Exam 3 HC

Fee For Service (FFS)

Payment method in which all items are billed individually and paid for individually

Value Based Payment (VBP)

Also known as pay for performance, e.g. outcomes and/or quality measure

Marketplace distortion

These are factors like subsidies which may cause artificial changes in the cost of healthcare

Principles of Insurance

This addresses risk in individuals and groups and can be used for healthcare, cars, homes, etc.

Moral Hazard

people consume more medical services than necessary because they do not incur the full cost of these services

“No skin in the game”; “I don’t care how much it costs, I’m not paying for it”

Adverse Selection

Purchaser of a health plan has knowledge that the health plan doesn’t have concerning future needs

Cost Sharing

This is the high-level term for what your part of the healthcare bill is

Deductible

The specific dollar amount you contribute before your insurance “kicks in”

The Four Parts of Medicare

A, B, C, D

Medicaid

Jointly run by Federal and State govt., but it can be implemented and executed differently depending on the state you live in

Network

The list that a health plan has that says where you can get authorized services from

Managed Care Organizations (MCO)

Hallmarks of this type of insurance are paying providers a fixed sum and having restrictions on patient access

Employer Sponsored Insurance (ESI)

This type of insurance purchased through someone’s job grants tax

breaks for the patient and their job

Capitated

Pre-negotiated price per patient for healthcare

Price Elasticity

Unlike many goods and services this relationship in healthcare doesn’t seem to line up with demand

Insurance Risk Rating (Community vs. Experience rating)

Insurance premiums are based on the average costs for a large group, vs. based on average costs for specific subgroups of patients

High-Deductible health plans

Also known as consumer-directed health plans

Health Savings Account (HSA)

This account is owned by the patient and is portable

Gatekeeper and Prior Authorization

The method many insurers use to slow down or limit your use of services

Health insurance exchanges (aka ACA plans

Created as a product of the Affordable Care Act to allow people to more easily purchase health insurance by comparing plans