US Healthcare Delivery: Healthcare Financing Questions with Correct Answers
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Course
UHC Certification
Institution
UHC Certification
Healthcare Financing Correct Ans the system that a society uses to pay for healthcare services.
USA does not have a single-payer system like Europe and Canada
We have insurance plans which both patients and providers benefit from. (Patient gets a discount while Provider gets reimbursed). Financi...
US Healthcare Delivery: Healthcare Financing
Questions with Correct Answers
Healthcare Financing Correct Ans ✓✓ the system that a society uses to
pay for healthcare services.
USA does not have a single-payer system like Europe and Canada
We have insurance plans which both patients and providers benefit from.
(Patient gets a discount while Provider gets reimbursed). Financing
increase the demand for service and the supply of professionals.
Insurance (Insurer or Underwriter) Correct Ans ✓✓ Protects the insured
against risk.
Companies do not want to lose money so try to underwrite risks
Insurance and Health Care Services Correct Ans ✓✓ Medicare (65 or
older)
Employment-based or Self-financed: under 65 years or age
Poor Individuals: Medicaid and Children's Health Insurance Program
CHIP
Veterans: Department of Veteran Affairs
Uninsured
Health Insurance Plan Correct Ans ✓✓ "Are you under a plan?"
Plan: information pertaining to costs, covered services, and ways to
obtain health care when needed
Employer-Sponsered Plans: Single coverage and family coverage
, Government based plans are individual
Private Health Insurance Correct Ans ✓✓ voluntary health insurance
and are usually employment based.
Examples: Commercial Insurance Companies, Non Profit BCBC,
MCOs, Businesses
Ratings Correct Ans ✓✓ Experience
Community
Adjusted Community
Experience Rating Correct Ans ✓✓ based on groups own medical
claims experience
Differ from risk group to risk group
Community Rating Correct Ans ✓✓ spreads risk among members of a
larger population (premiums based on utilization experience of the entire
population in the same type of insurance)
Adjusted Community Rating Correct Ans ✓✓ (Modified Community
Rating): price differences take certain demographic factors into
account(age, gender, geography, family composition) while ignoring
other risk factors
Cost Sharing Correct Ans ✓✓ insured individuals pay a share of
premiums via payroll deductions or out-of-pocket costs
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