Health Science 3700 Final Exam

How does one qualify for Medicare?

1. Turn the age 65 years old

2. Have a permanent disability: be eligible for Social Security Disability Insurance Payments for 24 months.

3. Be diagnosed with End Stage Renal Disease or ALS.

Who is the single largest payer of healthcare in the U.S.?

Medicare

Which Medicare part is considered “hospital insurance?”

Medicare Part A

What does Medicare Part A Cover?

Inpatient hospital care

skilled nursing care

hospice care

home health care

Which parts of Medicare make up Traditional Medicare?

Part A & B

Which Medicare part is considered “medical insurance?”

Medicare Part B

What does Medicare Part B cover?

Doctors visits

other health care providers’ services outpatient services,

medical equipment

home health care

What does Traditional Medicare NOT cover?

Dental

Long-Term Care

Prescription Drugs

Hearing

Vision

Cosmetic Surgery

365 days hospitalization

First 3 pints of blood

Foreign Emergency Care

What are the 6 Domains of Healthcare Quality?

Safe

Effective

Patient-Centered

Timely

Efficient

Equitable

Bismarck Model

Non-profit insurance system w/employers but regulated by government; all covered

Beveridge Model

Provided & financed by the government so all covered.

Private providers but paid by government; all covered.

National Health Insurance Model

Out of Pocket Model

Lack of government assistance or insurance = very limited access (wealthy only.

According to the Dollar Dentist Documentary what is a major concern with franchise dental services? Specifically, Kool Smiles.

Quality of Care

True or False: You can use an HAS to pay for dental services?

True

What is a central issue highlighted in Dollars and Dentist?

Limited access to dental care for low-income

What do Pharmacy Benefit Managers do?

negotiate drug costs, discounts, and rebates to drug manufactures

create formularies for insurance plans

tell insurance what pharmacies are in network and out of network and also decided what drugs can be mail order;

help with processing claims

Who does the pharmacy purchase drugs from?

Wholesaler

True or False: Mental health is the same as mental illness

False

Who is the single largest payer for behavioral health services?

Medicaid

What does 2008 Mental Health Parody and Addiction & Equity Act permit?

It matches the pay for physical health with the pay for mental health.

True or False: Phase 3 of clinical trials is used to study short term side effects in the FDA drug approval process?

False

How many years on average does it take to develop a new drug and get it on the market?

10-15 years

How long is a patent for a new drug?

20 years

Who qualifies for Tricare?

Military Members, Spouse & Dependents, Retirees-including spouse and dependents, survivors-spouse and children.

Who qualifies to use the VA?

Veterans ONLY

True or False: Tricare is Free for retired veterans

False

True or False: Tricare is Free for active duty

True

Which model of healthcare system: single-payer, gov’t controlled, private providers and facilities but paid by the gov’t

National Health Insurance Model

Which model of healthcare system: Gov’t. controlled, single payer, and facilities owned by the gov’t

Beveridge Model

Which model of healthcare system: Multiplayer; private-ish, non-profit insurance system with employers, but regulated by the gov’t

Bismarck Model

What type of Healthcare System model does Canada have?

National Health Insurance Model

What type of Healthcare System model does India have?

Out of Pocket Model

What type of Healthcare System model does Germany have?

Bismarck Model

True or False: Americans are more likely to defer medical care due to costs than citizens in other countries?

True

What is included in Triple Aim?

Patient-Centered Care, Experience of Care, & Per Capita Cost

True or False: The VA system follows the Beveridge Model?

True

A Medicare advantage plan must provide at least the standard set of which parts(s) of Medicare?

Part A & B

True or False: Medicare Advantage plans allow you to see any healthcare provider out-of-network without paying a higher fee?

False

Who qualifies for the IHS?

Alaska and Native peoples of federally recognized tribes AND select non-Indian individuals

What is included in the Bureau of Protections Budget?

Salaries, Clothing, and Medical Supplies