Health Insurance Challenges for Employed and Unemployed Individuals
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Questions and Answers

Which factor contributes the most to premature death according to the text?

  • Medical Care
  • Genetic
  • Social and Environmental Factors
  • Lifestyle And Behaviors (correct)

    • What was the main change in where healthcare services were provided from the 1950s to the 2000s?

  • Movement towards outpatient centers
  • Movement towards doctors offices
  • Movement towards patient's homes
  • Movement towards hospitals (correct)

    • Which mode of paying for healthcare is the most prevalent according to the text?

  • Individual Private Insurance
  • Government Financing and Subsidies
  • Out of Pocket
  • Employment-Based Private Insurance (correct)

    • What was the initial purpose of Employment-Based Private Insurance?

    <p>To incentivize workers during WWII wage controls</p> Signup and view all the answers

    Which type of insurance is very expensive since there is no group discount?

    <p>Individual Private Insurance</p> Signup and view all the answers

    What problem did an increase in out of pocket payments aim to control?

    <p>Premium costs</p> Signup and view all the answers

    Which group is more likely to be employed but uninsured?

    <p>People of Color (POCs)</p> Signup and view all the answers

    What is one of the reasons why some employed individuals are uninsured?

    <p>They work for small firms</p> Signup and view all the answers

    Which group is more likely to be unemployed but uninsured?

    <p>People with expensive health insurance</p> Signup and view all the answers

    Why is financing for healthcare considered regressive?

    <p>It takes a falling percentage of income as income increases</p> Signup and view all the answers

    What is one of the forms of financing for healthcare mentioned in the text?

    <p>IBRA</p> Signup and view all the answers

    Why are unemployed individuals with low income ineligible for Medicaid?

    <p>They have too much income</p> Signup and view all the answers

    Which type of insurance rating sets insurance rates based on a group's actual healthcare expenses in a prior period?

    <p>Experience Rating</p> Signup and view all the answers

    Which part of Medicare covers hospital insurance?

    <p>Medicare Part A</p> Signup and view all the answers

    Which program provides healthcare coverage for children from families at or below 200-300% of the Federal Poverty Level?

    <p>SCHIP</p> Signup and view all the answers

    What are the financial barriers to insurance?

    <p>Underinsurance</p> Signup and view all the answers

    What are the non-financial barriers to insurance?

    <p>Primary Care Physician Shortage</p> Signup and view all the answers

    What is one reason why the healthcare market is not a normal market?

    <p>Information Asymmetry</p> Signup and view all the answers

    What is the most popular type of health insurance coverage in the 1900s?

    <p>Indemnity</p> Signup and view all the answers

    Which type of health insurance coverage has the most freedom for patients to self-direct care?

    <p>PPO</p> Signup and view all the answers

    Which type of health insurance coverage requires a PCP responsible for healthcare and making referrals to specialists?

    <p>HMO</p> Signup and view all the answers

    Which type of health insurance coverage combines fee-for-service and pre-paid insurance?

    <p>POS</p> Signup and view all the answers

    Which type of health insurance coverage is relatively inexpensive and emphasizes preventative care?

    <p>HMO</p> Signup and view all the answers

    What does COBRA stand for and what is one of its limitations?

    <p>Consolidated Omnibus Budget Reconciliation Act of 1985, premiums may be unaffordable with little to no income</p> Signup and view all the answers

    Which payment model involves an established rate to cover a person's medical care for a specified time?

    <p>Capitation</p> Signup and view all the answers

    What is the purpose of the Medicare Resource Based Relative Value Scale?

    <p>To estimate the time and effort required for each service</p> Signup and view all the answers

    Which payment model involves a fee determined by the doctor and paid by the insurance provider?

    <p>Fee for Service</p> Signup and view all the answers

    What is one advantage of capitation as a payment model?

    <p>Better ability to plan and control costs</p> Signup and view all the answers

    What was a focus of cost containment in the 1910s?

    <p>Limiting the number and costs of services</p> Signup and view all the answers

    What is the current focus of cost containment?

