Question

QUESTION 1 - THE CONCENTRATION OF HEALTH EXPENDITURES

WHAT IS THE PRINCIPLE OF CONCENTRATION OF HEALTH EXPENDITURES IN LARGE GROUPS OF PEOPLE? DESCRIBE BRIEFLY. READING 6.A., PAGES 1 AND 2.



QUESTION 2 - THE SOCIAL IMPORTANCE OF LARGE GROUP HEALTH INSURANCE/THE SOCIAL APPROACH TO HEALTH INSURANCE

CONTEXT: IN THE SOCIAL APPROACH TO HEALTH INSURANCE - THERE IS A BELIEF THAT THERE ARE BENEFITS TO ALL OF SOCIETY, NOT JUST INDIVIDUALS AND FAMILIES, IF MOST RESIDENTS IN THE UNITED STATES HAVE ACCESS TO A COMPREHENSIVE PACKAGE OF PERSONAL HEALTH CARE GOODS AND SERVICES THROUGH AFFORDABLE GROUP HEALTH INSURANCE.

QUESTIONS: USE READING 3. C.- ALL; AND READING 3.D., PAGES 1-2.


A. WHAT DOES IT MEAN WHEN WE SAY THAT THERE ARE POSITIVE EXTERNALITIES ASSOCIATED WITH A PARTICULAR GOOD OR SERVICE – IN THIS CASE, ACCESS TO AFFORDABLE GROUP HEALTH INSURANCE PROVIDES ACCESS TO PERSONAL HEALTH CARE GOODS AND SERVICES.


B. BRIEFLY DESCRIBE THE TWO (2) TYPES OF POSITIVE EXTERNALITIES WHICH ARE CONNECTED WITH THE ACCESS TO MEDICAL SERVICES WHICH AFFORDABLE GROUP HEALTH INSURANCE CREATES.


C. USING ACCESS TO MEDICAID AS AN EXAMPLE, BRIEFLY DESCRIBE TWO (2) LONG TERM, POSITIVE, MEASURABLEW BENEFITS THAT CAN BE ASSOCIATED WITH MEDICAID COVERAGE. READING 1.D., PAGES 1-2.







QUESTION 3 - TRADITIONAL HEALTH INSURANCE VS. EMPLOYER SELF INSURANCE


A. BRIEFLY DESCRIBE WHAT WE MEAN BY FINANCIAL RISK IN GROUP HEALTH INSURANCE. READING B.1. – ALL AND READING B.2. – ALL.


B. HOW DOES EMPLOYER SELF INSURANCE DIFFER FROM TRADITIONAL HEALTH INSURANCE IN ITS APPROACH TO FINANCIAL RISK? READING A., PAGES 1 AND 2.


QUESTION 4 - DIFFERENT APPROACHES TO RISK IN GROUP HEALTH INSURANCE:


A. BRIEFLY DESCRIBE THE TWO KEY APPROACHES TO RISK IN THE HISTORY OF GROUP HEALTH INSURANCE. READING B.1. – ALL AND READING B.2. – ALL.


WHICH APPROACH IS ASSOCIATED WITH INDEMNITY AND SERVICE HEALTH INSURANCE PLANS? READINGS A., B.1., AND B.2.

THIS SHOULD BE A VERY SHORT ANSWER.



B. WHICH APPROACH IS ASSOCIATED WITH MANAGED HEALTH INSURANCE (HMOs, POS Plans, PPOs (Preferred Provider Organizations)?

READINGS A., B.1., AND B.2.

THIS SHOULD BE A VERY SHORT ANSWER.





QUESTION 5: WHAT HAPPENS WHEN PEOPLE ARE UNINSURED OR UNDERINSURED?


USE ATTACHED READINGS 4.A., PAGES 5-6; 4.B. - ALL, AND 4.C., PAGES 22 - 26.

A. Briefly define what it means to be Underinsured and give ONE (1) key reason why some individuals and families are Underinsured.


B. Briefly describe 3 measures that are used to determine the negative impacts of people being Uninsured. READING 4.A., PAGES 5-6



QUESTION 6: INDEMNITY AND SERVICE HEALTH INSURANCE PLANS:

USE ATTACHED READINGS 1.A., PAGES 1-4; READING 1.2, PAGES 1-3; AND READING C.

A. Did the Indemnity and Service plans which dominated the U.S. private group health insurance market from the 1930’s through the 1980’s focus on Financial Risk Management of health insurance benefits (making sure health plan expenditures did not exceed health plan revenues from premiums), OR on broader Medical Risk Management of the health status of health plan enrollees as well as the management of Financial Risk? READING 1.A., PAGES 1 -2 AND READING C, PAGES 2 - 4.


