MHA 707 Study Guide for Exam 3 C
How much $$ is spent on HC in US? Per capita and % of GDP? - CORRECT
ANSWER-$3.49trillion,
17.9% GDP and
$10,739 per capita.
Financing health care in U.S. - CORRECT ANSWER-.Workarounds
•Redundancies
•Contradictions
Percentage spent in hospitals? - CORRECT ANSWER-33%- largest share of NHE
Percentage spent on Doctors? - CORRECT ANSWER-26%- second highest share of
NHE
Percentage spent on drugs? - CORRECT ANSWER-9.5%-10.5%- third highest share of
NHE
Chronic disease? - CORRECT ANSWER-defined broadly as conditions that last 1 year
or more and require ongoing medical attention or limit activities of daily living or both.
(i.e. heart disease, cancer, and diabetes)
What are "personal behaviors" and how do they fit into the leading causes of death? -
CORRECT ANSWER-10 leading CODs attributed to personal behaviors- Tobacco,
obesity, poor diet, substance misuse/abuse.
90% 0f Americans have 1 risk factor, 52% have 2 or more
highest proportion in impoverished and racial/ethnic minorities
(NHEA) - CORRECT ANSWER-National Health Expenditure Accounts
National health expenditures (NHE) - CORRECT ANSWER-All health care consumption
and investments in medical structures and equipment and non commercial health
services and biomedical research.
What percentage of NHE shares are spent on chronic disease? - CORRECT ANSWER-
90%- chronic conditions are also considered some of the most preventable of all health
conditions.
,What percent of top utilizers account for 50% of spending in HC? - CORRECT
ANSWER-5% of top utilizers (ambulatory and dental services)
Other "truths" in motivating physicians behaviors include - CORRECT ANSWER-
Employed doctors are easier to motivate than independent practitioners
Physicians identity themselves as "doctor" with a higher level of intensity than "your
employee"
What is Asymmetry of information? - CORRECT ANSWER-A gap in knowledge from
person/group to another.
What is non-marketability of risk? - CORRECT ANSWER-inherent of medicine and
medical practice
Moral Hazard - CORRECT ANSWER-behaving differently when you know someone
else is taking the risk (induced demand)
Adverse selection - CORRECT ANSWER-the sicker people likely want more insurance
(the healthier the less)
Pooling risk - CORRECT ANSWER-sharing risk proportionately among many is a basic
insurance concept
What is PHC? - CORRECT ANSWER-(a subset of HCE) includes all medical goods and
services that are used to diagnose, treat, and prevent health problems in a specific
person.
Personal Health Care
What are personal behaviors and how do they fit into the leading causes of death? -
CORRECT ANSWER-Half of the mortality from 10 leading CODs attributed to personal
behaviors (i.e. tobacco use, obesity, poor diet, substance misuse/abuse) most chronic
disease
90% of americans have 1 risk factor - CORRECT ANSWER-52% have 2 or more
highest proportion in impoverished and racial/ethnic minorities.
What percent of Americans were hospitalized in 2018? - CORRECT ANSWER-only
6.7% (about 7%)
How many US people are uninsured? - CORRECT ANSWER-26.4M (~8% - creates big
cost)
, What portion of Americans under age 65 are covered by private health insurance? -
CORRECT ANSWER-about 66% (about 8% of people under the age of 65 were
uninsured/self pay in 2019)
What is cost-plus reimbursement? - CORRECT ANSWER-is how hospitals describe
payment received for services they have already provided plus additional percentage of
those costs (includes built-in profit)
Fee for service - CORRECT ANSWER-common method when the scope of work is
clear to both sides (the oldest form of payment - inefficiency costs the provider / Bad
advice costs the patient) Provider centric outcome
Capitation - CORRECT ANSWER-fixed prepayment per person to the health care
provider for an agreed-on array of services (per member/per month - PMPM) may put
the physician at odds with the patient
What is value-based payment? - CORRECT ANSWER-most often used when value is
easy to measure and indisputable
[This is debatable! At least the goals are set in advance of the care given - usually]
(P4P - pay for performance)
MCO - CORRECT ANSWER-Managed care organizations- distinguishing feature of
managed care is ability to steer members to preferred providers, negotiate rates and
manage utilization.
.United health group is the largest in 2017
Example of Managed Care Plans - CORRECT ANSWER-• Health Maintenance
Organizations (HMO)
• Preferred Provider Organization (PPO)
• Point-of-Service (POS) plans
• Exclusive Provider Organizations (EPO)
• Other Permutation
What are Managed Care, P4P, Bundled payments, PCMH, and ACOs? - CORRECT
ANSWER-Are all designed to re-establish the importance of primary care and improve
the reimbursement for primary care relative to specialty care.
PPO - CORRECT ANSWER-preferred provider organization-
is an arrangement with an insurance company in which a network of medical
professionals and facilities provide services at reduced rates.
HMO - CORRECT ANSWER-Health Maintenance organization- is a network or
organization that provides health insurance coverage for a monthly or annual fee.
POS - CORRECT ANSWER-Point of service- is a managed-care health insurance plan
that provides different benefits for using in-network or out-of-network providers.
