Reference no: EM134040587
Questions
1. One of the major issues driving the healthcare reform debate is the number of uninsured Americans and their limited access to medical care. Describe the typical person in the United States without insurance. Does lack of insurance mean the uninsured have no access to medical care?
2. What is asymmetric information? How does it present a problem to medical providers and health insurers?
3. Why do firms self-insure?
4. Does the availability of free health care improve health status? Explain.
5. What is the purpose of deductibles and coinsurance? To what problem are insurers responding?
6. You heard someone state, "If the purpose of insurance is to protect people against large financial losses, then requiring patients to make co-payments and pay co-insurance defeats the purpose of insurance." Clearly explain why health plans require patients to pay a portion of their medical expenses out-of-pocket.
7. Define each of the following terms used regularly by the major third-party payers, and explain how they are supposed to affect providers' incentives, fees, and overall utilization:
a. fee-for-service
b. assignment
c. capitation
d. risk sharing
8. "As the health care delivery system becomes increasingly cost conscious, physicians are no longer able to serve as advocates for their patients' medical needs." In light of this concern, discuss the changing role of the physician in the managed care environment.
9. What are the distinguishing characteristics of an HMO? How do HMOs differ from other insurers operating in the health insurance industry?
10. What are the primary cost-saving features of managed care?
11. How will the expansion of managed care produce competitive effects throughout the health care system?
12. In theory, how is managed care expected to affect patient and provider incentives, and hence, the cost and use of medical care? What is the evidence?
13. In a series of articles in the February 10, 1993, issue of the Journal of the American Medical Association, researchers were said to have estimated that 2.4 percent of all bypass surgeries are inappropriate, and 7 percent are clearly unnecessary-roughly, one-fourth as much as previously estimated. Results were similar for coronary angioplasty and coronary angiography. Some analysts are using these results to claim the problem is now underuse instead of overuse. How do you define terms such as "inappropriate" and "unnecessary"? What are the lessons to be learned about the use of outcomes research?
14. Explain how the theory of managed care with prospective payment was expected to affect patient and provider incentives, and the consequent effect on the cost and use of medical care.