Things We'd Sooner Forget
In 1945 this accounted for 4% of the U.S. Gross Domestic Product (GDP), now it is more like 18%.
What is/are health care costs? (or medical care spending)
Enacted in 1965, this federal health insurance program today covers 60 million Americans at a cost of over $700 billion a year, including those with end-stage renal disease and permanent disabilities.
What is Medicare?
This type of insurance, exemplified by Medicare and Social Security, is characterized by government involvement, compulsory participation, and earned benefits.
What is social insurance?
Theamount you pay each year for covered health care services before your insurance plan starts to pay.
What is deductible?
The form of payment about which George Bernard Shaw wrote, “the more appalling the mutilation, the more the mutilator is paid”.
What is fee for service?
A group that in the 20thcentury persistently and repeatedly resisted government sponsored health care programs in the United States.
What is the AMA?
The German Chancellor who instituted the first social insurance program in 1883.
Who is Prince Otto Eduard Leopold von Bismarck? (or just Bismarck)
The type of insurance in which, in exchange for regular payment of a premium, an insurance company compensates the insured party following a loss.
What is indemnity insurance?
A fixed amount ($20, for example) you pay for a covered medical service after you've paid your deductible, these are often higher for visits to a specialist than to a primary care doctor.
What is a copayment (coinsurance also acceptable, the difference is coinsurance is a percentage, for example 20% rather than $20)?
A measure of the time, effort, skill, intensity, complexity, stress, and practice expenses associated with different medical services, this measure is used by Medicare and many private insurers as the basis to pay doctors.
What is an RVU? (or relative value unit)
A term with no specific meaning used historically to refer to any efforts to increase the organization of or control over medical practice, including well-baby programs, private insurance, public insurance, and the Affordable Care Act.
What is socialized medicine?
The first large-scale private coverage scheme for hospital care, this plan grew out of hospitals’ efforts in Sacramento and elsewhere to offer prepaid service benefits that included a choice of all hospitals in a given community.
What is Blue Cross?
Insurers worry about this happening when their health insurance plans attract a disproportionately sick population.
What is adverse selection?
This government health care program, which covers many low-income Americans, is an example of the public assistance or welfare approach to financing medical care.
What is Medicaid?
A form of payment where physicians receive a set amount of money each year for a patient regardless of how many medical services patients use.
What is capitation?
The method used by insurance companies to charge higher premiums to groups of people who are more likely to be sick and need health care and lower premiums to those who are more likely to stay healthy.
What is experience rating? (or medical underwriting)
This decade is when private health insurance had its most explosive growth in the United States.
What are the 1940’s?
Networks of physicians and other providers that are held accountable for the cost and quality of the full continuum of care delivered to a group of patients. These networks have a financial incentive to hold down spending since they typically can receive a share of any cost savings achieved.
What is an ACO (or Accountable Care Organization)?
Under this system of pricing health insurance, the entire population of an area is charged the same premium, regardless of their health status.
What is community rating?
Enhanced primary care arrangements that emphasize access to care, care coordination, team-based care, and quality improvement.
What is a PCMH? (or Patient Centered Medical Home)
The tendency of insurance to change the behavior of insured persons so thatcoverage against a loss might increase risk-taking behavior—or in the case of health insurance, increase utilization of medical services—by the insured person.
What is moral hazard?
Enacted by Congress in 1935, this law created a federal program for old-age insurance but omitted any reference to health insurance.
What is the Social Security Act?
This represents approximately 8% of health care costs in the U.S. but 1% to 3% of health care costs in other high income countries?
What are administrative costs?
In 1971, this American president, a Republican, proposed a comprehensive health reform plan centered around a mandate on all employers to provide health insurance to their workers.
Who is Richard Nixon?
To the nearest trillion, the total amount of money the United States spent last year on medical care
What is $4 trillion? (we spent an estimated $3.6 trillion on medical care in 2018 or over $11,000 per person on average).