The difference between retrospective versus prospective reimbursement is that: a. Prospective reimbursement is cost-based and payments are based on each healthcare services/goods done or given; retrospective reimbursements are based on set standards such as DRGs in the case of hospitalizations.

The difference between retrospective versus prospective reimbursement is that: a. Prospective reimbursement is cost-based and payments are based on each healthcare services/goods done or given; retrospective reimbursements are based on set standards such as DRGs in the case of hospitalizations.

EBK HEALTH ECONOMICS AND POLICY

7th Edition

ISBN:9781337668279

Author:Henderson

Publisher:Henderson

Chapter7: The Market For Health Insurance

Section: Chapter Questions

Problem 11QAP

See similar textbooks

Related questions

Q: Which of the following statements regarding a nonresident insurance producer is CORRECT? 1.The…

A: Nonresident Agent — an agent who is authorized in a house in which the person doesn't reside.

Q: How much is deducted each month from his paycheck for medical insurance?

A: Annual insurance payment by Company = 3,300 x 80% = 2,640 Annual insurance payment by David = 3,300…

Q: explain the major social and economic costs of insurance

A: A. indemnification of loss is one of the benefits which are provided by insurance to the society as…

Q: Economics 1. Does the demand for healthcare services vary in size with the affordable costs? 2.)…

A: Since you have asked multiple questions, we will solve the first question for you. If you want any…

Q: Suggest a relevant government policy in Barbados that would yield the efficient outcome and…

A: Public goods cause market disappointments if a small number of purchasers opt not to pay and instead…

Q: Besides the common practice of charging copayments, health insurers have no successful strategies…

A: Moral hazard refers to the risk associated with one part facing problems due to misleading…

Q: Economically, price refers to a dollar value but not time taken sitting in the health clinics…

A: In economics, price is the term that is used to show the monetary value of any good or services at…

Q: The study relating to the procurement of funds and its productive utilization is: A)Insurance…

A: In an economy, money plays a vital role as it is needed to make economics and businesses activities.…

Q: What are the government’s role in equity in the provision of healthcare resources in society.

A: What are the government’s role in equity in the provision of healthcare resources in society.…

Q: Question - Which of the following is not a basic question that must be answered as a result of…

A: Human wants are unlimited, and there are no limits to the wants of the consumers. But the resources…

Q: Describe how the following facts represent solutions to problems of asymmetric information. a. Auto…

A: The market situation where buyers and sellers have different information regarding a transaction is…

Q: Assignment a Medicare policy providing physicians with a guaranteed payment of 80 percent of the…

A: Introduction about Medicare policy providing physicions There is a strain to change the Medicare…

Q: (a)Explain what is meant by "asymmetric information." Identify and explain the two basic types of…

A: Answer to the question is as follows:

Q: Outline the ‘second-generation model’ and point out in what respects it may (or may not) be relevant…

A: The Second-Generation Model is defined as model which is followed by the First-Generation Model,…

Q: Imagine that patients stay in HMO with capitation payments for two periods early in life (period 1)…

A: In 1st case patients pay $1000 in period 1 with preventive care and $500 in period 2 In 2nd case…

Q: Explain in your own words the concept of economic incentives in healthcare and provide an example…

A: The phrase "health care economics" refers to the different elements that interact to determine the…

Q: The figure shows estimated medical costs versus what a user actually pays for three health insurance…

A: To correlate health outcomes with healthcare costs, the parameter is life expectancy. At present,…

Q: Under symmetric information, competitive insurance markets would offer A) complete coverage to high…

A: The insurance contract deals with the transferring of risk from consumer to firm. The symmetric…

Q: Which of he following stalements about lhe Time Limil on Certain Defenses provision in an Accident…

A: Time limit on certain defences arrangement in a singular medical coverage strategy that restricts…

Q: Define "Risk Sharing" and explain how it affects providers' incentives, fees and overall…

A: RISK-SHARING (HAZARD SHARING) Hazard Sharing — otherwise called "hazard appropriation," hazard…

Q: Why would payers want to add shared savings components to PMPM or enhanced FFS payments to primary…

A: FFS is the medical care installment model where doctors and clinicians are paid in light of the…

Q: insurance is pure liability coverage over and above the coverage provided by other types of…

A: We have to find given question answer.

Q: producer collects he initial premium for a healih policy and gives he applicant a conditional…

A: As indicated by the Health Insurance Association of America, health care coverage is characterized…

Q: Why is survival time considered to be a good indicator of health status? A. It measures health…

A: Survival time is considered to be a good indicator of health status because it measures the accounts…

Q: Now assume the consumer is part of a partial insurance plan with a coinsurance provision. Her…

Q: he transfer of Pure risk from one party to another best determines the idea of Proximate cause…

A: risk refers to the chance something harmful or unexpected would happen. the risk might involve the…

Q: Which of the following reports has the primary purpose lo inform an insurance company about a…

A: Medical insurance is a form of insurance that covers all or part of a person's risk of incurring…

Q: Which of the following examples describe the "adverse selection problem"? ntara contoh berikut, yang…

A: Disclaimer: “Since you have asked multiple questions, we will solve the first question for you. If…

Q: nsurance buyers have more information about whether they are high-risk or low-risk than the…

A: Asymmetric information exists where information is not distributed between the buyer and sellers.…

