Health Insurance Concepts Quiz
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Questions and Answers

What is a potential consequence of risk rating in insurance?

  • Reduction in the number of available benefit packages
  • Higher premiums based on expected medical benefits (correct)
  • Increased coverage for all individuals
  • Equal premiums for all risk categories
  • What is the primary purpose of community-rated premiums?

  • To consider the overall risk characteristics of the entire plan membership (correct)
  • To charge individuals based on their health history
  • To incentivize high usage of medical services
  • To offer personalized insurance packages
  • What is a potential effect of adverse selection in the insurance market?

  • Enhanced competition among providers
  • Improvement in patient outcomes
  • Increased availability of insurance plans
  • Price spirals leading to higher premiums (correct)
  • Which of the following is a strategy insurers may use to address moral hazard?

    <p>Charging deductibles and copays (D)</p> Signup and view all the answers

    How can declining block pricing affect out-of-pocket spending?

    <p>By allowing high spending to be capped at a stop loss threshold (D)</p> Signup and view all the answers

    What is one of the policy goals for voluntary health insurance (VHI)?

    <p>To reduce fiscal pressure on public budgets (C)</p> Signup and view all the answers

    What is the purpose of implementing risk equalization schemes in insurance?

    <p>To prevent adverse selection and ensure equitable access to insurance (D)</p> Signup and view all the answers

    What challenge might low users face as they age in relation to health insurance?

    <p>Higher likelihood of developing chronic conditions necessitating more extensive coverage (B)</p> Signup and view all the answers

    What is one major concern regarding voluntary health insurance (VHI)?

    <p>It may exacerbate fiscal pressure. (D)</p> Signup and view all the answers

    Which principle is essential for the effective integration of public and private resources in health policy?

    <p>Clarity about goals. (A)</p> Signup and view all the answers

    How can VHI affect public spending?

    <p>It may undermine equity and value in public spending. (A)</p> Signup and view all the answers

    Which of the following countries operates under a competitive public insurance model?

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

    What is a common characteristic of the social insurance unreformed system?

    <p>It is occupationally based with no choice of insurance fund. (C)</p> Signup and view all the answers

    What is a key characteristic of a centralised single payer health system?

    <p>It involves national taxes that allocate resources centrally. (A)</p> Signup and view all the answers

    Which of the following best describes a competitive private social insurance system?

    <p>Premiums and payment methods defined by government. (C)</p> Signup and view all the answers

    What does careful policy design and capacity for regulation aim to achieve in health systems?

    <p>Minimize risks associated with health insurance. (A)</p> Signup and view all the answers

    What is the primary characteristic of voluntary health insurance (VHI)?

    <p>It can be purchased at the discretion of individuals or employers. (A)</p> Signup and view all the answers

    Which type of funding source potentially decreases equity in health care distribution?

    <p>Private revenues through voluntary health insurance. (B)</p> Signup and view all the answers

    What can lead to a 'death spiral' in voluntary health insurance markets?

    <p>Healthier enrollees opting out due to rising premiums. (D)</p> Signup and view all the answers

    What is a common effect of adverse selection in health insurance?

    <p>Increased average cost per enrollee. (B)</p> Signup and view all the answers

    Which type of insurance is primarily used to cover 'good' risks like employed individuals?

    <p>Private insurance (A)</p> Signup and view all the answers

    What strategy is used to reduce adverse selection in voluntary insurance markets?

    <p>Risk-rated premiums based on individual characteristics. (D)</p> Signup and view all the answers

    What effect does opting out of a public insurance system potentially have?

    <p>Segmentation of public risk pools (D)</p> Signup and view all the answers

    Which factor is NOT typically used to assign individuals to different risk categories?

    <p>Geographical location (B)</p> Signup and view all the answers

    What distinguishes voluntary health insurance from statutory or public health insurance?

    <p>VHI is optional for individuals and employers. (C)</p> Signup and view all the answers

    Which of the following questions relate to evaluating a funding system's impact on equity?

    <p>Is the funding system progressive and horizontally equitable? (A)</p> Signup and view all the answers

    How does public financing of health care primarily detach payment from health status?

    <p>By pooling funds regardless of individual health risks. (D)</p> Signup and view all the answers

    In the context of healthcare funding systems, what does allocative efficiency refer to?

