CEBS – GBA TEST BANK QUESTIONS & ANSWERS-What is the basic assumption underlying concept of a free market and how is it challenged by the theory of
... [Show More] "bounded rationality?" (Mod 1.1) - Assumption that rational customers will make informed decisions about value, quality and price, while producers who meet consumer's demands will be rewarded with market share and profit. However this is challenged by the consumer's "bounded rationality" - rational consumer is only functional up to a certain point because choices are constrained or bound by limited knowledge and understanding of their choices.
What are economic benefits of a free market? (Mod 1.1) - If an individual does not like their provider or health plan, the should be able to "vote with their feet" and select other options. This choice empowers customers, regulates producers and drives efficiency.
Describe several ways the US Healthcare market does not function like a normal market. (Mod 1.1) - Healthcare market has significant asymmetry in information between consumers, providers and insurers. Moral hazard is a problem because the marginal cost of covered care is zero, causing some to overconsume medical care. Many consumers choose doctors initially by convenience, accessibility or recommendation. Cost has also been shown to be lower on priority scale for choosing a provider.
List several recent initiatives in the US that purport (to claim, often falsely) to use market forces to increase efficiency in the healthcare system. (Mod 1.1) - 1) Employers are offering more HDHPs with some as high as $10,000. These plans, often paired with HSAs, are coupled with the idea of transparency, or making more info available to consumer on cost and quality. Idea is that consumers will have more skin in game and be prudent purchasers of care with their own money.
2) ACA is creating marketplaces that employ a form of managed competition where standardized health plans compete on cost and quality.
3) Public Medicaid and Medicare programs are moving towards requiring or making choices available for managed care products that structure care within provider networks.
Indicate the approximate percentages of the population covered by major health programs. (Mod 1.2) - Largest portion of Americans (48%) receive health insurance through an Employer, 16% through Medicaid, 15% through Medicare, 6% purchase insurance on their own
How did ACA change Medicare? (Mod 1.2) - ACA expanded Medicare's wellness and prevention benefits, improved prescription drug coverage and financed experiments to control health care costs by testing alternative payment methods and delivery systems.
How did ACA change eligibility for Medicaid benefits and how is this change affecting the number of people who are enrolled? (Mod 1.2) - ACA shifted program eligibility from category based (ex: single parents with dependents or people w/disabilities) to an income-based standard. Medicaid once covered fewer than half of low-income Americans, but now ACA Medcaid expansion has been steadily increasing enrollment, with largest increase in the states who are participating.
Explain significance of US Supreme Court case National Federation of Independent Business v Sebelius in 2012 (Mod 1.2) - ACA sought to expand Medicaid coverage to all individuals and families with incomes below 138% of the poverty level. US (first time) would have had a solid safety net of insurance coverage for all lower income citizens. In the case, the court rules states could choose not to expand (and Medicaid funding would not be withheld). By Jan 2015, 25 states chose not to expand.
How has ACA affected number of uninsured Americans? (Mod 1.2) - Prior to ACA, 16.3% or 49.9 million Americans were uninsured. By 2014, this number reduced to 13% and by the first quarter of 2016 to 8.6%.
Describe private health insurance coverage with regard to a) size of firm
b) HDHPs with Medical Savings Accounts
c) variability of coverage by states (Mod 1.2) - a) 98% of employers with 200+ EE's offer health insurance but fewer than 45% of firms with 3-9 EE's do so. Larger employers offer more choice of health plans than smaller employers; small employers tend to offer POS plans that require higher EE cost sharing to go outside network.
b) In 2006, HDHPs with medical savings accounts accounted for 4% of ER-sponsored market, but by 2012, accounted for over 20%. In 2016, this rose to almost 30%.
c) Range of ER-based options and quality of options available vary widely by state. The percentage of the population covered by private insurance varies as well as the options for different types of coverage.
What are the basic differences between the four medal categories of ACA health plans? (Mod 1.3) - Bronze, Silver, Gold and Platinum plans all have same actuarial value. However, they differ in regard to amount of deductibles, coinsurance, other out of pocket costs and premiums. Bronze plan has lowest premium but most out of pocket costs. Platinum plan has lowest out of pocket cost, but highest premium.
Why is the Silver Plan the [Show Less]