MHA 707 Exam D Test Questions And Answers Verified 100% Correct

MHA 707 Exam D Test Questions And Answers Verified 100% Correct Blue cross and blue shield covered 33% of federal employees - answer by the 1960s, blue cross had ____million members and blue shield had 40 million members Blue cross and blue shield covered 33% of federal employees community rating - answer consistent with their charitable mission, blue cross and blue shield plans used _______, not experience rating, to set prices for their products [data was too poor to do anything else] -medicare for people 65 and older -medicaid for uninsured, low-income people -children's health insurance program (chip) for uninsured, moderate income - answer as a result, between 1965 and 1999, congress passed legislation for three groups not covered by employerbased insurance: Medicare for people 65 and older Medicaid for uninsured, low-income people Children's health insurance program (chip) for uninsured, moderate income emtala and hipaa - answer filling gaps in health care coverage: 1)___ 2)____ the complex system of private and public health insurance, with many people covered through employment, created gaps in coverage For example, people who changed jobs or lost jobs - answer in 1986, two federal health policies enacted to solve problems related to health care coverage: -emergency medical treatment and labor act (emtala) -health insurance portability and accountability act (hipaa) two-day - answer continuity or "portability" of coverage in the private health insurance markets Health insurance coverage for at least a ________ hospital stay for women who give birth vaginally and four days for cesarean deliveries (c-sections) - sponsored by texas senator phil gramm mental health - answer ____ was given the same status as physical health by the hipaa legislation hippa - answer also created national standards for certain electronic health care transactions to improve efficiency and privacy Important to constrain discrimination because of poor health status hill-burton act - answer community hospitals built with federal funds through ___________ private sector - answer voluntary, nonprofit hospitals built by _______ members, veterans and their families - answer hospitals built by military for _____,_____,and_____ public hospitals - answer ______ built by government entities for the poor (usually local governments) - answer population had exploded from 76.2 million in 1900 to 180.7 million in 1960 More and more people had health insurance and could afford health care Large portion of the uninsured were about to receive coverage through medicare or medicaid 0,3% - answer health care costs were also surging: About _____percent of gross domestic product (gdp) from 1900 through 1930 1.3% 4.1% - answer health care costs were also surging: Rose steeply to_______gdp in 1960 (↑ 4x; four-fold ↑; ↑ by 400%) Rose to_______by 1980 ( little over 3 x since 1960; 13.6 x since 1930) info - answer in this growth environment, financing and organization of the health care system underwent several important, incremental changes: Expansion of capitation and the rise of managed care Growth of vertical and horizontal integration of health care organizations and integrated delivery systems Increase in for-profit health care organizations capitation and indemnity health insurance - answer ________ and __________are two contrasting ways to pay health care providers for their services At the heart of their differences is who assumes the risk for cost of the care—the health care provider or the health care payer. capitation - answer practice of paying flat fee to health care provider in exchange for stipulated range of services during a given time period, usually a year Flat fee guarantees medical coverage for that person regardless of how much or how little care the individual needs or uses indemnity health insurance - answer reimburses an individual for fees paid for medical services after they are performed Payments may be made to the patient or directly to the provider, on a retrospective, fee-for- service basis. Providers not employed by, contracted to, or owned by the payer (insurer) Insurer simply pays for care according to some agreed-to schedule Financial responsibility (or risk) for the cost of health care is born by the insurer beneficiaries - answer (in most cases, the beneficiaries' employers) pay sums (usually called premiums) to the insurance companies. In turn, insurance companies pay the providers for the care used by the beneficiaries. Payment is made on a fee-for-service or item-of-service basis, after service is received (or retrospectively). There are usually some out-of-pocket (deductibles and coinsurance) paid by beneficiaries, and dollar-amount limits on services covered by the insurance. health maintenance organizations Managed care organizations - answer began with development of prepaid group medical practices Later with ________________ (hmos) Then with ____________ (mcos) Efficiency, cost containment, and improved quality of care motivated these changes value= quality/cost - answer value "equation" value=outcome( quality, efficacy, safety)/cost (resource tallies, dollars) - answer value equation - modified - answer growth of vertical and horizontal integration of health care organizations Increasingly, individual hospitals needed to affiliate with other hospitals to form systems if they were to remain financially viable For example, in new york city in 2010, 43 general hospitals Of these, only 17 were independent Remaining 26 were members of just five hospital systems multi-unit hospital systems - answer include two or more acute-care hospitals owned, leased, or managed by a single corporate entity Number and size will continue to increase - answer increase in for-profit health care organizations