Questions and Answers of Business Economics And Finance

One way health care markets differ from classic free markets is that in a classic free market, oversupply decreases demand and enhances cost and quality competition. True/False
In health insurance, a deductible is another term for a copayment. True/False
In fee-for-service reimbursement models, providers have little incentive to limit treatment or consider the cost of treatment. True/False
Insurance companies are also called third-party payers. True/False
In a classic free market, consumers bear the financial consequences of their decision to purchase a product or use a service. True/False
Develop a presentation for your peers that details the ways in which the decision to use health care is similar to other decisions and the ways it is different. Explain the relationship of these to
Define the following key terms:Maximum out-of-pocket limits Self-rationing Small-area variation Supplier-induced demand Third-party payer Moral hazard
To what extent should providers be accountable for the cost and outcomes of care that they recommend? Provide a rationale for your answer.
To what extent should patients feel a financial impact when they seek care? How can needed care best be separated from unnecessary care? Provide a rationale for your answer.
Imagine you are a 62-year-old female with multiple chronic conditions.For you, what are the pros and cons of a lower monthly insurance premium with higher cost sharing, versus a higher monthly
Imagine you are a healthy 30-year-old male. For you, what are the pros and cons of a lower monthly insurance premium with higher cost sharing, versus a higher monthly premium with lower cost sharing?
Nursing skills valued in a reformed health care system include A. Care process reengineering B. Care coordination C. The use of data D. All of the above
Fee-for-service reimbursement A. Creates financial incentives to reduce avoidable health care utilization B. Creates financial incentive to coordinate care C. Both A and B D. Neither A nor B
Global budgets in health care A. Create financial incentives to reduce avoidable health care utilization B. Create financial incentives to coordinate care C. Both A and B D. Neither A nor B
ACO shared savings programs A. Create opportunities for nurses to influence the value of care provided through care coordination and care redesign B. Require that quality thresholds be met before
One of the ways ACOs differ from HMOs is A. Generally there are no gatekeepers in ACOs B. ACOs do not limit beneficiaries’ access to health care or choice of providers C. Both A and B D. Neither A
In addition to employing physicians and nurses, patient-centered medical homes rely on A. Community health teams B. Health coaches C. Both A and B D. Neither A nor B
Linking reimbursement to achievement of quality metrics A. May result in better health care outcomes B. May create metric-driven behavior that creates metric-driven patient harm C. Both A and B D.
Fee-for-service reimbursement A. Creates strong incentives for care coordination B. Contributes to the nation’s difficulty containing health care costs C. Both A and B D. Neither A nor B
Bundled payments create a financial incentive to coordinate care across the entire episode of illness or condition management. TRUE OR FALSE
Under fee-for-service reimbursement, nurses are often viewed by management as a labor cost. TRUE OR FALSE
Hospital global budgets provide hospitals with a predictable revenue outlook. TRUE OR FALSE
The term superutilizer refers to individuals who use a disproportionally high amount of health care. TRUE OR FALSE
An ACO may be defined as a group of providers who agree to be accountable for the cost and quality of the care provided. TRUE OR FALSE
The optimal configuration of team members in a patient-centered medical home has been defined and is firmly supported by empirical evidence. TRUE OR FALSE
The Affordable Care Act defined potential members of the community health team. TRUE OR FALSE
Another term for patient-centered medical homes is advanced primary care. TRUE OR FALSE
The acronym P4P refers to a form of health care financing termed preferred for payment. TRUE OR FALSE
All forms of reimbursement create the same treatment incentives and disincentives. TRUE OR FALSE
Develop a presentation to explain payment reform models to your peers, including a description of how each model works, its value to society, and its strengths and weaknesses.
Define the following key terms:Accountable care organization Benchmarking Global budget Patient-centered medical home Pay for performance Risk adjusted Shared savings program
What are the potential unintended consequences of each of the payment reform models?