    <p>Optimizing resource distribution for health services (B)</p> Signup and view all the answers

    Which of the following is NOT a key policy question related to raising revenue for healthcare?

    <p>How does the financing affect the environmental situation? (D)</p> Signup and view all the answers

    What is a significant risk associated with high user charges in complementary VHI?

    <p>Inadequate financial protection (C)</p> Signup and view all the answers

    Which factor is necessary for the successful development of complementary VHI covering excluded services?

    <p>Technical, financial, and political resources (B)</p> Signup and view all the answers

    What is a notable concern regarding regressive VHI premiums in France?

    <p>They create income-related inequality in VHI access (B)</p> Signup and view all the answers

    Which demographic was highlighted as lacking VHI in France, primarily due to financial barriers?

    <p>4 million individuals without VHI (C)</p> Signup and view all the answers

    How does supplementary VHI create healthcare access disparities?

    <p>By providing faster access to a select few (C)</p> Signup and view all the answers

    What might high transaction costs in VHI lead to?

    <p>Undermined value-based user charges policy (D)</p> Signup and view all the answers

    What does the term 'dual practice' refer to in the context of supplementary VHI?

    <p>Private and public healthcare providers serving simultaneously (D)</p> Signup and view all the answers

    Which of these factors contributes to the rare occurrence of large VHI markets?

    <p>Regulatory pressures over time (C)</p> Signup and view all the answers

    What was the approximate increase in the number of private supplementary insurance holders from 1997 to 2018?

    <p>15 million (B)</p> Signup and view all the answers

    What was the main condition for those over 55 wishing to return to GKV in Germany?

    <p>They cannot return to GKV at all (C)</p> Signup and view all the answers

    Which demographic had the highest prevalence of GP contact between public plan and VHI holders?

    <p>People aged 65+ (B)</p> Signup and view all the answers

    What percentage of the total spending is administrative spending for SHI in Chile?

    <p>1.2% (D)</p> Signup and view all the answers

    In terms of waiting times for a gastroscopy, how do public plans compare to VHI?

    <p>Public plans have longer waiting times (A)</p> Signup and view all the answers

    What impact did the 10% surcharge on new premiums have on VHI for those over 55?

    <p>Funded ageing reserves (D)</p> Signup and view all the answers

    In substitute VHI in Chile, how are premiums calculated?

    <p>Risk-rated premiums (D)</p> Signup and view all the answers

    What is the public plan's population coverage percentage in Chile?

    <p>79% (D)</p> Signup and view all the answers

    Which of the following conditions reflects a statistically significant difference between public plan and VHI users?

    <p>Chronic disease prevalence (D)</p> Signup and view all the answers

    What percentage of VHI holders reported difficulties paying for outpatient prescriptions?

    <p>9% (C)</p> Signup and view all the answers

    Flashcards

    Voluntary Health Insurance (VHI)

    Health insurance that individuals or employers choose to purchase and pay for, including the state as an employer. It can be provided by public, quasi-public, for-profit, or non-profit organizations, even if private insurers offer statutory coverage.

    Adverse Selection

    The tendency for individuals with higher health risks to be more likely to purchase insurance, leading to higher costs and potential market instability.

    Community-Rated Health Plan

    A type of health insurance plan where all members pay the same premium, regardless of their individual health risk.

    Death Spiral

    A situation where, due to adverse selection, premiums in voluntary health insurance markets rise so high that only individuals with the highest health risks remain, leading to a potential collapse of the market.

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    Risk-Rated Premiums

    Individuals are placed in different risk groups based on characteristics such as age, gender, occupation, family history, and prior illnesses.

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    User Charges

    A cost associated with using healthcare services, directly paid by the patient.

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    Social Health Insurance (SHI)

    A financing mechanism where individuals contribute to a pool of funds to cover healthcare costs, with reimbursements determined by the system's rules.

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    Financial Protection

    The allocation of financial burden for healthcare, considering fairness and equity in how costs are distributed.

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    Community-rated premiums

    Premiums are set based on the average expected medical costs of the entire group of insured people, not on individual health history.

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    Moral hazard

    When individuals consume more healthcare services due to having insurance, often leading to higher costs.

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    Deductible

    A fixed amount that the insured person must pay before the insurance company starts covering costs.

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    Co-pay

    A fixed amount you pay for each medical service (like a doctor's visit) after the deductible is met.

