DPT772: HEALTH CARE ECONOMICS EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
Deductible
the amount the individual must pay each year before the health care plan begins to pay
Co-Insurance
proportion of the cost paid by the individual after the deductible has been met, with the
remainder paid by the insurer
Co-Pay
set fee each time services or drugs are bought
Premium
a set fee, usually paid monthly to be covered by the insurance
HMO (Health Maintenance Organization)
individual pays co-pay per each service
- organization that provides for the overall health care of a defined population of
enrollees under the closed-panel model
- provides services to maintain health along with usual medical necessary care in case
of illness or injury
- enrollees must see their assigned primary care physician
- primary care physician (gatekeeper) is responsible for allocating medically necessary,
health care resources, such as access to specialists, including physical therapists,
special tests, and so on, and coordination of enrollees care
, - care is provided only by a specific group of providers, that is, a closed panel
- payment is a fixed amount paid monthly per member (per member per month fee
PMPM)
- PT is a specialty service that is available through referral from a patient's primary care
physician
PPO (Preferred Provider Organization)
consists of a deductible and co-insurance
- preferred provider plan
- offers a choice of providers
- managed care plan that allows enrollees to seek care from a variety of approved
providers
- usually pays a discounted FFS
- may be closed panel
Catastrophic Insurance
a type of accident insurance designed to provide lifelong medical, rehabilitation, and
disability benefits for a victim of devastating injury
Health Savings Account (HSA)
a tax-free savings account—funded by employees, employer, or both—to spend on
routine medical costs. Usually combined with a high-deductible policy to pay for
catastrophic care
Flexible Spending Account (FSA)
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
Deductible
the amount the individual must pay each year before the health care plan begins to pay
Co-Insurance
proportion of the cost paid by the individual after the deductible has been met, with the
remainder paid by the insurer
Co-Pay
set fee each time services or drugs are bought
Premium
a set fee, usually paid monthly to be covered by the insurance
HMO (Health Maintenance Organization)
individual pays co-pay per each service
- organization that provides for the overall health care of a defined population of
enrollees under the closed-panel model
- provides services to maintain health along with usual medical necessary care in case
of illness or injury
- enrollees must see their assigned primary care physician
- primary care physician (gatekeeper) is responsible for allocating medically necessary,
health care resources, such as access to specialists, including physical therapists,
special tests, and so on, and coordination of enrollees care
, - care is provided only by a specific group of providers, that is, a closed panel
- payment is a fixed amount paid monthly per member (per member per month fee
PMPM)
- PT is a specialty service that is available through referral from a patient's primary care
physician
PPO (Preferred Provider Organization)
consists of a deductible and co-insurance
- preferred provider plan
- offers a choice of providers
- managed care plan that allows enrollees to seek care from a variety of approved
providers
- usually pays a discounted FFS
- may be closed panel
Catastrophic Insurance
a type of accident insurance designed to provide lifelong medical, rehabilitation, and
disability benefits for a victim of devastating injury
Health Savings Account (HSA)
a tax-free savings account—funded by employees, employer, or both—to spend on
routine medical costs. Usually combined with a high-deductible policy to pay for
catastrophic care
Flexible Spending Account (FSA)
