RMIN4000 EXAM BROWN #4 NOTES FOR THE EXAM with Complete Solutions
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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
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