UMass Amherst PUBHLTH 129 - Exam 2 Study Guide (13 pages)

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Exam 2 Study Guide

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Exam 2 Study Guide


Chapter 5, 6, 9, 11, 12, and 13 are covered in depth.

Study Guide
University of Massachusetts Amherst
Pubhlth 129 - Health Care for All GenEd: SBU
Health Care for All GenEd: SBU Documents
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Public Health 129 1st Edition Exam 2 Study Guide Chapter 5 1 What main types of information technology applications are used in medical care delivery a Expensive increased expectation people believe that they are getting the best care available and should get better soon overspecialized it leads to wasteful expenditures many tests aren t need but are still done just cause they re available 2 What is meant by technology diffusion What role does the Food and Drug Administration play in technology diffusion a If someone makes a new MRI machine it s going to be highly sought after and soon it ll be used more frequently in more places it wasn t available before almost like the act of diffusion The FDA ensures the medical technologies safety and how they are diffused 3 What outcomes may suggest technology s positive impact on quality of life a Quality is enhanced when new procedures can prevent or delay the onset of serious disease provide better diagnosis make quicker or more complete cures possible increase safety of medical treatment minimize undesirable side effects promote faster recovery from surgery increase life expectancy and add to quality of life p 118 4 What impact has technology made on access to medical care a Home care they can just stay at home if they re too old Telemedicine lets physicians talk to other people to provide their care using technology such as Skype and help people that need their services but might be too far 5 What is meant by technology assessment What is the main practical use or objective of assessment a Health Technology Assessment HTA refers to the evaluation of medical technology to determine its efficacy safety and cost effectiveness Assessment can go beyond examining the direct effects of technology to include its social economic and ethical consequences Cost effectiveness is also looked into to evaluate it s the safety and efficacy of the technology in relation to its cost p 123 Chapter 6 1 What is meant by financing What are its desirable and undesirable effects a Desirable Basically a way to pay off something monthly b Undesirable fees on top of monthly payment c Trying to stop moral hazard 2 Briefly explain how insurance functions in relation to risk for individuals and groups a Insurance is a way to protect against risk Risk in terms of insurance is substantial financial loss from an event b If you have insurance you are referred as the insured or as the enrollee or beneficiary c Risk is unpredictable for the individual insured but it can be predicted reasonably in a population d Insurance provides a mechanism for transferring or shifting risk from the individual to the group e Actual losses are shared by all members of the insured group pg 133 3 Discuss how cost sharing applies to health insurance a Assuming someone s not going to abuse the system moral hazard We have to pay a co payment to have people limit the times we use the services and that the insurance doesn t have to pay for it all and you re sharing the burden with your insurance company b Premium Annual Sum c Deductible What you have to pay before your insurance starts working Baseline sum d Co payment the amount you have to pay when you visit a physician You might have a low co payment and higher one for a specialist so it makes you want see your physician first e Co insurance the percent of co payment 4 Why are managed care plans regarded as health insurance How do managed care plans differ from traditional insurance a Managed care plans are regarded as health insurance because managed care organizations assumes risk in return for an insurance premium They are mainly offered by health maintenance organizations HMOs and preferred provider organizations PPOs Unlike traditional companies however MCOs assume responsibility for obtaining health services for their enrollees by contracting with a network of providers b MCOs use a variety of mechanisms to monitor utilization and a variety of methods to reimburse providers for their services i Pg 137 5 What is Medicare Part A Discuss the financing Medicare Part A What services does Part A cover a Hospital Insurance financed through taxes through jobs income b Is financed by a special payroll taxes paid equally by employers and employees 6 What is Medicare Part B Discuss the financing of Medicare Part B What services are covered under Part B a Its voluntary care outpatient care wisdom teeth removed dentist etc b Part C Medicare Advantage managed portion of Medicare c Part D Pharmaceuticals d B C and D are out of pocket and must have to enroll in it Optional With A you don t have to pay for A 7 Discuss the financing eligibility and covered services for the Medicaid program a Is jointly financed by the federal government and state government b The Fed Gov matches funds to the states based on the per capita income in each state c Wealthier states have smaller share of their costs reimbursed by the federal government 8 Discuss the payment method and risk sharing under capitation a Capitation is a mechanism used by HMOs Under this reimbursement scheme a provider is paid a set monthly fee per enrollee regardless of how often an enrollee sees the provider b Capitation removes the incentive for provider induced demand and makes doctors only uses necessary services 9 What is the main difference between retrospective and prospective methods of reimbursement What are the main advantages of a prospective payment system a Retrospective the insurance pays no matter what you get but it s expensive i Its based on costs related to length of stay services rendered and costs of providing those services providers aren t really interested in lowering the cost and health institutions can increase their costs b Prospective the insurance is going to pay depending what disease you have It ll be less money because they wont be doing extra tests c Fee for service the insurance company pays and then the prices are set by the hospital doctor depending on what they do The more the doctor does the more the doctor gets paid Retrospective 10 Discuss the prospective payment system under DRGs a How it relates to DRGs Medicare is being reimbursed by the government they assign an actual value on the doctor hospital is going to be paid page150 b DRG based prospective reimbursement has forced hospitals to control their costs by minimizing the length of the patients stay Chapter 9 1 What is capitation How does this payment arrangement share risk with providers a Risk is

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