![EBK HEALTH ECONOMICS AND POLICY](https://www.bartleby.com/isbn_cover_images/9781337668279/9781337668279_largeCoverImage.jpg)
To provide definitions to terms used regularly by third party payers and explain these terms affect the providers’ incentives, fees and overall utilization.
a)
Fee for service payment model.
![Check Mark](/static/check-mark.png)
Answer to Problem 1QAP
The fee for service payment model is a traditional payment method in medical care where the provider bills for each service provided.
Explanation of Solution
Within a fee for service payment model providers can pass reimburse all their costs, with no regard on how inefficient the production of services. This system can be described as a cost-plus pricing system.
There is no incentive for providers to search for more efficient methods of production in a cost-plus environment. Furthermore, patients have no incentive to search for providers who offer lower prices. In comparison, competitive markets reward providers for offering quality products at the lowest price. However, in cost-plus markets, providers are rewarded by offering more services at higher prices while passing on the additional costs to third-party payers.
Introduction:
Certain concepts that exist within health care involve certain variances in terms of providers’ incentives, fees and overall utilization.
b)
Assignment.
b)
![Check Mark](/static/check-mark.png)
Answer to Problem 1QAP
An assignment can be defined as a Medicare policy that provides physicians a guaranteed payment of 80 percent of the allowable fee. By accepting an assignment, physicians agree to accept the allowable fee as full payment and forgo the practice of balance billing.
Explanation of Solution
From the perspective of the physician, the problem of assignment centers on the relationship between the fee usually charged for the service provided and the Medicare allowable fee, which is often much lower. Physicians' issue with the Medicare allowable fee is that it is below their average cost of providing medical services. Even though providing care to the Medicare segment of the market may not cover fully allocated costs, each transaction is reimbursed at a rate that covers the physician’s
c)
Capitation.
c)
![Check Mark](/static/check-mark.png)
Answer to Problem 1QAP
Capitation can be defined as a payment method that provides a fixed, per capita payment to providers for a specified medical benefits package. Capitation requires the providers to treat a well-defined population for a fixed sum of money, paid in advance, without regard to the number or nature of the services provided to each person.
Explanation of Solution
Providing care for a fixed fee changes the nature of the physician-patient relationship. Capitation has reduced the incentive of providers to purchase services that are largely unnecessary and take advantage of uninformed consumers. However, there is a risk of omitting potentially beneficial care in the name of cost-saving. However, under capitation, all necessary care is provided for a well-defined group. Hence utilization of services is in control of the provider.
d)
Risk Sharing.
d)
![Check Mark](/static/check-mark.png)
Answer to Problem 1QAP
Risk sharing contracts involves in the spreading of financial risks of health care towards the providers.
Explanation of Solution
Risk-sharing discourages the over utilization of services, the use of expensive technology, brand-name prescription drugs, referrals to specialists, and inpatient hospital procedures. Many managed care plans contract with primary care physicians using either prepayment or capitation (lump-sum payments per enrollee determined in advance). Prepayment shifts the financial risk to the providers. Rather than making payments on a per-service basis, primary care physicians will receive a fixed payment determined in advance to provide all necessary primary and preventive care for a specific group of patients. Some managed care plans involve withholding a percentage of the authorized payment so that providers control utilization and cost. Primary care physicians serve as gatekeepers who are under strict budgets for hospital services, specialty referrals, and prescription drugs for patients they cover. Bonuses are provided to physicians who provide care within the predetermined budgets. Those who do not are penalized. They are penalized through either forfeiting part or all of their withholdings to the plan. This risk-sharing arrangement provides strong incentives for physicians to control utilization.
Want to see more full solutions like this?
