RMIN4000 EXAM BROWN #4 NOTES FOR THE EXAM with Complete Solutions
6 views 0 purchase
Course
RMIN4000
Institution
RMIN4000
RMIN4000 EXAM BROWN #4 NOTES
FOR THE EXAM with Complete Solutions
Effects of Third-Party Healthcare Transactions - (1)
Patient/Insured/Employee
(2) Healthcare Providers
(3) End Result of Health transaction
Patient/Insured/Employee - - lower "user prices" of healthcares
- less incentive to ac...
Effects of Third-Party Healthcare Transactions - ✔✔(1)
Patient/Insured/Employee
(2) Healthcare Providers
(3) End Result of Health transaction
Patient/Insured/Employee - ✔✔- lower "user prices" of healthcares
- less incentive to act as a traditional consumer
- increases moral hazard
Healthcare Providers - ✔✔- payment system based on fee for service
- for service (x-ray, flu test, etc) a separate fee is paid
End Result of Health Transaction - ✔✔over-utilization of healthcare =
patient with insurance + providers paid by FFS
Global Contributions to High Cost - ✔✔- advances in technology
- aging population
- behavioral factors
- third-party financing
,US Contribution to High Costs - ✔✔- employer-sponsored health insurance
- fee for service providers
- high administration cost
- lack of transparency in cost and quality
- cost-shifting in medicare and Medicaid
- defensive medicine
Major defects in U.S. healthcare system - ✔✔- rising healthcare
expenditures
- large number of uninsured
- considerable waste and inefficiency
- harmful insurer practice
Affordable Care Act (ACA) - ✔✔Federal legislation passed in 2010 that
includes a number of provisions designed to increase access to healthcare,
improve the quality of healthcare, and explore new models of delivering
and paying for healthcare.
Guaranteed Issue (under ACA) - ✔✔Insurers cannot deny coverage due to
preexisting conditions
Community Rating (Under ACA) - ✔✔Insurers may only rate on a few
variables
, Minimum Standards for Health Insurance (under ACA) - ✔✔- cannot drop
policyholders
- dependents can remain on policy until the age of 26
- no annual of lifetime limits
- coverage for essential health benefits
- individual mandates
- health insurance
- subsidies for low income individuals/families
- employee mandate
- increases adverse selection
Individual Mandate - ✔✔Buy health insurance or pay a penalty
Employer Mandate - ✔✔Firms with 50+ employee must provide health
insurance or pay a fine
- requires health insurers to pay 85% of premiums
- example: $10 million premiums, $8.5 million claims
Copayment - ✔✔a flat amount the insured must pay for certain benefits,
such as an office visit or generic drugs
- does not count toward annual deductible
- policies may include individual/family deductibles
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller JOSHCLAY. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.99. You're not tied to anything after your purchase.
