Why may cost differences across plans be partly due to enrollee selection? Low-risk users are less likely to require medical services All plans inherently cost the same to administer Plans can segment their market to attract low-risk users and avoid high-risk users High-risk users tend to choose plans with higher premiums for more comprehensive coverage
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- The size of the uninsured and underinsured population in the United States has become an indication of the access problems in the US healthcare system.TrueFalse Health economics can be defined as An examination of factors that impact healthcare An explanation of theories, models and tools that can be applied to understand costs, access, and quality One way to understand how best to compare and contrast alternatives Help healthcare leaders understand the costs and consequences of options All of the aboveWhat effects would joining a MCO have on your clinic regarding staffing, patient volume, and financial stability?What policies and procedures should be used by the MCOs to reduce costs for their clientele?For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amount of $21,313.50. Outlier threshold for Medicare is $25,800. (a) John admitted hospital A for pancreas transplant. The charges for John’s treatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How much payment hospital A would get from Medicare? (b) Bryan admitted hospital B for pancreas transplant. The charges for Bryan’s treatment was same as John, $128,000, but cost to charge ratio for Hospital B was 0.25. How much payment hospital B would get from Medicare?
- What is the effect of Certificate of Need (CON) on the economics of long-term care economic decision making and how is this different from that of a hospital?Insurance coverage has been shown to diminish the importance of time in the decision about how much medical care to seek and which providers to use. True OR FalseWhich of the following is NOT a healthcare good or service? A)Vaccine B)Patient advocate (social worker) C)Life insurance D)Privately purchased a knee brace
- describe Diagnostic Research DesignHealth insurance scams have resulted in (a) higher medical insurance costs (b)low quality medical technology (c)the failure of many health insurance companies (d)an increase in federal income taxH applied for a individual major medical policy. When H filed a claim within the first year of coverage and the underwriter noticed that the H's age on the claim form was different than what was listed on the application. The insurer will take which of the following actions regarding H's claim? A: Deny the claim and refund premiums B: Deny the claim, cancel the policy and keep all premiums C: Pay the claim in full and keep the policy as is D: Adjust the claim benefit amount to the insured's correct age
- Which method would you use to evaluate a new medication based only on the cost? Cost effectiveness analysis, cost utility analysis or a cost benefit analysis and why? How can you perform an economic review?How can the seven deadly sins of CRM failure be used to manage post-pandemic shopping?What is the true cost of going to the doctor? options: The amount you pay minus the amount your insurance covers (i.e. the amount you pay out of pocket) The amount you pay out of pocket, plus the worth of the time you lose while waiting, plus the travel cost, plus the increased risk of being infected with Covid-19 while at the doctor's office There is no cost if your insurance is good enough. The amount you pay