MEDICAL SOCIOLOGY FINAL EXAM QUESTIONS ANSWERED CORRECTLY GRADED A+
Chap 8 - Blue Cross/Blue Shiel - Answers •Designed to protect doctors and hospitals
•Fee-for-service insurance
Community rating: Each person charged based on average risk of entire community
Health Maintenance Organizations (HMOs) - Answers •Designed to provide affordable health
care
•Salaried doctors, monitored for unnecessary care
•Emphasis on prevention
Medicare (1960) - Answers •For persons over 65 and permanently disabled
•Funded and organized by the federal government
•"Entitlement"
Medicaid (1960) - Answers •Primarily for poor persons
•Funded jointly by states and the federal government
•"Charity"
Commercial insurance - Answers •For-profit rather than nonprofit
•Actuarial risk rating: Individual premium based on individual risk
•Avoid insuring unhealthy persons
Managed Care (revolution) - Answers •Any system that controls costs by monitoring and
controlling provider decisions
-Price schedules
-Utilization review
-Formularies
•Response to increasing health care costs
•Managed care itself has little impact on health care outcomes
•Backlash against managed care
•President Clinton's 1993 Health Care Security Act - Answers •Not passed due to political
opposition
,•State Children's Health Insurance Program - Answers •Passed
•Extended coverage for children under 18 via Medicaid
President Obama's ACA - Answers •passed in 2010
•To gain support from stakeholders, worked within existing neoliberal system
•Individual mandate
•Employer mandate
•Limits put on insurance deductibles and copayments
•BUT Supreme Court ruled that states did not have to expand Medicaid
myths of US health care costs - Answers •Myth 1: It's the malpractice suits.
•Myth 2: It's our aging population.
•Myth 3: It's our advanced technologies.
•Myth 4: It's because we receive more and better care than do others.
ACA under attack - Answers •Numerous attacks against it by Congress and in courts.
•Eligibility restricted, premiums raised, subsidies reduced
•Individual mandated dropped
•More to come...
Impact of ACA - Answers •20 million gained insurance coverage
•Increases financial security and physical health
•More economic growth and less unemployment in states that expanded Medical coverage
Health Care Costs - Answers •Administrative costs of fragmented system
•Health care providers largely set prices
•The for-profit basis of the US health care system
Health care costs and the ACA - Answers •ACA is unlikely to lower costs:
•Multitude of insurers so continues administrative inefficiency
• Limited efforts to add cost controls
, •Many health care expenses are still not covered
•Preserves the for-profit system
"Big Pharma" and rising cost - Answers •New patent regulations entice researchers and increase
profits
•Manipulation of drug testing and research
•Marketing drugs to doctors and consumers
•Marketing diseases
•"Off-label" prescribing encouraged
•Declining power of the FDA
uninsured and underinsured Americans - Answers •Less likely to report good health
•Less likely to receive needed health care
More likely to die from potentially treatable conditions
Prospects for State-level reform - Answers •ACA gives states some leeway
•Hawaii as a model
•Strong points?
•Weaknesses?
•Struggle between liberal belief that government has a responsibility to make people's lives
better, and conservative belief in individual responsibility
Chap 9 - Convergence Hypothesis - Answers •Health care systems become increasingly similar
over time.
•Causes include:
•Globalization
•Demographic changes
•Economic shifts
Germany: Social insurance - Answers •Cities, occupations, and industries banded together to
insure residents, workers, or members.
•These "social insurance" groups are known as sickness funds.
Chap 8 - Blue Cross/Blue Shiel - Answers •Designed to protect doctors and hospitals
•Fee-for-service insurance
Community rating: Each person charged based on average risk of entire community
Health Maintenance Organizations (HMOs) - Answers •Designed to provide affordable health
care
•Salaried doctors, monitored for unnecessary care
•Emphasis on prevention
Medicare (1960) - Answers •For persons over 65 and permanently disabled
•Funded and organized by the federal government
•"Entitlement"
Medicaid (1960) - Answers •Primarily for poor persons
•Funded jointly by states and the federal government
•"Charity"
Commercial insurance - Answers •For-profit rather than nonprofit
•Actuarial risk rating: Individual premium based on individual risk
•Avoid insuring unhealthy persons
Managed Care (revolution) - Answers •Any system that controls costs by monitoring and
controlling provider decisions
-Price schedules
-Utilization review
-Formularies
•Response to increasing health care costs
•Managed care itself has little impact on health care outcomes
•Backlash against managed care
•President Clinton's 1993 Health Care Security Act - Answers •Not passed due to political
opposition
,•State Children's Health Insurance Program - Answers •Passed
•Extended coverage for children under 18 via Medicaid
President Obama's ACA - Answers •passed in 2010
•To gain support from stakeholders, worked within existing neoliberal system
•Individual mandate
•Employer mandate
•Limits put on insurance deductibles and copayments
•BUT Supreme Court ruled that states did not have to expand Medicaid
myths of US health care costs - Answers •Myth 1: It's the malpractice suits.
•Myth 2: It's our aging population.
•Myth 3: It's our advanced technologies.
•Myth 4: It's because we receive more and better care than do others.
ACA under attack - Answers •Numerous attacks against it by Congress and in courts.
•Eligibility restricted, premiums raised, subsidies reduced
•Individual mandated dropped
•More to come...
Impact of ACA - Answers •20 million gained insurance coverage
•Increases financial security and physical health
•More economic growth and less unemployment in states that expanded Medical coverage
Health Care Costs - Answers •Administrative costs of fragmented system
•Health care providers largely set prices
•The for-profit basis of the US health care system
Health care costs and the ACA - Answers •ACA is unlikely to lower costs:
•Multitude of insurers so continues administrative inefficiency
• Limited efforts to add cost controls
, •Many health care expenses are still not covered
•Preserves the for-profit system
"Big Pharma" and rising cost - Answers •New patent regulations entice researchers and increase
profits
•Manipulation of drug testing and research
•Marketing drugs to doctors and consumers
•Marketing diseases
•"Off-label" prescribing encouraged
•Declining power of the FDA
uninsured and underinsured Americans - Answers •Less likely to report good health
•Less likely to receive needed health care
More likely to die from potentially treatable conditions
Prospects for State-level reform - Answers •ACA gives states some leeway
•Hawaii as a model
•Strong points?
•Weaknesses?
•Struggle between liberal belief that government has a responsibility to make people's lives
better, and conservative belief in individual responsibility
Chap 9 - Convergence Hypothesis - Answers •Health care systems become increasingly similar
over time.
•Causes include:
•Globalization
•Demographic changes
•Economic shifts
Germany: Social insurance - Answers •Cities, occupations, and industries banded together to
insure residents, workers, or members.
•These "social insurance" groups are known as sickness funds.