In which payment mode would you prefer to be? Provide a rationale for your response.A. A 28-year-old with poorly controlled type 1 diabetes B. An elder with multiple chronic conditions C. A pediatric
In which of the following health insurance plans, would you pay the least out-of-pocket when using health services?A. Bronze B. Silver C. Gold D. Platinum E. In each of these, you would pay the same
In which of the following health insurance plans, would you pay the most out-of-pocket when using health services?A. Bronze B. Silver C. Gold D. Platinum E. In each of these, you would pay the same
The Patient Protection and Affordable Care Act had as a goal enhanced access to health insurance. Which of the following mechanisms were used? Select all that apply.A. Insurance companies can no
Which of the following statements about the Patient Protection and Affordable Care Act of 2010 is TRUE?A. As passed, included an individual mandate, which was deemed unconstitutional in 2012.B. As
Which of the following statements about the Patient Protection and Affordable Care Act of 2010 is NOT true?A. It represents the most sweeping health reform law since the introduction of Medicare and
The Patient Protection and Affordable Care Act of 2010 replaced Obamacare. TRUE AND FALSE:
The Patient Protection and Affordable Care Act of 2010 remains intact exactly as passed. TRUE AND FALSE:
The Patient Protection and Affordable Care Act of 2010 required Medicaid expansion, which was deemed unconstitutional by the U.S. Supreme Court in 2012. TRUE AND FALSE:
The Patient Protection and Affordable Care Act of 2010 requires that a person select a bronze plan on the exchange to receive a subsidy. TRUE AND FALSE:
The Patient Protection and Affordable Care Act of 2010 is a form of socialized medicine. TRUE AND FALSE:
Develop a presentation detailing the insurance-related elements of Patient Protection and Affordable Care Act.
Interview peers, coworkers, or family on what they know about the Patient Protection and Affordable Care Act (ACA). What do they know about Obamacare? How many elements of the ACA listed in Box 3.1
Define the following key terms:Individual mandate Employer mandate Metal levels Essential benefits Cost sharing Cost-sharing reduction Rating factors Rating bands Reinsurance Risk corridors Risk
What strategies offer important corrective steps?
Why do some Americans support the Patient Protection and Affordable Care Act and others so strongly oppose it?
What might the U.S. health care system look like if Richard Nixon’s proposal had become law?
As originally enacted, the Affordable Care Act financing model included A. Public funding through taxes B. Employer insurance mandates C. Individual insurance mandates D. All of the above
Hospital reimbursement via diagnosis-related groups (DRGs)A. Financially incentivizes long hospital stays B. Creates the potential for premature hospital discharge of patients C. Removes incentives
Medicare A. Began paying hospitals prospectively by diagnosis-related groups (DRGs) starting in 1983 B. Is publicly funded through taxes and beneficiaries cost sharing C. Both A and B D. Neither A
The enactment of Medicare and Medicaid within fee-for-service reimbursement A. Fueled rapid growth in the health care industry B. Fueled unbundling of services, so that each piece of health care
Employer-based insurance A. Grew dramatically due to wage and price controls during World War II B. Is a pretax fringe benefit C. Excludes retired and unemployed individuals D. All of the above
Which of the following is not true: As a result of the Flexner Report, A. Medical education became longer and more expensive B. Medical education opportunities for women and people of color increased
Holistic models of health A. Consider health to be the absence of disease B. Consider the human mind–body interplay and the interplay of the mind–body with physical, social, and spiritual
Capitated reimbursement within health maintenance organizations(HMOs) creates the same treatment incentives as fee-for-service reimbursement. TRUE OR FALSE
Hospital nursing services have largely remained bundled into hospital room charges. TRUE OR FALSE
Medicare and Medicaid were enacted in 1965 as a potential solution to the unintended consequences of employer-based health insurance. TRUE OR FALSE
National health insurance was considered for inclusion in the original Social Security Act during the administration of President Franklin D. Roosevelt. TRUE OR FALSE
Blue Shield was established to ensure physician reimbursement for care provided. TRUE OR FALSE
The American Hospital Association established Blue Cross, which enabled insurees to have a choice of hospitals. TRUE OR FALSE
The first U.S. employer-based health insurance was offered to Dallas schoolteachers for $6 a year. TRUE OR FALSE
In response to the Flexner Report, nursing became a more highly compensated profession, with resulting increased social status for nurses. TRUE OR FALSE
In the early 1900s, hospitals were the most highly preferred settings for medical treatment. TRUE OR FALSE
One characteristic of the biomedical model is that the concept of health includes physical, mental/emotional, spiritual, and social aspects. TRUE OR FALSE
Develop a presentation on the pros and cons of the three financing approaches in the Affordable Care Act.
