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econ 5333 exam 2 quiz's

Terms in this set (25)

Texas had the highest percentage of uninsured people in the country as of 2015, and it chose not to expand medicaid under the ACA. T or F
True
The affordable Care Act insurance exchanges resemble Medicaid more than was intended; they have attracted more low income people eligible for subsidies than expected and fewer middle income people than expected. T or F
True
Health Insurance companies have been disappointed that the mandate to buy insurance has not been enforced more effectively. T or F
True
After the ACA became law, when the number of uninsured was at an all time low, approximately how many people had become insured?
20 million
what are ways in which the ACA has been funded ?
About 1/4 of costs are offset by added taxes on medical device makers and drug companies.
Families with incomes above 250,000$ a year pay more in Medicare payroll taxes.
About 1/2 the costs are offset by projected savings in Medicare payments to insurers and hospitals.
According to the article "Obamacare appears to be making people healthier", those in states where Medicaid did expand under the ACA were less likely to postpone care or avoid taking prescribed drugs because of the cost and were less likely to be struggling with a medical bill, compared to those in Texas. T or F
True
According to the podcast, about _____% of those buying insurance on the ACA exchange receive subsidies to make insurance coverage more affordable.
85
According to the podcast, after the ACA passed, many assumed that small businesses were no longer going to offer insurance to employees and would instead send people to the ACA exchanges. This did not happen to a large extent and led to increased adverse selection in the exchanges. T or F
True
Historically, hospital productivity has grown much quicker than productivity in other sectors like retail, wholesale, transportation, agriculture, and durable goods. T or F
False
an example of low value care would be ?
A scan that fails to yield an improvement in detection of any type of tumor.
what are reasons why low value care occurs ?
Many doctors operate under a fee for service compensation scheme, which incentivizes the ordering of tests and procedures.
A back pain specialists hasnt kept up with the latest research and is still offering tests and scans that have shown to not be helpful.
A patient demands a particular test or threatens to go to another doctor, so the doctor gives in.
About 1/2 the ACA cost was to be covered by projected savings in Medicare payments to insurers and hospitals. Research has shown that hospitals have become more productive as growth in Medicare reimbursements has slowed. T or F
True
what mechanism gives ACO members (hospitals, doctors, and other healthcare providers) the incentive to provide high value care (high quality at a reasonable cost)?
ACO members are given a portion of the savings they generate for Medicare, if they also meet quality goals.
In some hospital systems, measuring labor costs by using a stop watch to determine how long processes and procedures take has led to hiring lower cost scribes, instead of doctors, to record notes in the emergency room. T or F
True
Centers of excellence (COE) are healthcare institutions that offer many different types of care in one place, but do not necessarily specialize in a particular field. T or F
False, they have unusually high concentrations of expertise, talent, and resources relating to one or more care disciplines.
two years into the Walmart Centers of Excellence program, an unexpected pattern emerged: the biggest savings and improvements in care are coming from avoiding procedures that shouldn't be done in the first place. T or F
True
Overuse of low value services in Mcallen Tx was due to a profit maximizing medical culture, in which many doctors also owned stakes in home health care agencies, surgery and imaging centers, and the local for profit hospital. T or F
True
After the article "The Cost Conundrum" about McAllen Tx caused a lot of drama and after the passage of the ACA, McAllen was able to turn around runaway costs through the use of ACO's, saving Medicare $26 million, with 60% of that going back to healthcare providers. T or F
True
According to the blogspot "4 key characteristics of successful integrated managed care models", integrated managed care models generally do well when?
Hospitals and health systems establish "true partnerships" with a group of physicians. In urban densely populated areas.
when a pharmaceutical has a patent on a drug, the amount of the drug produced will be higher than in a competitive market. T or F
False
According to "the real reason the EpiPen and other offpatents are so expensive" what factors contribute to high or increasing prices for drugs that are not under a patent?
Low profit margins on some drugs, preventing competition.
Consolidation in the pharma industry.
FDA regulations and backlog.
according to the author of "prizes, not patents" the patent system restricts knowledge and makes important drugs unaffordable for those who do not have insurance. T or F
True
According to "I am paying for your expensive medicare" we all pay for an exorbitantly priced drug even if we don't take the drug. The high costs are hidden in increasing insurance premiums. T or F
True
according to Steven Brill, _______________ was able to pass congress because it did nothing about prices.
Obamacare
According to "The bitter pill" as hospitals are consolidating by buying doctors practices and other hospitals, insurance companies lose bargaining power and often end up negotiating over chargemaster discounts rather than using Medicare reimbursements as a starting point. T or F
True
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