Healthcare Economics Test

provides prepaid plans to cover hospitalization costs

groups of physicians used to cover physician service fees

The most significant change in government healthcare financing which approved the Medicare and Medicaid programs

receives most of its funding from local, federal, or state sources

receives federal, state, and local tax exemptions in exchange for providing community benefits

for-profit institutions usually owned by corporations

healthcare plans funded by the government

an insurance system for active and retired service personnel

healthcare program for older Americans 65 or older; uses prospective payment system

pays healthcare provider a fixed amount based on diagnosis or specific procedure, rather than actual cost

offers insurance to low-income and disabled people

inpatient hospital care not requiring premium

outpatient care services

allows people to buy into private health insurance

gives prescription drug coverage

another name for Medicare Part C

the year managed care was started

in place to protect yourself if you get sick or injured

gives people the right to continue a work-based group plan after a job loss, death of spouse, divorce, or eligibility loss for dependent coverage

the age a person can stay on their parents plan for

the monthly amount paid to a private insurance company for health insurance coverage

the money a person must pay yearly before an insurance company provides benefits

the total amount of money payed for care that is not covered by insurance

a flat fee that many health insurance plans require patients to pay each time they receive health care service.

the portion of medical costs a patient may still have to pay once deductible has been payed

the highest out-of-pocket amount that can be paid before insurance pays for everything including copay and co-insuarnce.

a health care provider that has a contract with a managed care insurance plan

a healthcare provider who is not in a particular managed care health insurance plan

a work place is required to get employee health insurance benefits if they have this many employees.

takes into account age, location, tobacco use, individual or family plan, and plan category to determine premium

a monetary account commonly paired with a high-deductible health insurance plan that allows individuals to pay for qualified medical care using pre-tax dollars until they meet their deductibles. Any funds remaining at the end of each year are rolled over and can be saved for future use.

a monetary account, offered through an employer, into which money is put through payroll deductions, before it is taxed. Funds can be withdrawn for qualified medical expenses as needed, but the funds must be spent each year.

a classification system used by Medicare and Medicaid to determine payment for health services based on diagnosis, surgical procedure, age, other information

the act of paying for health care with one's own money

a physician who not only delivers primary care services, but also makes referrals for specialty care.

measures designed to lower health care costs that aim to create an affordable health care system for all Americans.

a type of health insurance plan that establishes predetermined rates for services with health care providers such as doctors and hospitals, and puts providers in the position of managing patients' use of health care.

a health insurance plan that provides coverage only if the care is delivered by a member of the plan's hospital, physician, or pharmacy panel.

a physician-coordinated health insurance plan that combines characteristics of both HMO and PPO plans

a health insurance plan that allows patients to receive care from a non-plan provider, but requires them to pay a higher out-of-pocket price if they do so.

a health insurance system that allows individuals to obtain group health benefits through an organization, such as an employer, a union, or an association

making better use of health care resources to cut costs

a process in which an insurer reviews decisions by physicians and other providers about how much care to provide.

Deductible > Copay > co-insurance >

6.2 percent

20.3 percent

clinics, services for those who cannot afford it

usually a "chain", multiple facilities in multiple states

military treatment facilities, veteran affairs hospitals (VA), public or government funded hospitals, state mental hospitals, state rehabilitation facilities

government plans, private insurance, direct payment

through their employer

manage care plans

managed health care plans are dependent on a network of health care providers, doctors, and facilities that establish a contract with an insurance provider.

generally, services will cost less with DRGs, which lower the amount of money that healthcare providers will receive.

To conserve resources, time, and energy to be able to treat more patients more efficiently.