Chapter 3: Financing and Organizing
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Questions and Answers

What is a characteristic of Medicare Part B?

  • Provides voluntary prescription drug benefit
  • Funded by federal and state revenues
  • Requires beneficiaries to pay a monthly premium (correct)
  • Covers inpatient services

Who are termed 'dual-eligibles'?

  • Individuals receiving only Medicaid coverage
  • Individuals enrolled in Medicare Advantage plans
  • Individuals who receive both Medicare and Medicaid coverage (correct)
  • Individuals eligible for Medicare Part D

Which Act introduced Medicare Part C, known as Medicare + Choice?

  • 1997 Balanced Budget Act (correct)
  • 2003 Prescription Drug Act
  • 2014 Medicare Modernization Act
  • 1965 Medicare Act

What percentage of Medicare beneficiaries were enrolled in a Medicare Advantage plan in 2014?

<p>30% (A)</p> Signup and view all the answers

What is the primary reason why individuals participate in risk pools?

<p>To share the financial risk of illness (C)</p> Signup and view all the answers

How is Medicaid funded?

<p>By federal and state revenues with no beneficiary premiums (D)</p> Signup and view all the answers

Why might low-income individuals find it challenging to participate in health insurance risk pools?

<p>They lack the financial means (C)</p> Signup and view all the answers

What determines the amount of federal matching funds a state receives for Medicaid?

<p>Economic status of the state and size of vulnerable populations (D)</p> Signup and view all the answers

What is underinsurance in the context of health coverage?

<p>Insurance that requires high cost sharing (B)</p> Signup and view all the answers

Which statement about the administration of Medicaid programs is true?

<p>Allows for substantial flexibility in coverage and implementation at the state level (B)</p> Signup and view all the answers

Why do high-deductible health plans fall under the category of underinsurance?

<p>They require patients to cover high healthcare costs out of pocket (C)</p> Signup and view all the answers

What role do healthy individuals play in maintaining risk pools?

<p>They contribute towards covering the costs of those who are sick (D)</p> Signup and view all the answers

How does underinsurance affect access to healthcare services?

<p>It can act as a significant financial barrier to care (A)</p> Signup and view all the answers

What is the consequence of not being part of a financing pool for individuals with high healthcare needs?

<p>They are more susceptible to financial hardship (D)</p> Signup and view all the answers

Why do some insured individuals face financial hardship despite having insurance?

<p>Having plans with high cost-sharing requirements can lead to this outcome (D)</p> Signup and view all the answers

What factors can influence the composition of providers in a healthcare safety net?

<p>State Medicaid policies and the competitiveness of the local health-care market (A)</p> Signup and view all the answers

What is the term used by the Institute of Medicine to refer to practitioners and healthcare organizations caring for uninsured and vulnerable populations?

<p>Core safety net providers (B)</p> Signup and view all the answers

Which term is synonymous with 'core safety net providers' as mentioned in the text?

<p>Providers of last resort (C)</p> Signup and view all the answers

What type of care do core safety net providers offer to vulnerable populations?

<p>Uncompensated care (B)</p> Signup and view all the answers

What is the primary mission of core safety net providers?

<p>Serving vulnerable populations in their communities (C)</p> Signup and view all the answers

Which factor does NOT influence the composition of providers in a healthcare safety net according to the text?

<p>The number of Starbucks in the community (D)</p> Signup and view all the answers

Why are core safety net providers also called 'providers of last resort'?

<p>'Providers of last resort' serve patients regardless of ability to pay. (A)</p> Signup and view all the answers

Why are core safety net providers essential for vulnerable populations?

<p>As they serve uninsured, Medicaid beneficiaries, and other vulnerable populations (C)</p> Signup and view all the answers

What is required to protect individuals from the unpredictability of severe illness?

<p>Risk pooling (A)</p> Signup and view all the answers

What program mandates that everyone must participate in some form of insurance or face a fine?

<p>The Accountable Care Act (D)</p> Signup and view all the answers

What is one reason many public hospitals are at risk of closure?

<p>Dwindling revenue sources (C)</p> Signup and view all the answers

Which program is specifically mentioned as a source of revenue in the text?

<p>CHIP (D)</p> Signup and view all the answers

What does the individual mandate under The Accountable Care Act prevent insurance companies from doing?

<p>Excluding patients based on pre-existing conditions (A)</p> Signup and view all the answers

Which revenue source differs based on eligibility criteria and sources of revenue?

<p>Medicaid (C)</p> Signup and view all the answers

Why are health professionals in a unique position to advocate for strategies to bolster the safety net?

<p>Based on their hands-on experience in healthcare (A)</p> Signup and view all the answers

What is the primary purpose of risk pooling in health system financing?

<p>To protect individuals from unpredictable severe illnesses (C)</p> Signup and view all the answers

What percentage of ambulatory care in the United States does ED visits account for?

<p>10% (D)</p> Signup and view all the answers

Which act guarantees screening and stabilizing treatment in the ED regardless of the patient’s ability to pay?

<p>Emergency Medical Treatment and Active Labor Act (EMTALA) (B)</p> Signup and view all the answers

What contributes to higher use of the ED as the site of care by vulnerable patients?

<p>Requirements under EMTALA in combination with inadequate access to primary care (B)</p> Signup and view all the answers

In 2012, what was the percentage of individuals with at least one ED visit among uninsured children?

<p>15% (A)</p> Signup and view all the answers

Why did Mr. Walsh's diabetes and hypertension not increase the cost of the premium for his new insurance plan?

<p>ACA mandates that insurers cannot increase rates due to preexisting conditions (C)</p> Signup and view all the answers

What preventive care benefits did Mr. Walsh and his family take advantage of in their new insurance policy?

<p>Flu shots and cancer screening tests (A)</p> Signup and view all the answers

What did Mr. Walsh's primary care physician identify him having?

<p><strong>Proteinuria</strong> and <strong>renal insufficiency</strong> (D)</p> Signup and view all the answers

After losing health insurance sponsored by his employer, what did Mr. Walsh do?

<p><strong>Purchased a new insurance plan on the health insurance exchange and received a tax credit</strong> (C)</p> Signup and view all the answers

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