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    Co-insurance

    A percentage of the cost of medical services that you are responsible for paying after the deductible is met.

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    Stop-loss

    The maximum amount of out-of-pocket costs an insured person has to pay in a year.

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    Declining block pricing

    A type of insurance pricing where the premium decreases as the amount of coverage increases.

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    Private Supplementary Insurance

    Private supplementary insurance is when individuals choose to purchase additional health insurance on top of their social health insurance (SHI) coverage. It adds extra benefits and often reduces waiting times for healthcare services.

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    Social Security Contribution Limit (SSCL)

    In Germany's social health insurance (SHI) system, the amount individuals contribute is capped, even if their income exceeds a certain limit. This means they don't pay more once they reach a certain level of earnings.

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    SHI to PHI Shift

    This refers to the shift in Germany where people are switching from social health insurance (SHI) to private health insurance (PHI).

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    Prevalence in VHI

    The prevalence refers to the proportion of people who experience certain health conditions or use particular health services. These statistics show that those with private health insurance (VHI) in Germany tend to be younger, healthier, and have less difficulty accessing care.

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    State Intervention in Germany

    Germany has regulations in place for people over 55 who decide to switch to private health insurance. These regulations aim to ensure fairness and stability within the system.

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    Substitutive VHI in Chile

    In Chile, the public health insurance system covers a large portion of the population while the private insurance system covers a smaller percentage. The private system offers more varied plans but at a higher cost.

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    Open Enrollment

    This is a feature of some health insurance plans that allows people to join or exit the plan at specific times, often without restrictions.

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    Spending per Capita

    Spending per capita refers to the average amount of money that is spent on healthcare for each person in a population. It gives an idea of how much is invested in healthcare in different countries.

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    VHI's limitations

    Voluntary Health Insurance (VHI) might not address major health problems and may create new challenges for the healthcare system.

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    VHI's impact on finances

    Voluntary Health Insurance (VHI) can increase fiscal pressure, potentially leading to higher government spending, especially if it replaces existing public insurance.

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    VHI's equity implications

    VHI can harm equity in healthcare by favoring those who can afford private insurance, potentially widening disparities in access and quality.

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    VHI challenges in larger markets

    Larger markets for Voluntary Health Insurance (VHI) can lead to more significant challenges, like increased complexity and potential market failures.

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    Clarity in VHI policy

    When designing healthcare policy, it's important to clearly define goals and understand how VHI complements public healthcare.

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    Careful VHI design

    VHI should be carefully designed to anticipate and minimize risks, such as adverse selection and moral hazard.

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    Regulation of VHI

    VHI requires strong regulation and oversight to ensure it functions properly and doesn't undermine public health goals.

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    Single-payer system

    A single-payer system involves a single public entity covering healthcare costs for all citizens, typically funded through taxes.

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    Complementary VHI

    When VHI covers services that are not already covered by a universal healthcare system, it can lead to inequities in access and financial protection. It also raises the issue of potential market instability.

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    Supplementary VHI

    A situation where individuals choose to purchase VHI because they believe it will give them faster access to healthcare and more choices regarding their treatment.

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    User Charges in Healthcare

    User charges are direct payments made by patients for healthcare services. They are often used to supplement government funding of healthcare systems, but can be controversial as they can lead to financial barriers and inequities in access.

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    Cost-Related Non-Adherence

    When access to healthcare services is dependent on the ability to pay, this can result in individuals forgoing essential care due to financial constraints.

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    Risk-Rated Premiums in VHI

    The practice of insurers setting premiums based on an individual's health risks, resulting in higher costs for individuals with pre-existing conditions or a higher likelihood of future health issues.

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    Death Spiral in VHI

    The potential for VHI markets to collapse when only individuals with high health risks remain, leading to rising premiums and ultimately making insurance unaffordable for most.

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    VHI Policy Concerns in France

    In France, the growing policy concerns with VHI are driven by factors such as persistent barriers to access, declining quality of coverage, regressive premiums, and increased transaction costs.

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    Mixed Healthcare System

    A healthcare financing system combining public and private insurance, where the public system covers high-risk individuals (e.g., elderly, disabled) and private insurance covers lower-risk individuals (e.g., employed people).

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    Opt-Out from Public Insurance

    The option for individuals to opt out of a public health insurance system and choose private insurance instead, leading to potential risk segmentation and weakening of the public system.

