Concepts

Front 1

the 3 major challenges of the health care system

Back 1

controlling cost, providing access, ensuring quality

Front 2

the 5 players in the health care system

Back 2

consumers, providers, employers, insurers, federal and state policy makers

Front 3

factors contributing to the rising health care costs

Back 3

changing demographics, technology and intensity, price inflation, malpractice and defensive medicine

Front 4

in the 1920s, concerns about the cost and maldistrubition of medical care resulted in

Back 4

the formation of the Committee on the Costs of Medical Care

Front 5

todays healthcare is a $___ industry

Back 5

2 trillion

Front 6

just ___% of the population accounts for ___% of all expenditures

Back 6

1
27

Front 7

___% of all expenditures are related to chronic diseases

Back 7

70

Front 8

___% of the healthcare coverage is paid by employers

Back 8

80

Front 9

healthcare spending is ___ times the amount spent on nationl defense

Back 9

4.3

Front 10

consumers ultimately bear the burden of paying for increasing healthcare costs through

Back 10

higher taxes, reduced wages, higher product costs

Front 11

financing healthcare (sponsors)

Back 11

public system and private system

Front 12

the public system consists of

Back 12

government, federal, and state

Front 13

the private system consists of

Back 13

businesses (employers) and households/individuals

Front 14

public sources that pay for healthcare

Back 14

medicare, medicaid, public health, military (tri care), veterans, prisioners, indian health service

Front 15

medicare was enacted in ___ by ____.

Back 15

1965
Centers for Medicare and Medicaid (CMS)

Front 16

there is no ___ qualification for medicare

Back 16

income

Front 17

the 3 factors that make a person eligible for medicare are

Back 17

65 years old or older, end stage renal disease, under 65 with a disability for a minimum of 2 years

Front 18

medicare was origionally a ___ part program

Back 18

2

Front 19

the 2 parts are

Back 19

A. hospital insurance (HI)
B. medical insurance (SMI)

Front 20

part C =

Back 20

medicare + choice program

Front 21

part C was established by the

Back 21

Balanced Budget Act of 1997 (BBA)

Front 22

part C expanded the

Back 22

option for beneficiaries to enroll in private managed care plans

Front 23

part D =

Back 23

medicare prescription drug benefit

Front 24

part D was created by the ___ and began in janurary 2006

Back 24

medicare modernization act of 2003 (MMA)

Front 25

part D entailed

Back 25

new drug discount cards which began in 2004 and preventive benefits

Front 26

part A (HI) coverage costs

Back 26

automatic and without premium

Front 27

part B (SMI) coverage costs

Back 27

deducted from social security benefit (monthly premium)

Front 28

financing medicare: hospital program (HI)

Back 28

mandatory payroll taxation

Front 29

financing medicare: supplemental program (SMI)

Back 29

premium payments

Front 30

financing medicare: medicare+choice

Back 30

capitated payments from the HI and SMI trust funds

Front 31

retrospective payment system (prior to 1982)

Back 31

health care institutions were paid their "reasonable and necessary charges"

Front 32

in the retrospective payment system, billing

Back 32

was submitted AFTER services were provided and institution was paid

Front 33

prospective payment system (PPS) was established by

Back 33

the tax equity and fiscal act of 1982 (TERFA)

Front 34

in the PPS, reinbursement is made according to

Back 34

a predetermined classification system

Front 35

the first area affected by the PPS was the ___. it created ___.

Back 35

hospitals
diagnostic related groups (DRG)

Front 36

PPS was established by the

Back 36

balanced budget act of 1990 (BBA)

Front 37

the second area affected by the PPS was the ___, the third area was ___, and the last area was ___.

Back 37

nursing homes (MDA)
home health care (OASIS)
ambulatory care

Front 38

notable outcome from PPS

Back 38

earlier discharge of clients, decline in the number of admissions, increased number and type of out-patient services, limited delivery of services, and increased emphasis on costs

Front 39

medicaid was enacted in ___ , jointly with ___.

Back 39

1965
medicare

Front 40

medicaid provides

Back 40

federal matching funds to states to help pay the cost of medical care for low income persons (medically indigent)

Front 41

medicaid is administered by

Back 41

each state medicaid office

Front 42

to be eligible for medicaid (determined by each state)

Back 42

medically indigent
disabled over 1 year

Front 43

income requirements to be able to recieve medicaid

Back 43

income total less than $1,635 a month; total cash assets of $2,000 or less; spouse may exempt some income and property

Front 44

medicaid pays

Back 44

premiums for medicare SMI (part B), deductible for medicare HI (part A), and some other services

Front 45

some other services that medicaid pays for

Back 45

prescription medcations, eyeglasses, dental services, skilled nursing care(NH), durable medical equipment

Front 46

medicaid acts as a ____. this means that:

Back 46

vendor program
states pay providers (vendors)

Front 47

the vendor program of medicaid relies ___ or ___.

Back 47

directly on a fee-for-service basis
through pre-paid (capitated) arrangements

Front 48

state childrens health insurance program (SCHIP) was established by

Back 48

title XXI of the social security act

Front 49

SCHIP began in ___. ___ was the first state with a SCHIP plan.

Back 49

1997
alabama

Front 50

SCHIP provides funds to

Back 50

states to expand medicaid eligibility to a greater number of uninsured children

Front 51

in most states, the largest percentage of medicaid expenditures is for

Back 51

nursing homes and home health

Front 52

private health insurance is insurance that may purchased

Back 52

individually or by groups

Front 53

private insurance can be either

Back 53

not-for-profit or for-profit

Front 54

a not-for-profit organization

Back 54

blue cross blue shield

Front 55

for-profit organizations

Back 55

metropolitan life, aetna, travelers

Front 56

health care money goes first to ___ then to ___ then to ___ then to ___ then to ___ then to ___ and lastly to ___.

Back 56

hospitals
physicians/clinics
prescription drugs
nursing homes
home care agancies
public health
administrative

Front 57

managed care

Back 57

a philosophy of health care that integrates the financing, delivery, and use of care

Front 58

the goal of managed care

Back 58

provide cost-effective, quality care and improved outcomes for clients

Front 59

types of managed care arrangements

Back 59

health maintenance organizations (HMO), preferred provider organizations (PPO), case management

Front 60

four basic options for slowing the trends in health care spending

Back 60

increase the efficiency of health care delivery, increase the incentives for patients to limit their use of services, increase the administrative controls on the use of services, and limit the resources available to the health care system

Front 61

specific options for slowing the trends in health care spending

Back 61

adherence to clinical practice guidelines, professional liability reform, more and better use of technology, involve the patient as a more prudent consumer of services, reward primary care providers for coordinating care, more health planning at the community and state level, more emphasis on preventative services

Front 62

cost increases are inevitable until

Back 62

the baby boomer generation moves through the system

Front 63

baby boomers were born ___. they will retire ____. expire ___.

Back 63

1946 - 1964
2011 - 2029
2021 - 2039

Front 64

concerns beyond the high cost of health care

Back 64

uneven quality of care across the country, worse care for radical and ethnic minorities, reimbursement for care not recommended by experts or based on evidence, medical errors, increasing number of uninsured or underinsured

Front 65

the u.s. is spending more but we are getting more

Back 65

newer diagnostic tests, less invasive surgeries, low birth weight babies are surviving, better prescription medications, targeted chemo/radiation therapies for cancer