In the United
States, approximately __% of the population
obtains their health insurance from their employer; this is about ___ million
Approximately __% of the population receives public health
care (Medicaid, Medicare and SCHIP).
Some problems with
health care in the United
States is the only industrialized nation
that does not have national health insurance.
Approximately __% (__ million) of all Americans are uninsured; approximately __% of the uninsured are
Health care costs in
are out of control rising well above the rate of ______.
Health care costs in
are out of control rising well above the rate of inflation.
Reasons for the high cost of health care are?
Tries to balance the need for cost containment with access
and quality of service.
Four major managed care plans?
Prepaid managed care networks that guarantee patients a range of health care services for a fixed monthly fee. ____'s are based on a "_______" payment system rather than a fee-for-service system. Under this type of payment system, the cost and reimbursement rates are based on the number of people served, not the services provided.
Under ____s, employers or their insurance carriers reimburse
a higher percentage of services – for example, hospital care – if employees
used designated hospitals or other providers.
If patients venture outside the network, they must pay a
greater share of cost.This developed as a result of competition among healthcare providers who want to keep their patient counts high and are willing to negotiate lower fees to do so. This type provides a volume discount.
____ plans combine features of the ____ and ____ models.
This is a managed care system in which a primary care
physician controls access to the rest of the network.
Individuals can see other providers without the permission
of their primary care physician, but at an increased rate.
____s are large groups of health professionals that join
together and accept the financial risks of covering their patients’ health care
needs. These are run by the medical provider themselves.
Medicare has also tried to contain costs through
the use of_____.
Created in 1983, the ___ system is a prospective reimbursement
method in which the federal government specifies in advance what it will pay
hospitals for the treatment of 487 different illnesses.
This system provides a treatment and diagnostic
classification scheme, using the patient’s medical diagnosis, prescribed
treatment, and age as a means for categorizing and defining hospital service.
In other words, this system determines the length of a
typical patient’s hospital stay and reimburses hospitals only for that period
According to lecture, what three health care system
changes are considered mandatory to institute an effective universal health
care system in the United States?