The A's have it
This moved the US healthcare system closer a model of distributive justice.
What is the Affordable Care Act?
This ratio kicks in after a patient has met their deductible.
What is coinsurance?
Your HMO is likely to charge less for doctors that are this than doctors that are not.
What is in-network?
Before one’s insurance kicks in, a person must pay this; an amount which has more than quadrupled in the past decade.
What is a deductible?
When your insurer adds some amount to customers’ premiums to cover salaries, utilities, and other bills, they are covering this.
What are administrative expenses
An example of this phenomenon is when Herkie visits the doctor when he has a slight cough just because he has health insurance; costing the insurer more money.
What is moral hazard?
This broad category of health care delivery was instituted in part to reign in doctors from providing unnecessary care.
What are managed care plans?
If you are able to get insurance no matter what your health status, you are benefiting from this type of policy.
What is a guaranteed issue?
If two people are charged different premiums because one smokes and the other does not, the insurer is following this vision of justice.
What is actuarial fairness?
This is the broad term for when insurers do not pay the full amount of care, but instead leave some costs to the patient.
What is cost-sharing?
If a doctor orders unnecessary medical tests it is a sign of this, one of the factors that explain high American health care costs.
What is overutilization?
If your insurance plan covers everything but diabetes treatments it may be because you have one of these applied.
What is a pre-existing condition exclusion?
If Herkie’s group health insurance card is from ABC Insurance, but there is a note on it that says “ABC is not responsible for any health care costs”, ABC is mostly likely this.
What is a third-party administrator?
When a provider is given a lump sum to perform a health procedure it is called this.
What is capitation?
Daily double bonus: What are the benefits and downsides to capitation as a method of price control?
When an insurer pays for each individual procedure or visit at one time, it is called this.
What is fee-for-service?
You may be able to tell that a company’s insurer uses this type of rating system if the group’s premiums rise the year after multiple staff members are diagnosed with cancer.
What is experience rating?
These are collections of claims and payment information about healthcare services that are meant to provide transparency about price and quality information.
What are all-payer claims databases?
If a self-insured employer has one year where multiple employees undergo major surgeries, they may wish they had purchased this.
What is stop-loss reinsurance?
Many doctors who used to work in independent offices or physician groups are now being bought up by large healthcare systems, a sign of this in the health care system.
What is consolidation?
This may occur if an insurer advertises their health plan in Runners Weekly instead of Couch Potato Periodical.
What is favorable selection?