Vocab 2

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  1. Gatekeeper
    Responsible for the administration of the patient's treatment and must coordinate and authorize all medical services, lab studies, specialty referrals and hospitalizations.
  2. Geographic Market Definition
    Used in anti-trust analysis to determine the relevant market in which a health care provider competes.
  3. Government Policy Instruments
    The use of tax policy, expenditures and reulation available to government to achieve its policy objectives.
  4. Government Policy Objectives
    According to Public Interest theorists - 1 improve market efficiency and improve equity and/or redistribute resources (based on a societal value judgement)
  5. Guaranteed Issue
    Health insurers have to offer health insurance to those willing to purchase it.
  6. Guaranteed Renewal
    Requires health insurers to renew all health insurance policies within standard rate bands.
  7. Health Care Financing Administration
    HCFA - part of the US Dept of Health and Human Services - responsible for administering Medicare and federal aspects of Medicaid programs.
  8. Health Inputs
    The resources that are used to produce a specific output referred to as "good health"
  9. HIPAA
    Health Insurance Portability and Accountability Act - includes Guaranteed Issue, Guaranteed Renewal. Portability enables employees to conitnue their insurance coverage if they move to another employee group of self employed.
  10. Health Maintenance Organization
    Type of managed care plan that offers prepaid comprehensive health care coverage for hospital and physician services relying on its medical providers to minimize the cost of providing medical services. HMO contract with or directly employ participating health care providers.
  11. Health Manpower Surplus
    Occurs when physicians (or others) are earning below-normal rate of return.
  12. Health Production Function
    The technical relationship between each of the health inputs and their effects on health.
  13. HEDIS
    Health Plan Employer Data Information Set and the Consumer Asessement of Health Plan Survey (CAHPS).
  14. HHI Index
    The meausre of concentration used by the Dept of Justice on its merger guidelines. Uses the square of each provider's market share, so it is sensetive to the # of firms and their relative sizes.
  15. Horizontal Merger
    When two or more firms from the same market merge to form one firm.
  16. Hospital Collusion
    Competing hospitals in the same market agree on price, output, and/or wage policies.
  17. Incidence of the payroll tax
    The extent to which the payroll tax is borne by employers or employees is determed by the elasticity of demand and supply curves for labor.
  18. Income Contingent Loan Repayent Plans
    A student loan program to cover both tuition and living expenses which would be repaid by paying a fixed percentage of their adjusted gross income.
  19. Indemnity Insurance
    Medical insurance that pays the provider or the patient a pre-determined amount for the medical service provided.
  20. Independent Provider Association
    IPA - A physician owned and controlled contracting organization compised of solo and small groups of physicians.
  21. Indirect Subsidies
    Financial aid not targeted to a specific group or recipient, available to all users of the subsidized service.
  22. Individual Mandate
    A proposed national health insurance plan under which individuals are required to buy a minimum level of health insurance.
  23. Inferior Good
    An increase in income leads to a decrease in consumption of that good or service.
  24. Infra-Marginal Externalities
    Even though there may be external benefits, the private market produces the optimal quantity (e.g., physicians)
  25. In-Kind Subsidies
    Non-cash subsidies provided to specific beneficiary groups based on the donor's preferences.
  26. Insurance premium
    1. The expected medical expense of the insured group, 2. the loading charge which includes administrative expenses and profit.
  27. Integrated Delivery System
    IDS - A health care delivery system that includes or contracts with all the health care providers to provide coordinated medical services to the patient. An IDS views itself as being responsible for the health status of its enrolled population.
  28. Law of Demand
    The lower the price, the greater the quantity demanded.
  29. Law of Supply
    The higher the price, the greater is the quantity firms are willing to produce.
  30. Loading Charge
    That portion of the health insurance premium that is added to the pure premium to include administrative expense and profit.
  31. Managed Care Organizatioin
    MCO - controls medical care costs and quality through utilization management, drug formularies and profiling participating providers according to their appropriate use of medical services.
  32. Mandated Benefits
    According to state and insurnace laws, specific medical services providers and/or groups must be included in health insurance policies.
  33. Mandated Benefits
    According to state and insurnace laws, specific medical services providers and/or groups must be included in health insurance policies.
  34. Marginal Benefits
    The change in total benefits from purchasing one additional unit.
  35. Marginal Contribution of Medical Care to Health
    The increase in health status resulting from an additional increment of medical services.
  36. Marginal Costs
    The change in total costs from producing one additional unit.
  37. Market Equilibrium
    When independent actions of buyers and sellers cause quantity demanded to equal quantity supplied.
  38. Market Failure
    May occur when there are market imperfections so that price-competitive markets will not produce the optimal amount of output.
  39. Market Imperfections
    Occur as a result of lack of information by consumers regarding their medical diagnoses, treatment needs, quality of different providers and prices charged by different providers. Others are tax-free employer paid health insurance, restrictionis on entry and on tasks and externalities.
  40. Market Performance
    An indication of the economic efficiency of the market, which occurs when the market price equals the marginal cost.
  41. Market Power
    An indication of the degree of monopoly power possessed by the firm. Measured by the firm's price to marginal cost ratio.
  42. Market Structure
    # of Suppliers in the market which is determied by the extent of economies of scale in relation to the size of the market, and entry barriers usually define the competitiveness of the market.
  43. Medicaid
    Health insurance program financed by federal and state governments and administered by the states for qualifying segments of those with low incomes.
  44. Medicaid Risk Contracts
    A Medicaid managed care program in which an HMO contracts to provide medical services in return for a capitation premium.
  45. Medical Care Price Index
    Calculated by the Bureau of Labor Statistics and included as part of the consumer price index, it is used as a measure of the rate of inflation in medical care prices.
  46. Medical Group
    A group of physicians who coordinate their activities in one or more group facilities and who share common overhead expensees medidal records, and professional technical an administrative staffs.
  47. Medical Loss Ratio
    The percentage of the total premium paid out in benefits to each insured group.
  48. Medical Savings Accounts
    MSA - A form of national health insurance in which a person can annually contribute, tax free, an amount into their MSA equal to 75% of their deductible.
  49. Medicare
    Part A provides hospital insurance for inpatient care, home health agency visits, hospice and skilled nursing facilities. The aged are responsible for a deductible but not a premium. Part B provides payment for physician services, physician ordered supplies and services and outpatient hospital services.
  50. Medicare Risk Contract
    Federally qualified HMOs receive from the government a monthly capitated fee for each enrolled Medicare beneficiary
  51. Medigap Insurance Policies
    Privately purchased insurance policy by the elderly to supplement Medicare coverage by covering deductibles and copayments.
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Vocab 2
MHA6320 Vocab quiz 2
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