B. Deductibles and Coinsurance: READING A., PAGES 3 - 4, OR READING 1.A., PAGES 2-3.

 Define the difference between a Deductible and Co Insurance?

 Are these two different forms of Out-of-Pocket Spending? YES, or NO?



C. As a rule, prior to the 1970s, did Indemnity and Service health insurance plans actively attempt to manage physician and hospital decisions about the length of hospital stays, or the location and choice of medical treatments for patients?

READING 1.A., PAGES 1-3.


D. Between the 1930’s and the late 1960’s, how did the predominant Indemnity and Service Health Insurance plans CHANGE in terms of Out-of-Pocket Expenditures, and the Coverage of Physician and Hospital Services?

READING 1.A., PAGES 2-3.


QUESTION 7: BASICS OF MEDICARE AND MEDICAID

USE ATTACHED READINGS:

OVERVIEW 5.
READING 5.B. ON MEDICAID.
READING 5.D. ON MEDICARE


A. MEDICAID – What are the sources of funding for the State Medicaid programs?


B. MEDICAID -- Which level of government is responsible for the day – to – day management of the Medicaid programs?


C. MEDICAID -- Which level of government is responsible for defining the basic benefits covered by Medicaid, and for general oversight of the Medicaid programs?


D. MEDICARE – Briefly describe the Personal Health Goods and Services (benefits) covered by Medicare Part A, Part B, and Part D?


E. MEDICARE – TRUE OR FALSE: Medicare program is administered only by the Federal government – State governments are not involved in managing Medicare.

Answer 1

It appears you have multiple questions related to various readings on health insurance and related topics. I can provide brief answers to your questions:

**Question 1 - The Concentration of Health Expenditures**
The principle of concentration of health expenditures in large groups of people suggests that a relatively small portion of the population typically incurs a significant portion of total healthcare costs. This principle reflects the uneven distribution of healthcare expenses among individuals.

**Question 2 - The Social Importance of Large Group Health Insurance/The Social Approach to Health Insurance**
A. Positive externalities in the context of health insurance mean that providing access to affordable group health insurance not only benefits individuals and families but also society as a whole.
B. The two types of positive externalities connected with access to medical services through affordable group health insurance are improved public health outcomes and economic stability.
C. Two long-term, positive, measurable benefits associated with Medicaid coverage are improved health outcomes for low-income individuals and families and reduced financial burden on states due to decreased uncompensated care costs.

**Question 3 - Traditional Health Insurance vs. Employer Self-Insurance**
A. Financial risk in group health insurance refers to the potential financial burden or exposure that insurers or self-insured employers may face due to healthcare costs.
B. Employer self-insurance differs from traditional health insurance in that self-insured employers assume the financial risk for their employees' healthcare expenses rather than transferring it to an insurance company.

**Question 4 - Different Approaches to Risk in Group Health Insurance**
A. The two key approaches to risk in the history of group health insurance are indemnity (fee-for-service) plans and managed health insurance plans.
- Indemnity and service health insurance plans are associated with the indemnity approach.
B. Managed health insurance plans (HMOs, POS Plans, PPOs) are associated with the managed care approach.

**Question 5: What Happens When People Are Uninsured or Underinsured?**
A. Being underinsured means having insufficient health insurance coverage to meet one's healthcare needs. One key reason for underinsurance is high deductibles and out-of-pocket costs.
B. Three measures used to determine the negative impacts of people being uninsured are:
1. Delayed or foregone medical care.
2. Increased financial burden on individuals and families.
3. Negative public health outcomes due to lack of preventive care.

**Question 6: Indemnity and Service Health Insurance Plans**
A. Indemnity and service health insurance plans primarily focused on the management of financial risk of health insurance benefits.
B. Deductibles and coinsurance are different forms of out-of-pocket spending. Deductible is a fixed amount you pay before insurance coverage kicks in, while coinsurance is a percentage of the costs shared between you and the insurer.
C. Indemnity and service health insurance plans did not actively attempt to manage physician and hospital decisions about treatment or length of hospital stays.
D. Between the 1930s and late 1960s, indemnity and service health insurance plans changed by increasing out-of-pocket expenditures for individuals and expanding coverage of physician and hospital services.

**Question 7: Basics of Medicare and Medicaid**
A. Medicaid is jointly funded by federal and state governments.
B. State governments are responsible for the day-to-day management of Medicaid programs.
C. State governments define basic benefits covered by Medicaid, with federal oversight.
D. Medicare Part A covers hospital care, Part B covers medical services, and Part D covers prescription drugs.
E. FALSE: Medicare is administered by the Federal government, but state governments play a role in Medicaid, not Medicare.