US Health Care Policy
Medicare and Medicaid were both created in this year under President Lyndon B. Johnson as amendments to the Social Security Act.
What is 1965?
This is the amount an insured person must pay for health care services before their insurance begins to pay.
What is a deductible?
Once a brand-name drug's patent expires, these competitors can enter the market and typically sell the same chemical compound at a much lower price.
What are generic drugs?
This type of care does not require an overnight stay.
What is outpatient care? (Will also accept ambulatory care!)
These non-medical factors -- like housing, income, education, and food security -- are widely considered to have a larger effect on health than medical care.
What are social determinants of health?
This is the most common type of health insurance coverage in the United States.
What is employer-sponsored health insurance (ESI)?
This managed care cost-control tool requires patients to get approval from their insurer before receiving certain services, procedures, or medications.
What is prior authorization?
The IOM's Crossing the Quality Chasm identified six aims for high-quality health care: safe, timely, effective, efficient, equitable, and this sixth aim.
What is patient-centered?
This is what happens to hospital prices when two hospitals merge.
What is "go up" or increase?
Michael Austin, COO of Universal Primary Care, said that Bradford, PA faces major shortages of this type of physician.
What are OB/GYNs?
This organization was a major impediment to Truman's plan for national health insurance.
What is the American Medical Association (AMA)?
This provider payment method incentivizes volume over value, because providers are paid more the more care they deliver.
What is fee-for-service?
This practice occurs when a branded drug manufacturer hands money to a generic company threatening to enter the market -- in exchange for that company doing nothing.
What is "pay-for-delay"?
This is the primary payer for long-term care in the United States.
What is Medicaid?
People under 65 can also qualify for Medicare if they have this specific health condition.
What is end-stage renal disease (ESRD)?
This Medicare program, sometimes called "privatized Medicare," allows beneficiaries to receive their Medicare benefits through private insurance plans.
What is Medicare Advantage (or Part C)?
In this type of managed care plan, enrollees must choose a primary care physician and obtain referrals to see specialists.
What is an HMO (Health Maintenance Organization)?
This landmark 1999 IOM report brought national attention to patient safety, estimating that up to 98,000 Americans die annually from preventable medical errors.
What is To Err is Human?
These non-physician providers are playing an increasing role in primary care.
What are nurse practitioners (NPs)? (Will also accept physician assistants, or PAs)
Often located in medically underserved areas (MUAs), these clinics provide care regardless of patients' ability to pay.
What are Federally Qualified Health Centers (FQHCs)? (Will also accept Community Health Centers, or CHCs)
This legislation, which took effect in 2022, protects patients from receiving large, unexpected bills when they unknowingly receive care from an out-of-network provider.
What is the No Surprises Act?
This is the term for the economic concept that explains why people may use more health care when they have insurance (because they don't pay the full cost).
What is moral hazard?
In a landmark 2003 RAND study on health care quality, researchers found that Americans received recommended health care this percentage of the the time.
What is 55%? (Will accept anywhere from 50-59%.)
This hospital metric represents the average number of inpatients receiving care each day.
What is the average daily census?
This is the name of Pennsylvania's health insurance marketplace, where residents can shop for ACA-compliant plans.
What is Pennie?