Chapter 8 Solutions
EBK HEALTH ECONOMICS AND POLICY
- 0000 Health Suppose that you graph nations' health expenditures against income and see that the US's point lies below others (like in the stylized figure below). From the graph below, it appears that the US is However, this may not be the case if_ Switzerland UK US HPF Health expenditures productively inefficient; The US has a population that prefers spending their resources on health productively efficient; The US has a population that prefers spending their resources on health productively efficient; The US has lower levels of inherent health, therefore it has its own HPF which is lower than the others. productively inefficient; The US has lower levels of inherent health, therefore it has its own HPF which is lower than the others.arrow_forwardPlease match the definition to the term that best fits. This occurs when less-risky people are more likely to enroll in health insurance. How much spent out-of-pocket before insurance kicks-in. When no more units of a good can be produced without decreasing the amount of another good or service The amount that the insurance company pays the customer when an insured event occurs. When an individuals income is state independent Behavior changes that occur before an insured event happens and make that event more likely to occur. The fraction of the medical bill that the consumer is responsible for. The fixed amount that is paid for a service at the time service is rendered. This occurs when marginal benefit of a good to a consumer is equal to marginal cost of production Behavior changes that occur after an insured event happens and make recovering from that event more expensive. Monthly fee to enroll in insurance The oversupply of low-quality goods, products, or contracts that results…arrow_forwardfor the 2nd part the last option got cut off, there is also a none of the above choice tooarrow_forward
- MCB MCA The figure to the right shows the marginal cost of pollution abatement for two firms, A and B. The firms were initially abating 36 units of pollution each. Now they can trade pollution permits at a price of $32. As a result, firm permits and firm B A permits. Both firms are now better off and their total saving will be (Enter your answer rounded to the nearest $ whole number.) Dollars per Unit ($) 44 32 20 The Efficiency of Tradable Pollution Permits 31 36 41 Quantity of Pollution Abatement k -6°C Mostly clear Nextarrow_forwardThe figure to the right shows the marginal costs of abatement for an industry's only two firms, A and B. These firms were initially abating 30 units of pollution (the vertical dashed line). Now they can trade permits. The market price for permits under which an efficient pollution abatement will be achieved is $ rounded to the nearest whole number.) 192 176- 160- (Enter your response 144- 128- 112- 96 80- 64- 48- 32- 16 0 0 MC MCB 10 20 30 40 50 60 70 80 90 100 110 12 Pollution Abatement -6°C Mostly clear Nextarrow_forwardThe figure shows the private and social marginal costs and the marginal benefit of producing paper. The marginal social net benefit derived from the production of paper is OA. maximized at an output level of 35 because that is where MCp equals MB. OB. maximized at an output level of 25 because that is where MCs equal MB. OC. zero at an output level of 25 because that is where MCs equals MB. OD. zero at an output level of 35 because that is where MCp equals MB Dollars per Unit 25 35 Quantity of Paper -6°C Mostly clear D=MB Next MCS MCarrow_forward
- Refer to the given figure. MB and MC represent the social marginal benefit and social marginal cost of pollution abatement. The total net benefit from the optimal level of pollution abatement is $ (Enter your response rounded to the nearest whole number.) D Dollars per Unit 0 MC 18 810 Pollution Abatement -6°C Mostly clear Next MBarrow_forwardSuppose that each firm pollutes 100 units and is given 70 pollution permits (i.e., each firm must reduce pollution by 30 units if they do not trade their permits). If firms are allowed to trade their permits, then the equilibrium price of permits will be and permits. and as a result of being able to trade their OA. $10; firm A buys 20 permits from firm B profits fall by $200 for A and rise by $200 for B OB. $10; firm A buys 20 permits from firm B profits rise by $40 for A