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    Vertical Equity

    A policy question that considers how fairly a health financing system distributes the burden of healthcare costs across different income levels.

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    Study Notes

    Financing Health Care Lecture 3

    • Health care financing sources include public (taxation, social health insurance) and private (voluntary insurance, medical savings accounts, user charges, informal payments).
    • Policy choices regarding funding mix significantly impact financial protection and equity.
    • Public funding detaches payment from health status.
    • The higher the private revenue share, the lower the equity in financial burden distribution.
    • All health financing systems use multiple sources.

    Voluntary Health Insurance (VHI)

    • VHI is taken up and paid for by individuals or employers at their discretion.
    • It can be offered by public, quasi-public, for-profit, or non-profit organisations.
    • Voluntary versus statutory is a more useful distinction than public versus private.

    Adverse Selection

    • Adverse selection occurs in community-rated, self-pay health plans, where healthier individuals are less likely to join, causing average costs to increase.
    • This can lead to a "death spiral", where premiums increase so much that healthier individuals drop out, further increasing costs, and potentially crippling the market.
    • Risk-rated premiums mitigate adverse selection by assigning individuals to risk categories based on factors like age, gender, occupation, family history, and prior illnesses, making premiums more closely aligned with expected medical benefits. This encourages healthier lifestyles and helps to keep the insurance market stable.

    Risk-Rated Premiums

    • Risk-rated premiums assign individuals to different risk categories based on personal characteristics.
    • This system is designed to align premiums more closely with expected health care costs, thereby mitigating adverse selection and potential market failure.
    • Premiums are based on benefit design and coverage, relating risk category to expected costs.
    • This system encourages healthier behaviors but can lead to financial access problems for high-risk populations.

    Community-Rated Premiums

    • Community-rated premiums are based on entire plan membership risk characteristics and their expected medical costs.
    • This approach does not consider individual health histories, which can lead to potential adverse or favorable risk selection and either price spirals or under-insurance.
    • It requires risk equalisation schemes and regulation for effective implementation.

    Insurer Responses to Adverse Selection and Moral Hazard

    • Insurers sometimes counter adverse selection by charging deductibles/copays, excluding individuals with pre-existing conditions, limiting providers, charging more for individual policies.
    • They apply strategies of market/risk segmentation, offering different plans with high or low benefits to separate "high" and "low" users.

    Insurance Declining Block Pricing

    • Insurance premiums and out-of-pocket costs (like copays and deductibles) often decrease with increasing spending.

    Policy Goals for VHI

    • Relieve fiscal pressure on public budgets.
    • Strengthen health system performance.
    • Address coverage gaps.
    • May need to consider other factors like financial protection and available services; population covered, and risk.

    VHI Roles

    • Substitutive: replace public health insurance.
    • Complementary: provide additional coverage for specific services.
    • Supplementary: handle cost-sharing arrangements.

    Is VHI the Right Policy Tool?

    • Does VHI address coverage gaps?

    • Does VHI provide access to those who need it?

    • Does this result in undermining public spending on health? (e.g. making those reliant on existing statutory coverage worse off)

    • Global VHI markets are relatively small.

    • Variation in VHI types and coverage.

    Inefficiency in VHI

    • Inefficient practices can arise in VHI systems, such as rising administrative costs or high premiums, leading to fewer benefits.

    • Administrative costs in VHI can be substantial.

    VHI and Out-of-Pocket Spending

    • Voluntary health insurance (VHI) has a generally weak correlation with out-of-pocket health spending worldwide

    Regulatory Goals, Approaches, Examples

    • Regulatory goals include market stability, consumer protection, access to care.
    • Approaches may involve financial requirements (solvency), material changes (open enrolment, standardized benefits, prohibiting pre-existing condition exclusions), and community ratings to address risk selection.

    Recap: Financing Health Care

    • Is the funding progressive and horizontally equitable?
    • Does it result in redistribution?
    • How does it impact health coverage, access, allocative efficiency, technical efficiency, cost containment, and the wider economy?

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    Description

    Test your knowledge on key concepts related to health insurance such as risk rating, community-rated premiums, and adverse selection. This quiz explores various strategies insurers use to manage risks and the implications for policyholders. Perfect for students or professionals looking to reinforce their understanding of health insurance fundamentals.

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