Exam 5: Insurance Contracts and Managed Care

Which of the following assertions about the uninsured is incorrect?

Medicare is the most important health insurer in the U.S because it insures the most people, followed by employer sponsored private insurance, privately purchased health insurance, Medicaid and other federal insurance programs.

A common criticism of HMOs, PPOs and other managed care organizations is that the sickest patients resist use of managed care because they are uncomfortable with the gatekeepers and managers involved in obtaining their health care.

The proportion of an insurance company's premium income spent on provision of treatments is called the

Which of the following statements about Medicare is false?

Medicaid is funded by a 1.45% tax on employers and a matching 1.45% tax on employees.

All of the following are examples of substituting cheaper forms of care for more expensive ones, except

The effect of either one of these two initiatives on consumers' welfare would be exactly the same.

When it comes to attempts of managed care to control costs, cutting prices is one of the most popular methods. Which of the following is not among the valid explanations of the rationale behind this practice?

The public perception of either one of these two initiatives, and the willingness to vote for either initiative, would be exactly the same.

Managed care organizations

Jayda receives a phone call from her doctor's office reminding her that it is time to bring her twelve year old son in for a wellness checkup. She is part of an HMO. How does one reconcile this unsolicited office visit with capitation, which has the goal of minimizing costs to HMOs.

A physician graduates from medical school and must decide whether to take a job as a junior member of a large group practice or work for an HMO directly. For the physician, a positive aspect of working for the HMO is

High deductible plans increase consumer awareness of costs of medical care by forcing them to pay for expenses up to a deductible amount. The negative aspect of this is that employees may not like having to spend extra time gathering information about price differences between providers.

Requiring patients to have psychological exams, echocardiograms, mammograms, and blood tests before undergoing bariatric surgery (an elective surgery which induces weight loss) is an example of

Explain why pharmacy benefits managers might be in favor of re-importation of prescription drugs from Canada to the U.S.

Your grandmother is admitted to the hospital with a heart attack at 8:00 a.m. By time you arrive for a visit at 4:30 p.m., the social worker is looking for you to schedule a meeting to discuss where your grandmother will go when she leaves the hospital. This is an example of

If Medicare significantly lowers its reimbursement rates to physicians, discuss the likely consequences of this event for all parties.

In 2012, U.S. spending on health care totaled almost 18% of GDP. Near term projections by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid (CMS) of the growth rate of national health care expenditures estimate that health care expenses will escalate to almost 20% of GDP within 10 years. Why is this issue important to the federal government? (Be sure to include the idea of opportunity cost.)

The size of private health insurance premiums depends on all of the following except