and rise by $40 for B OC. $12; firm A sells 10 permits to firm B; profits rise by $40 for A and rise by $40 for B OD. $12, firm A buys 10 permits from firm B profits fall by $120 for A and rise by $120 for B E. None of the above Marginal Abatement Cost ($) 18 16- 4 12- 10- 8- MCA 0 10 20 30 40 50 60 70 80 Pollution Abatement 90 -6°C Mostly clear Next M 40arrow_forwardConsider an economy in which there are two polluters: A and B. The marginal cost of pollution abatement curves are given in the diagram to the right. The total cost of reducing pollution by 60 units if it is done efficiently or $ equals $ if it is done by forcing each firm to reduce pollution by 30 units. OA. 925; 1125 OB. 900; 1100 OC. 850, 1050 OD. 800, 1000 OE. None of the above The efficient levels of pollution reduction can be achieved by using a pollution tax equal to $ unit A. 25 0 per MC 45 40 35 30- 25 20- 15 10- 5- Marginal Abatement Cost ($) 10 20 30 40 50 60 70 80 Pollution Abatement -6°C Mostly clear Next 90arrow_forward
- is initially abating Q units of pollution. Suppose that a system of tradeable pollution permits is introduced into this market and the equilibrium permit price is P* Firm B will sell permits to Firm A because OA. Firm A has lower costs of pollution abatement than Firm B. OB. Firm B's total cost of abating more pollution (area 1) is less than the revenue it earns from selling the permits (areas 5+3). OC. Firm B's total cost of abating more pollution (areas 3+1) is less than the revenue it earns from selling the permits (areas 5+3+1). OD. Firm B can buy the permits at a lower price than Firm A OE. the revenue Firm B earns from selling permits (areas 3+1) is greater than the cost it incurs from abating more pollution (area 1). Dollars per unit Q₁ Qo Q2 Pollution Abatement ил Next -6°C Mostly clear MCA MCBarrow_forwardThe accompanying diagrams show the marginal costs of pollution abatement for two firms, Firm 1 and Firm 2. If the government requires each firm to abate Q units of pollution, the social costs of this abatement OA. could be reduced further if Firm 2 increased abatement and Firm 1 reduced its abatement by the same amount OB. could be reduced further if each firm was required to abate more. OC. could be reduced further if each firm was allowed to pollute more. OD. would be minimized. WOE could be reduced further if Firm 1 increased abatement and Firm 2 reduced its abatement by the same amount. Dollars 5 Firm 1 MC1 Q1 Q2 Q3 Q4 Q5 Q6 Q7 Abatement Q Firm 2 6- MC2 E 屈 Dollars -6°C Mostly clear Nextarrow_forwardThe diagram to the right illustrates a competitive industry in which there is a negative production externality. If a tax equal to $20/unit (i.e., a tax equal to the marginal external cost) is imposed, then the net social benefit will OA. fall by area A+ C. OB. rise by area B+C. OC. fall by area C. OD. rise by area B. OE. None of the above. W Marginal Benefit, Marginal Cost ($) 50 MCS MCp 45 35 30- 25 20 15 10- 5 0- 0 B D 10 20 30 40 50 60 70 80 90 100 110 Quantity -6°C Mostly clear Nextarrow_forward
- Microeconomics: Private and Public Choice (MindTa...EconomicsISBN:9781305506893Author:James D. Gwartney, Richard L. Stroup, Russell S. Sobel, David A. MacphersonPublisher:Cengage LearningEconomics: Private and Public Choice (MindTap Cou...EconomicsISBN:9781305506725Author:James D. Gwartney, Richard L. Stroup, Russell S. Sobel, David A. MacphersonPublisher:Cengage Learning
- Managerial Economics: A Problem Solving ApproachEconomicsISBN:9781337106665Author:Luke M. Froeb, Brian T. McCann, Michael R. Ward, Mike ShorPublisher:Cengage LearningExploring EconomicsEconomicsISBN:9781544336329Author:Robert L. SextonPublisher:SAGE Publications, Inc
![Text book image](https://www.bartleby.com/isbn_cover_images/9781337668279/9781337668279_smallCoverImage.jpg)
![Text book image](https://www.bartleby.com/isbn_cover_images/9781305506893/9781305506893_smallCoverImage.gif)
![Text book image](https://www.bartleby.com/isbn_cover_images/9781305506725/9781305506725_smallCoverImage.gif)
![Text book image](https://www.bartleby.com/isbn_cover_images/9781285859460/9781285859460_smallCoverImage.gif)
![Text book image](https://www.bartleby.com/isbn_cover_images/9781337106665/9781337106665_smallCoverImage.gif)
![Text book image](https://www.bartleby.com/isbn_cover_images/9781544336329/9781544336329_smallCoverImage.jpg)