Reference no: EM133331047

CHAPTER 4: Financing Health Systems

1. Describe the size of the U.S. health care industry in financial terms, and discuss the growth in health care expenditures.

2. Describe the flow of finance in health care in the United States, referring specifically to payment sources and outlays for health care services.

3. Describe the three main types of health insurance in the United States, referring specifically to voluntary health insurance, social health insurance, and welfare medicine.

4. Briefly describe Medicare Parts A, B, C, and D.

5. Briefly describe the Medicaid program.

6. Discuss the methods of physician reimbursement in the United States.

7. Provide an overview of the prospective payment system.

8. Describe the resource-based relative-value scale payment method.

CHAPTER 5: Private Health Insurance and Managed Care

1. What is insurance, and why is it used?

2. How does private health insurance violate the standard principles of insurance?

3. Describe the three methods for categorizing health insurance in the United States.

4. Briefly describe the differences among commercial insurance industry, the Blues, and HMOs.

5. What is managed care? List the main objectives of managed care.

6. Briefly describe PPO and HMO plans.

7. List the common managed-care practices designed to influence physician behavior.

8. Describe the role of the gatekeeper.

9. Describe the impact of managed care on both the Medicare and Medicaid programs.

10. Discuss the conflict of interest inherent in managed care.