Health Care Essentials 3/4

  1. What is Professionalism
    • Behavior that will lead to;
    • adherence to ethical practice
    • effective interactions with patients
    • effective interactions with staff
    • reliability, and commitment to improvement
  2. Traditional Medicare
    • Fee for service
    • Can see any doctor that accepts Medicare
  3. Medicare Advantage
    • lower copay and deductible
    • extra benefits
    • have to see physicians in network
  4. Who are the stockholders?
    • Gov
    • Priv insurance
    • Tax payers
    • Health care provider
    • Patients
  5. Why gov gave 14% more money to Medicare Advantage than directly to health care providers?
    If procedure $20, gov have to pay $25. $20 for the procedure and $5 to the private insurance company
  6. Modes of paying for health care
    • out of pocket
    • individual private insurance
    • employment-based group private
    • gov financing
  7. Why out of pocket bad?
    • need vs luxury
    • hard to plan for
    • only rely on HCP recommendations
  8. Experience Rating
    Higher risk of problem, higher premium
  9. Community Rating
    Everyone pays the same premiums whether young or old
  10. Types of Private insurance
    • Traditional Fee for Service
    • Health Maintenance Organization (HMO)
    • Preferred Provider Organization (PPO)
  11. Traditional fee for service
    • most expensive
    • most flexibility when choosing HCPs
  12. Health Maintenance Organization (HMO)
    • lower copay
    • cover costs of more preventative services
    • few choices of HCPs
    • need PCP
    • HCP makes choices on surgeries not insurer
  13. Preferred Provider Organization (PPO)
    • lower copay (like HMO)
    • Pay more but get more options
    • more choices of HCPs than HMO
    • Can go out of network but have to pay more
    • dont need PCP
  14. Deductible
    Money you pay up to an amount and then insurance pays with you ($3000)
  15. What are copays for?
    Insurance company made to deter you from going somewhere so the doctors also make less money
  16. Co-insurance
    If insurance pay 80% you have to pay the other 20%
  17. Benefit max
    If you cost too much, stop paying
  18. Premium
    Amount you pay each month (part by employer and part by employee
Card Set
Health Care Essentials 3/4
Health Care Essentials 3/4