MHA 707 Study Guide for Exam 3 (C)CORRECT QUESTIONS & ANSWERS(SCORED A)
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Course
MHA 707
Institution
MHA 707
What is Asymmetry of information? Why is it important in healthcare? - ANSWER A gap in knowledge from person/group to another. Patient knowledge vs Physician knowledge vs insurance knowledge.
What is non-marketability of risk? - ANSWER inherent of medicine and medical practice. Cannot put a pr...
MHA 707 Study Guide for Exam 3
(C)CORRECT QUESTIONS &
ANSWERS(SCORED A)
What is Asymmetry of information? Why is it important in healthcare? - ANSWER A gap in
knowledge from person/group to another. Patient knowledge vs Physician knowledge vs insurance
knowledge.
What is non-marketability of risk? - ANSWER inherent of medicine and medical practice. Cannot put
a price on it
Moral Hazard - ANSWER people behaving differently when you know someone else is taking the risk
(induced demand- procedures when deductible has been met).
Adverse selection - ANSWER the sicker people likely want more insurance (the healthier the less)
Pooling risk - ANSWER sharing risk proportionately among many is a basic insurance concept. The
hope is that premiums of the less sick will cover the more sickly population.
What is PHC? - ANSWER (a subset of HCE) includes all medical goods and services that are used to
diagnose, treat, and prevent health problems in a specific person.
How much $$ is spent on HC in US? Per capita and % of GDP? - ANSWER $3.49trillion, 17.9% GDP
and $10,739 per capita.
Percentage spent in hospitals? - ANSWER 33%- largest share of NHE
,Percentage spent on Doctors? - ANSWER 26%- second highest share of NHE
Percentage spent on drugs? - ANSWER 9.5%-10.5%- third highest share of NHE, 10% per Bost
Chronic disease? - ANSWER defined broadly as conditions that last 1 year or more and require
ongoing medical attention or limit activities of daily living or both.
(i.e. heart disease, cancer, and diabetes)
What percentage of NHE shares are spent on chronic disease? - ANSWER 90%- chronic conditions
are also considered some of the most preventable of all health conditions (includes mental health)
What percent of top utilizers account for 50% of spending in HC? - ANSWER 5% of top utilizers
What are personal behaviors and how do they fit into the leading causes of death? - ANSWER Half of
the mortality from 10 leading CODs attributed to personal behaviors (i.e. tobacco use, obesity, poor
diet, substance misuse/abuse)
90% of americans have 1 risk factor - ANSWER 52% have 2 or more highest proportion in
impoverished and racial/ethnic minorities.
What percent of Americans were hospitalized in 2018? - ANSWER only 6.7%
How many US people are uninsured? - ANSWER 26.4M
What portion of Americans under age 65 are covered by private health insurance? - ANSWER about
66% (about 8% of people under the age of 65 were uninsured/self pay in 2019)
What is cost-plus reimbursement? - ANSWER is how hospitals describe payment received for
services they have already provided. The organization providing the services tracks all the cost
associated with each customer and then asks to be paid that amount. This type of contract specifies
that the organization will be reimbursed for actual cost plus an additional percentage of those costs
(includes built in profit)
Fee for service - ANSWER common method when the scope of work is clear to both sides
, oldest method of payment for health services
inefficiency costs the provider/ bad advice costs the patient
provider centric system
still a predominant system of paying physicians dentists, and private practice
Capitation - ANSWER fixed prepayment per person to the health care provider for an agreed-on
array of services (per member/per month). Payment is the same no matter how many services or
what type of services each patient gets. Encourages the selection of the least expensive treatments
and promotes services likely to result in the lowest overall cost - may put the physician at odds with
patient
What is value-based payment? - ANSWER Payment model in which provider is rewarded for the
value delivered. most often used when value is easy to measure and indisputable [This is debatable!
At least the goals are set in advance of the care given - usually].
MCO - ANSWER Managed care organizations- distinguishing feature of managed care is ability to
steer members to preferred providers, negotiate rates and manage utilization (limit care).
PPO - ANSWER preferred provider organization-is an arrangement with an insurance company in
which a network of medical professionals and facilities provide services at reduced rates.
HMO - ANSWER Health Maintenance organization- is a network or organization that provides health
insurance coverage for a monthly or annual fee.
POS - ANSWER Point of service- is a managed-care health insurance plan that provides different
benefits for using in-network or out-of-network providers.
What level of government monitors and regulates private healthcare insurance, other than
Medicare? - ANSWER US department of health and human services
NHE-HCE - ANSWER amount of investment in the medical sector of economy
What level of government licenses doctors? - ANSWER State medical board
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