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Podcast
Podcast
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Questions and Answers
Questions and Answers
What is the main purpose of managed care?
What is the main purpose of managed care?
- To increase healthcare costs
- To control healthcare costs and improve the quality of care (correct)
- To ensure that patients receive unnecessary care
- To decrease the quality of care
Which of the following is NOT a key feature of managed care?
Which of the following is NOT a key feature of managed care?
- Reimbursement to providers at full fees (correct)
- Physician gatekeeping
- Limited provider networks
- Utilization review
What are the three types of managed care plans?
What are the three types of managed care plans?
- PPO, POS, and EPO
- HMO, PPO, and EPO
- HMO, POS, and EPO
- HMO, PPO, and POS (correct)
Who is eligible for Medicare?
Who is eligible for Medicare?
What is Medicaid?
What is Medicaid?
What is negligence?
What is negligence?
What is malpractice insurance?
What is malpractice insurance?
What is the main goal of the Affordable Care Act (ACA)?
What is the main goal of the Affordable Care Act (ACA)?
Questions and Answers
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Flashcards
Flashcards
Managed Care
Managed Care
A system to manage costs, improve quality, and ensure appropriate care.
Medicare
Medicare
A social insurance program for those 65+, dialysis patients, and certain disabled individuals.
Medicaid
Medicaid
Health insurance for low-income individuals.
Negligence
Negligence
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Malpractice Insurance
Malpractice Insurance
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Affordable Care Act (ACA)
Affordable Care Act (ACA)
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ACA Dependent Coverage
ACA Dependent Coverage
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ACA Aims
ACA Aims
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Flashcards
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Study Notes
Study Notes
- Managed care is a healthcare delivery system designed to control healthcare costs, improve the quality of care, and ensure that patients receive the appropriate care for their needs.
- Key features of managed care include limited provider networks, utilization review, physician gatekeeping, regulating hospital stays, and reimbursement to providers at discounted negotiated fees.
- There are three types of managed care plans: HMO, PPO, and POS.
- Medicare is a social insurance program for individuals aged 65 and older, those requiring kidney dialysis, and certain disabled individuals.
- Medicare is divided into four parts, each covering specific healthcare services: Part A, Part B, Part C, and Part D.
- Medicaid is a government-funded health insurance program designed to provide subsidized health insurance for low-income individuals.
- Negligence occurs when an injury to the plaintiff was preventable, and it was reasonable to undertake the activity that would have prevented the injury.
- Malpractice insurance provides coverage for healthcare providers for liability arising from malpractice lawsuits.
- The Affordable Care Act (ACA) has several key components designed to expand healthcare access and control costs, including Medicaid expansion, health insurance exchanges, and premium credits.
- The ACA also introduced quasi community rating, premium credits, employer plans, and the individual mandate.- ACA introduced regulations for individual health insurance market, Medicare changes
- Funding sources include penalties, increased FICA tax, industry fees
- Children can stay on parents' plan until 26
- Trump changes: individual mandate penalty = $0, alternative health insurance options
- Biden changes: investment in marketing and outreach, American Rescue Plan Act funding for increased premium credits, incentives for Medicaid expansion, and federal government pays 95% for newly eligible for states that expand Medicaid
- ACA aimed for universal coverage and controlling healthcare expenditures.
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