Deck 11: Health Care Financing

Question 1

When is health care spending projected to increase by 4.9 percent due to more consumers being covered by employer-sponsored health insurance during an economic recovery?

A) 2010
B) 2014
C) 2015-2020
D) 2011-2013

Answer 1

2011-2013

Question 2

For the next how many years is federal spending on health care projected to continue to increase?

A) Through the next 10 years
B) Through the next 40 years
C) Through the next 20 years
D) Through the next 5 years

Answer 2

Through the next 40 years

Question 3

Which of the following is NOT true regarding the uninsured?

A) Over one-third are not poor.
B) Most are employed.
C) A majority of the uninsured are poor.
D) Most are unemployed.

Answer 3

Most are unemployed.

Question 4

When will 22.9 million new people be able to purchase insurance through plans established by the Affordable Care Act of 2010?

A) 2010
B) 2014
C) 2015-2020
D) 2011-2013

Question 5

When did health care spending grow at a historic low, with fewer people demanding health care services due to lost insurance coverage through unemployment?

A) 2010
B) 1980
C) 1990
D) 2000

Question 6

The government is responsible for how much of all health care spending in the United States?

A) More than half
B) About three-fourths
C) One-fourth
D) About two-thirds

Question 7

What happens if the national debt becomes too large?

A) The Treasury prints new money, adding to national "coffers."
B) Hospitals are closed to save funds.
C) It increases the probability of a financial crisis.
D) Nothing happens.

Question 8

Which of the following entities is NOT reimbursed by most medical health insurance companies?

A) Physician
B) Hospital
C) Consumer
D) Nursing home

Question 9

Which of the following is NOT a reason for the increase in purchasing of private health insurance?

A) Real income has decreased over time.
B) Health insurance as a fringe benefit of employment has increased.
C) Health insurance is more convenient than paying out of pocket.
D) Providers are reimbursed for their services.

Question 10

Why are increases in health care spending important to track?

A) They make it easier to predict life expectancy.
B) They should result in a commensurate improvement in the health status of the United States population.
C) They indicate a need for research and development
D) None of the above

Question 11

Most physicians in the United States are reimbursed through what type of system?

A) Fee-for-service
B) Resource-based relative value scale
C) Self-insurance
D) None of the above
Completion
Complete each statement.

Question 12

DRGs affect length of stay because hospitals can and do discharge patients to their home or long-term care (LTC) "quicker and ______."

Question 13

Which of the following is NOT a classic principle of insurance?

A) The definition of an insurable event is one where the financial risk is significant.
B) The risk or the probability of occurrence is measurable for a group.
C) The occurrence of the event is infrequent.
D) Service is desirable by the patient.

Question 14

What payment method reimburses the provider after health care services have been delivered to the consumer?

A) Self-insurance
B) Retrospective reimbursement
C) Retroactive insurance
D) Coinsurance

Question 15

What is the primary purpose of RBRVS?

A) To reevaluate the work performed by all physicians and caregivers
B) To reevaluate all procedure codes and set payment levels, while accounting for costs
C) To reevaluate the costs of training and malpractice insurance costs
D) To reevaluate all procedure codes and set payment levels, without consideration for costs

Question 16

Who is the gatekeeper under managed care and prospective payment systems?

A) Primary care physician
B) Consumer
C) Employer
D) Insurance company

Question 17

When is health care spending expected to grow at approximately 6.2 percent per year?

A) 2010
B) 2014
C) 2015-2020
D) 2011-2013

Question 18

A provision of the __Act of 2010 will provide incentives to employers to offer plans with lower premiums and higher cost-sharing requirements.

Question 19

A __is the gap between government revenues and government expenditures in a fiscal year.

Question 20

Which of the following is NOT a strategy used by insurance companies to attempt to shift the cost of care to patients and protect against moral hazard?

A) Copayments and coinsurance
B) Deductibles, or a dollar amount paid by the insured before insurance begins to pay for the services
C) Premiums
D) Exclusions for such services as cosmetic surgery other than to repair damage from an illness or an accident

Question 21

Based on the data, health care spending is expected to continue to increase above the rate of __for the foreseeable future.

Question 22

Match the term with the appropriate definition or description:
Sharing of expenses after the deductible

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 23

__rating is coverage of different groups in a defined service area or community at the same cost.

Question 24

The federal government issues Treasury __as a form of borrowing money from investors.

Question 25

A __schedule is a contractual arrangement between the provider and the payer regarding reimbursement for services.

Question 26

The customary, ______, reasonable (CPR) method is used to determine reimbursement rates for physicians.

Question 27

The accumulation of yearly deficits is called the ______.

Question 28

In the long term, a national debt that steadily increases is __for the United States economy.

Question 29

The primary reason why uninsured persons report that they are uninsured is the __of health insurance.

Question 30

Match the term with the appropriate definition or description:
A set amount of money given to physicians for each person who enrolls in their practice prior to the provision of any care

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 31

Match the term with the appropriate definition or description:
Funded from three primary sources: general revenues, payroll tax contributions, and premiums paid by beneficiaries

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 32

Match the term with the appropriate definition or description:
A fixed dollar amount paid by the insured for each type of service

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 33

___rating is based on the risk factor of the individual groups.

Question 34

Match the term with the appropriate definition or description:
More likely to encounter barriers to both receiving care and paying for it due to lack of insurance

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 35

__discrimination is a way to maximize profits by charging each group the most it can pay.

Question 36

__is an approach used by employers who are large enough to assume the financial responsibility for the health care costs of their workers.

Question 37

Match the term with the appropriate definition or description:
Employer deposits and other dollars set aside to insure against a catastrophic illness

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 38

Increased out-of-pocket expenses for patients usually mean decreased __of health care services.

Question 39

Match the term with the appropriate definition or description:
Maximum set amount of a specific benefit that accrues over a person's entire life

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 40

Match the term with the appropriate definition or description:
Have insurance coverage but do not have comprehensive coverage

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 41

Match the term with the appropriate definition or description:
Health care costs are lower for an employed group of individuals because working individuals are more likely to be in good health simply because they are able to work.

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 42

Match the term with the appropriate definition or description:
Explain why it is more likely that Americans will have health insurance that covers hospital, surgical, inpatient medical, and outpatient diagnostic services than other types of health insurance that cover outpatient physician, dental, and prescription services

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 43

Match the term with the appropriate definition or description:
A problem in which the high-risk enrollees with high health care costs drive out the low-risk persons, or those with low health care costs

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 44

Match the term with the appropriate definition or description:
Government program to provide coverage for the poor and disabled

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 45

Match the term with the appropriate definition or description:
The patient's portion of the cost of medical care

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 46

Match the term with the appropriate definition or description:
Rates based on risk factors

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 47

Match the term with the appropriate definition or description:
A system in which an employer or individual pays a premium to the insurance company; the patient seeks care as needed; the provider sends the insurance company a bill

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 48

Match the term with the appropriate definition or description:
A phenomenon where individuals who have health insurance tend to use more health services than those who do not

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 49

Match the term with the appropriate definition or description:
A system that spreads this risk more broadly because everyone in the community pays the same amount for insurance

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured

Question 50

Match the term with the appropriate definition or description:
Differences in access to care

A)adverse selection
B)capitation
C)classical principles of insurance
D)coinsurance
E)community rating
F)copayment
G)deductible
H)disparities
I)fee-for-service
J)health care savings accounts
K)healthy worker effect
L)individual or differential rating
M)lifetime cap
N)Medicaid
O)Medicare
P)moral hazard
Q)underinsured
R)uninsured