Chapter 3: Financing and Organizing

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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?

30% Signup and view all the answers

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

To share the financial risk of illness Signup and view all the answers

How is Medicaid funded?

By federal and state revenues with no beneficiary premiums Signup and view all the answers

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

They lack the financial means Signup and view all the answers

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

Economic status of the state and size of vulnerable populations Signup and view all the answers

What is underinsurance in the context of health coverage?

Insurance that requires high cost sharing Signup and view all the answers

Which statement about the administration of Medicaid programs is true?

Allows for substantial flexibility in coverage and implementation at the state level Signup and view all the answers

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

They require patients to cover high healthcare costs out of pocket Signup and view all the answers

What role do healthy individuals play in maintaining risk pools?

They contribute towards covering the costs of those who are sick Signup and view all the answers

How does underinsurance affect access to healthcare services?

It can act as a significant financial barrier to care Signup and view all the answers

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

They are more susceptible to financial hardship Signup and view all the answers

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

Having plans with high cost-sharing requirements can lead to this outcome Signup and view all the answers

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

State Medicaid policies and the competitiveness of the local health-care market 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?

Core safety net providers Signup and view all the answers

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

Providers of last resort Signup and view all the answers

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

Uncompensated care Signup and view all the answers

What is the primary mission of core safety net providers?

Serving vulnerable populations in their communities Signup and view all the answers

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

The number of Starbucks in the community Signup and view all the answers

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

'Providers of last resort' serve patients regardless of ability to pay. Signup and view all the answers

Why are core safety net providers essential for vulnerable populations?

As they serve uninsured, Medicaid beneficiaries, and other vulnerable populations Signup and view all the answers

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

Risk pooling Signup and view all the answers

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

The Accountable Care Act Signup and view all the answers

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

Dwindling revenue sources Signup and view all the answers

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

CHIP Signup and view all the answers

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

Excluding patients based on pre-existing conditions Signup and view all the answers

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

Medicaid Signup and view all the answers

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

Based on their hands-on experience in healthcare Signup and view all the answers

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

To protect individuals from unpredictable severe illnesses Signup and view all the answers

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

10% Signup and view all the answers

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

Emergency Medical Treatment and Active Labor Act (EMTALA) Signup and view all the answers

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

Requirements under EMTALA in combination with inadequate access to primary care Signup and view all the answers

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

15% 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?

ACA mandates that insurers cannot increase rates due to preexisting conditions Signup and view all the answers

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

Flu shots and cancer screening tests Signup and view all the answers

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

Proteinuria and renal insufficiency Signup and view all the answers

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

Purchased a new insurance plan on the health insurance exchange and received a tax credit Signup and view all the answers