healthcare and consumerism? |
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Definition
Health care is a consumer market
Cost changes care-seeking behaviors
Consumers want holistic care and resources to pursue wellness and healthy living
Consumers embrace innovations that enhance self-care, convenience, and personalization
Represented in Kissick’s cost containment, access, & quality triangle |
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Term
| How many Americans were uninsured in 2009? |
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Definition
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Term
| What groups are more likely to be uninsured? |
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Definition
| the young, less educated, poor, non-caucasian and non US citizens as well as men |
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Term
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Definition
| amt of money that beneficiary must pay before the insurance company begins to pay for covered services |
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Term
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Definition
| written agreement bet company (or gov) and ppl to pay for certain health care costs during a certain period in return for regular payments called premiums |
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Term
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Definition
| portion of an insurance company’s approved amounts for covered services that the beneficiary is responsible for paying |
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Term
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Definition
| type of co-insurance, a negotiated set fee |
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Term
| ID: found mostly in managed care plans; set price on per-member, per-month basis |
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Definition
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Term
| ID: max amt an insurer will pay for a certain service |
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Definition
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Term
| ID: condition present 6 months before the policy began |
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Definition
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Term
| What are the two most important factors that effect the cost of health insurance? |
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Definition
| risk of the group and amount of coverage provided |
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Term
| ID: provider panels, limited choice, gatekeeping, risk sharing, quality management, and utilization review |
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Definition
| managed care organizations (MCOs) |
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Term
| ID: closest to fee-for-service; contractual agreement bet provider and org to give service to members for discount rate |
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Definition
| Preferred provider organizations (PPOs) |
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Term
| ID: oldest form; combo of insurance and med care; uses primary care physicians and prepaid health care arrangement |
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Definition
| Health Maintenance Org (HMOs) |
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Term
| What are the advantages of managed care? |
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Definition
Comprehensive benefits
Evidence-based high quality care
Well-documented services provided through integrated delivery systems
Accountability for quality improvement |
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Term
| What are three concerns of managed care? |
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Definition
Reducing inpatient stays
Delays in receiving care
Cannot understand bills |
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Term
| Describe consumer-directed care |
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Definition
ives individuals better access to info and more control over their own health care
ncrease consumer involvement and raise awareness about the real cost of health care
Could be more affordable for employers to offer coverage and for ppl to purchase it
Consumer-directed products encourage healthy behavior |
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Term
| What are three Key Building Blocks of Healthcare Consumerism? |
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Definition
Disease management and case management programs
Information and decision support programs
Incentive and compliance reward programs
HRAs and HSAs |
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Term
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Definition
Health Reimbursement Accounts
Members receive annual employer defined allocation of HRA funds they can use for med services
Unused funds rolled over to future years for allowing accumulation over time |
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Term
| Define/describe Health Savings Accounts |
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Definition
| Similar to 401k plans; Triple tax advantaged plan req to be paired with high deductible policies; bring down monthly premiums; pay more out of pocket and some may skip needed care |
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Term
| What two types of insurance plans are usually paired? |
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Definition
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Term
| Describe the Health Care/Insurance Reform for 2010 |
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Definition
Subsidies begin for small businesses to provide coverage to employees
Insurance companies barred from denying coverage to children with pre-existing illness
Children can stay on parents’ plan till age 26 |
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Term
| Describe the Health Care/Insurance Reform for 2013 |
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Definition
NEw medicare taxes on ppl earning more than 200k/year and couples filing jointly earning more than 250K a year
Tax on wages rises 2.35% from 1.45%
New 3.8% tax on unearned income such as dividends and interest |
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Term
| Describe the Health Care/Insurance Reform for 2014 |
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Definition
| Create exchanges where people without employer coverage can shot for health coverage; Subsidies begin for lower and middle income families; Medicaid expands to all americans with income up to 133% of fed pov level |
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Term
| Describe the Health Care/Insurance Reform for 2016 |
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Definition
| Penalty for those who don’t have coverage rises to 2.5% of taxable income or $695 |
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Term
| Describe the Health Care/Insurance Reform for 2018 |
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Definition
| xcise tax of 40% imposed on health plans valued more than $10,200 for individuals and $27.500 for family coverage |
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