    <p>Negotiating blended payments</p> Signup and view all the answers

    Which factor contributes the least to premature death according to the text?

    <p>Medical Care</p> Signup and view all the answers

    Which mode of paying for health care is the least prevalent according to the text?

    <p>Individual Private Insurance</p> Signup and view all the answers

    Which mode of paying for health care has the most unpredictability according to the text?

    <p>Out of Pocket</p> Signup and view all the answers

    Which mode of paying for health care was initially introduced as a way to incentivize workers during WWII wage controls?

    <p>Employment-Based Private Insurance</p> Signup and view all the answers

    Which type of insurance rating sets insurance rates based on a group's average healthcare expenses in a prior period?

    <p>Experience Rating</p> Signup and view all the answers

    Which type of health insurance coverage is relatively inexpensive and emphasizes preventative care?

    <p>Health Maintenance Organization (HMO)</p> Signup and view all the answers

    Which group is more likely to be uninsured due to working part-time or having multiple part-time jobs?

    <p>People of Color (POCs)</p> Signup and view all the answers

    What is one reason why unemployed individuals with low income are ineligible for Medicaid?

    <p>They have too many assets</p> Signup and view all the answers

    Which form of financing for healthcare takes a falling percentage of income as income increases?

    <p>Regressive financing</p> Signup and view all the answers

    Which type of health insurance coverage is relatively inexpensive and emphasizes preventative care?

    <p>Medicaid</p> Signup and view all the answers

    What is one of the limitations of COBRA?

    <p>It is not affordable for low-income individuals</p> Signup and view all the answers

    Why is financing for healthcare considered regressive?

    <p>It takes a falling percentage of income as income increases</p> Signup and view all the answers

    What is the purpose of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)?

    <p>To provide insurance at group rates for people who lose insurance due to certain circumstances</p> Signup and view all the answers

    Which model of health care assumes the existence of illness or disease and emphasizes clinical diagnosis and medical interventions?

    <p>Medical Model</p> Signup and view all the answers

    What is the main limitation of Health Maintenance Organizations (HMOs)?

    <p>Limited choice of physicians</p> Signup and view all the answers

    What is the main advantage of Preferred Provider Organizations (PPOs)?

    <p>Wide choice of providers and hospitals</p> Signup and view all the answers

    What is the main feature of Point of Service (POS) plans?

    <p>Combining fee-for-service and pre-paid insurance</p> Signup and view all the answers

    What is the main benefit of having access to health insurance for employees in large firms?

    <p>Access to insurance at group rates</p> Signup and view all the answers

    What is one of the risks that providers face in a fee-for-service reimbursement system?

    <p>The risk of setting payment unilaterally</p> Signup and view all the answers

    What is the main difference between fee-for-service and capitation payment models?

    <p>Fee-for-service allows providers to set their own prices, while capitation provides a fixed rate per patient</p> Signup and view all the answers

    What is the purpose of the Medicare Resource Based Relative Value Scale (RBRVS)?

    <p>To correct for bias in physician payments</p> Signup and view all the answers

    What is one advantage of capitation as a payment model?

    <p>Better ability to plan, manage, and control costs</p> Signup and view all the answers

    What was the focus of cost containment in the 1910s?

    <p>Limiting the number and costs of services</p> Signup and view all the answers

    What is the current focus of cost containment?

    <p>Blended payments</p> Signup and view all the answers

    Which type of health insurance coverage provides coverage for hospital care and allows the choice of hospitals?

    <p>Blue Cross</p> Signup and view all the answers

    Which type of health insurance coverage provides coverage for physician and other outpatient services?

    <p>Blue Shield</p> Signup and view all the answers

    Which part of Medicare provides hospital insurance?

    <p>Medicare Part A</p> Signup and view all the answers

    Which part of Medicare provides coverage for physician and outpatient services?

    <p>Medicare Part B</p> Signup and view all the answers

    Which program provides healthcare coverage for low-income individuals and is financed by state and federal taxes?

    <p>Medicaid</p> Signup and view all the answers

    What is one of the financial barriers to insurance?

    <p>Underinsurance</p> Signup and view all the answers

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