Prepare a short presentation on the evolution of the health care system in the United States, from the early 1900s to the present day.
Define the following key terms:Capitation Health maintenance organizations Payment reform Per diem reimbursement Retrospective reimbursement Throughput Unbundled services Perverse incentives
The pandemic clearly underscored deficiencies in the U.S. health care financing and delivery system. What strategies offer important corrective steps?
What are the strategies that enable universal financial access to health care? Is one strategy better than others? Why or why not?
Why do some Americans support Medicare, yet oppose governmental involvement in health care?
What might the U.S. health care system look like if the Flexner Report was never written?
Which of the following payer mixes would provide the least reimbursement?A. 60% Medicaid, 20% uninsured, 5% commercial insurance, 15%Medicare B. 60% commercial insurance, 20% Medicare, 5% uninsured,
Which of the following payer mixes would provide the most reimbursement?A. 60% Medicaid, 20% uninsured, 5% commercial insurance, 15%Medicare B. 60% commercial insurance, 20% Medicare, 5% uninsured,
The term payer mix refers to the proportion of reimbursement a provider receives from commercial insurance, Medicare, and Medicaid.Payer mix is important because A. Organizations are reimbursed by
Medicare A. Is a publicly financed health care coverage for most Americans 65 years of age and older B. Is financed through a combination of state and federal taxes C. Both A and B D. Neither A nor B
In the United States, health care is financed via A. Taxes B. Insurance premiums C. Patients, as an out-of-pocket expense D. All of the above
The cost experience of an insurance pool includes both the medical trend and the pharmaceutical trend. TRUE OR FALSE
The cost experiences of an insurance pool determines the next year’s premium increase. TRUE OR FALSE
Nonprofit insurance companies have shareholders and an organizational mission that includes returning dividends to shareholders. TRUE OR FALSE
In health care, a payer mix of 80% Medicare will reimburse providers more than a payer mix of 80% commercial insurance. TRUE OR FALSE
In experience rating, insurance companies charge ill individuals more for health insurance than well individuals. TRUE OR FALSE
There is no difference in the amount of reimbursement providers receive from different payers. TRUE OR FALSE
Commercial insurance companies in the United States are always nonprofit organizations. TRUE OR FALSE
The best overall predictor of health status of a population is access to health care. TRUE OR FALSE
Health economics is a distinct branch in the field of economics. TRUE OR FALSE
In health care, financing and reimbursement refer to the same thing. TRUE OR FALSE
Develop a short presentation to describe how U.S. health care is financed.
You are asked to present to Nursing Grand Rounds. The organizers share that nurses seem to be confused about how insurance rates are determined as well as the concept of payer mix. Develop your talk
Define the following key terms:Behavioral economics Classic free market Commercial insurance Community rating Experience rating Governmental payers Health economics Health care financing Keynesian
What are the pros and cons of risk-rated insurance and communityrated insurance? Which is better and why?
What is the best way to finance health care? Why?
What is the role of government in the financing of U.S. health care?
Who pays for health care in the United States? How?
What is health economics? How is it similar to and different from other branches of economics? How does it differ from health financing?
What Are Social Determinants of Health?
What Is a Traunch?
What Is an Elective Procedure in Health Care?
Develop a learning agenda for enhancing personal political influence.

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