How much $$ is spent on HC in US? Per capita and % of GDP? - CORRECT
ANSWER-$3.49trillion,
17.9% GDP and
$10,739 per capita.
Financing health care in U.S. - CORRECT ANSWER-.Workarounds
•Redundancies
•Contradictions
Percentage spent in hospitals? - CORRECT ANSWER-33%- largest share of NHE
Percentage spent on Doctors? - CORRECT ANSWER-26%- second highest share of
NHE
Percentage spent on drugs? - CORRECT ANSWER-9.5%-10.5%- third highest share of
NHE
Chronic disease? - CORRECT ANSWER-defined broadly as conditions that last 1 year
or more and require ongoing medical attention or limit activities of daily living or both.
(i.e. heart disease, cancer, and diabetes)
What are "personal behaviors" and how do they fit into the leading causes of death? -
CORRECT ANSWER-10 leading CODs attributed to personal behaviors- Tobacco,
obesity, poor diet, substance misuse/abuse.
90% 0f Americans have 1 risk factor, 52% have 2 or more
highest proportion in impoverished and racial/ethnic minorities
(NHEA) - CORRECT ANSWER-National Health Expenditure Accounts
National health expenditures (NHE) - CORRECT ANSWER-All health care consumption
and investments in medical structures and equipment and non commercial health
services and biomedical research.
What percentage of NHE shares are spent on chronic disease? - CORRECT ANSWER-
90%- chronic conditions are also considered some of the most preventable of all health
conditions.
,What percent of top utilizers account for 50% of spending in HC? - CORRECT
ANSWER-5% of top utilizers (ambulatory and dental services)
Other "truths" in motivating physicians behaviors include - CORRECT ANSWER-
Employed doctors are easier to motivate than independent practitioners
Physicians identity themselves as "doctor" with a higher level of intensity than "your
employee"
What is Asymmetry of information? - CORRECT ANSWER-A gap in knowledge from
person/group to another.
What is non-marketability of risk? - CORRECT ANSWER-inherent of medicine and
medical practice
Moral Hazard - CORRECT ANSWER-behaving differently when you know someone
else is taking the risk (induced demand)
Adverse selection - CORRECT ANSWER-the sicker people likely want more insurance
(the healthier the less)
Pooling risk - CORRECT ANSWER-sharing risk proportionately among many is a basic
insurance concept
What is PHC? - CORRECT ANSWER-(a subset of HCE) includes all medical goods and
services that are used to diagnose, treat, and prevent health problems in a specific
person.
Personal Health Care
What are personal behaviors and how do they fit into the leading causes of death? -
CORRECT ANSWER-Half of the mortality from 10 leading CODs attributed to personal
behaviors (i.e. tobacco use, obesity, poor diet, substance misuse/abuse) most chronic
disease
90% of americans have 1 risk factor - CORRECT ANSWER-52% have 2 or more
highest proportion in impoverished and racial/ethnic minorities.
What percent of Americans were hospitalized in 2018? - CORRECT ANSWER-only
6.7% (about 7%)
How many US people are uninsured? - CORRECT ANSWER-26.4M (~8% - creates big
cost)
, What portion of Americans under age 65 are covered by private health insurance? -
CORRECT ANSWER-about 66% (about 8% of people under the age of 65 were
uninsured/self pay in 2019)
What is cost-plus reimbursement? - CORRECT ANSWER-is how hospitals describe
payment received for services they have already provided plus additional percentage of
those costs (includes built-in profit)
Fee for service - CORRECT ANSWER-common method when the scope of work is
clear to both sides (the oldest form of payment - inefficiency costs the provider / Bad
advice costs the patient) Provider centric outcome
Capitation - CORRECT ANSWER-fixed prepayment per person to the health care
provider for an agreed-on array of services (per member/per month - PMPM) may put
the physician at odds with the patient
What is value-based payment? - CORRECT ANSWER-most often used when value is
easy to measure and indisputable
[This is debatable! At least the goals are set in advance of the care given - usually]
(P4P - pay for performance)
MCO - CORRECT ANSWER-Managed care organizations- distinguishing feature of
managed care is ability to steer members to preferred providers, negotiate rates and
manage utilization.
.United health group is the largest in 2017
Example of Managed Care Plans - CORRECT ANSWER-• Health Maintenance
Organizations (HMO)
• Preferred Provider Organization (PPO)
• Point-of-Service (POS) plans
• Exclusive Provider Organizations (EPO)
• Other Permutation
What are Managed Care, P4P, Bundled payments, PCMH, and ACOs? - CORRECT
ANSWER-Are all designed to re-establish the importance of primary care and improve
the reimbursement for primary care relative to specialty care.
PPO - CORRECT ANSWER-preferred provider organization-
is an arrangement with an insurance company in which a network of medical
professionals and facilities provide services at reduced rates.
HMO - CORRECT ANSWER-Health Maintenance organization- is a network or
organization that provides health insurance coverage for a monthly or annual fee.
POS - CORRECT ANSWER-Point of service- is a managed-care health insurance plan
that provides different benefits for using in-network or out-of-network providers.
