39 Questions
What is a potential disadvantage of a hospital receiving a set annual budget from a regional health authority?
Reduced service quality due to budget inadequacy.
Which payment model aligns hospital payments with patient outcomes and satisfaction?
Value-Based Purchasing (VBP).
What challenge may hospitals face under the Value-Based Purchasing (VBP) payment model?
Meeting performance benchmarks for high-risk populations.
Under the Pay-for-Performance (P4P) model, what do physicians and hospitals receive financial incentives for?
Demonstrating low rates of hospital-acquired infections.
How does a hospital's reimbursement rates change under Value-Based Purchasing (VBP) based on its performance?
Increases for demonstrating high patient satisfaction and low infection rates.
What is a key advantage of the retrospective fee-for-service system?
It ensures hospitals can recover the costs of services provided
Which payment system may result in potential overuse of services due to the fee structure?
Prospective Fee-for-Service System
What is a disadvantage of the per diem fees payment system?
May not account for the variability in costs of services needed daily
How does the prospective fee-for-service system differ from the retrospective fee-for-service system?
Prospective system establishes payment in advance, unlike the retrospective system
Which health insurance payment system aligns with ensuring that hospitals are less likely to under-provide care?
Retrospective Fee-for-Service System
Which of the following payment models incentivizes cost reduction while maintaining quality of care?
Shared Savings Programs
What is the primary focus of Direct Primary Care (DPC) models?
Both A and B
Which payment model provides a fixed annual payment for all care for a patient or population?
Global Payment
What is a potential drawback of Pay for Performance (P4P) models?
Potential for gaming the system
Which payment model is specifically mentioned as being used in some state Medicaid programs?
Alternative payment models
What is one disadvantage of aligning financial incentives with health outcomes and patient satisfaction?
Providers may focus on easily measured aspects of care rather than complex patient needs.
What is a characteristic of Fee-for-Service (FFS) payment method?
Incentivizes high volume of services.
Which payment method risks under-service and may not cover all patient needs?
Capitation
What is a disadvantage of Capitation as a payment method?
Risk of under-service, potentially not covering all patient needs.
What advantage does Bundled Payments offer as a payment method?
Predictable costs and incentivizes keeping patients healthy.
What is the main disadvantage of out-of-pocket payments for healthcare?
Both A and B
Which of the following is a key strength of community health financing schemes?
They promote community ownership and solidarity
What is the primary purpose of social insurance programs like Medicare and Medicaid?
To provide federal health insurance coverage to eligible populations
Which of the following is a potential weakness of community health financing schemes?
They can be financially unstable and unsustainable without external support
What is the main advantage of out-of-pocket payments for healthcare?
Users may have a greater sense of ownership over the services they use
Which of the following is a fixed amount of money paid by the insured at the time of receiving a specific medical service or supply?
Copayment
What is the term used for the percentage fee that the insured pays for medical services or supplies after the deductible has been paid?
Coinsurance
Which of the following is the amount paid by the insured on a regular basis (monthly or yearly) to maintain their insurance policy?
Premium
What term refers to the covered benefits and services included in a health insurance plan?
Benefits/Coverage
Which of the following is an amount that the insured must pay out-of-pocket before the insurance plan starts to cover costs?
Deductible
What is one of the challenges associated with health insurance policies as mentioned in the text?
Rising cost and affordability
Why is financial protection important in the context of health insurance?
To prevent bankruptcy from unexpected medical expenses
What is a potential consequence of coverage gaps in health insurance policies?
Significant out-of-pocket expenses for some services
How does health insurance contribute to public health improvement?
By facilitating access to healthcare services
Which aspect of health insurance helps prevent individuals and families from facing financial ruin?
Financial protection from unexpected medical expenses
Why can the rising cost of healthcare and insurance premiums be a significant concern?
Making it difficult for some individuals and families to afford coverage
In what way does health insurance contribute to economic stability?
By protecting individuals and families from financial ruin
Why is it important for health insurance policies to cover every type of medical service?
Avoid excessive out-of-pocket expenses for some treatments or services
Simplicity in comprehending coverage and rights fully
Test your knowledge on Value-Based Payments (VBP) and Pay for Performance (P4P) models in healthcare. Learn about how payments are adjusted based on care quality, outcomes, and efficiency, as well as financial incentives for meeting specific performance measures.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