Q: Fun with cost-sharing. An important distinction in health insurance is between the list price (PL)…

A: Hello. Since you have posted multiple parts of the question and not specified which part of the…

Q: The type of credit insurance that landed AIG into trouble in 2008 is known as Question 8 options:…

A: Credit insurance:- Credit insurance is a form of insurance plan which a borrower purchases to pay…

Q: Which of the following statements regarding a nonresident insurance producer is CORRECT? 1.The…

A: Insurance producers are authorised to sell and negotiate life, health, property, and other types of…

Q: In a standard economic analysis, setting a higher copayment rate per day of hospital care 1) Has…

A: ANS A copay is a flat rate that we need to pay for obtaining a health care service. The patient…

Q: The impact of changing economic realities in the healthcare setting. Consider the customer…

A: Healthcare settings represent a broad range of services and places where healthcare services are…

Q: Describe perfect competition as it relates to health care economics. What are the key…

A: Perfect competition implies that both producers or the makers and customers are price-takers. Such a…

Q: Discuss the importance of ERM as one innovative strategy that healthcare managers would apply to…

A: Risk management and excellent healthcare are inextricably linked. Healthcare administrators and…

Q: In this example, imagine 4 consumers who are identical in every way with the exception that they…

A: Given, 4 Identical consumers with different insurance plans The demand schedule : Q=16-0.1P The…

Q: Which of the following is not a methodology used to determine the amount of necessary life…

A: Life insurance is a monetary apparatus that can assist people with achieving an assortment of money…

Q: U.S. healthcare coverage can broadly be divided into two main categories: (government-funded) and…

A: Us healthcare is funded by Government as well as privately funded by Corporations and employees.…

Q: adverse selection

A: The scenario in which either the buyer or the seller has information related to an aspect of product…

Q: Scarcity is a major cause of many of today's healthcare system problems. True False

A: Scarcity refers to the situation where the less availability of the resource that fails to meet all…

Q: Cost-sharing is used to combat moral hazard at the expense of equity. True False

A: The share of costs covered by your protection that you pay out of your own pocket. This term for the…

Q: How does the major ethical issues in the American prescription drug crisis affect business in…

A: In the American economy, the prescription drug crisis was the cause of shortages of output due to…

Concept explainers

Moral Hazard

The moral is a person's behavior towards himself /herself, society, organization, and others. Hazard is something that is happening and is not good. A person may be morally good or bad. It depends on his attitude, ethics, integrity, and values. A person may have the highest reverence for money to that for the truth. In this case, the person may lie and it is said that the person is morally bad.

Question

The difference between retrospective versus prospective reimbursement is that:

	a.	Prospective reimbursement is cost-based and payments are based on each healthcare services/goods done or given; retrospective reimbursements are based on set standards such as DRGs in the case of hospitalizations.
	b.	Retrospective reimbursement is cost-based and payments are based on each healthcare services/goods done or given; prospective reimbursements are based on set standards such as DRGs in the case of hospitalizations.
	c.	Both payment systems practically mean the same thing since it is a way to reimburse providers of health care services on the services they have already given to patients.
	d.	None of the choices are correct

Expert Solution

This question has been solved!

Explore an expertly crafted, step-by-step solution for a thorough understanding of key concepts.

This is a popular solution!

SEE SOLUTION Check out a sample Q&A here

Step 1

VIEW

Step 2

VIEW

Trending now

This is a popular solution!

Step by step

Solved in 2 steps

SEE SOLUTION Check out a sample Q&A here

Knowledge Booster

Learn more about

Need a deep-dive on the concept behind this application? Look no further. Learn more about this topic, economics and related others by exploring similar questions and additional content below.

Similar questions

Different reimbursement approaches/strategies involve more or less risk for health care providers and for health insurance companies. Which approaches/strategies involve the most risk for health are providers? Which approaches/strategies involve the most risk for health insurance companies? Explain “why” in each of your answers, and make sure you define all relevant terms and concepts
The Australian health sector suffers from informational asymmetry problems pertaining to ‘moral hazard’ and ‘adverse selection’. Please provide a reason for why you either agree or disagree with the statement.
One of the best ways to learn how the complicated healthcare system in the U.S. works is to examine the legal basis of the provision of healthcare in the U.S. follow the trail of money and trace the self-interest of all the parties involved. understand how the goal of serving public interests drives the actions of all the parties involved. carefully read and analyze healthcare-related reports and arguments in news media. stay up-to-date with the latest medical research findings.
Fun with cost-sharing. An important distinction in health insurance is between the list price (PL) and out-of-pocket price (PP) of a medical good or service. The list price is the official price that the provider charges the insurance company, while the out-of-pocket price is the price that the insurance customer faces. Sometimes, the out-of-pocket price depends on the list price. Draw a set of axes with list price PL on the y-axis and quantity Q on the x-axis (you will want to make your graph nice and big, because we will be adding several demand curves). Suppose a consumer’s demand for a particular medical procedure is as follows: Q = 100 - PP. Draw her demand curve in PL - Q space under the assumption of no insurance and label it D1. You will have to think about the relationship between PL and PP to draw it correctly. Now assume the same consumer is fully insured. Think about how this affects the relationship between PL and PP and draw a full-insurance demand curve in PL - Q…
Which of the following is not a methodology used to determine the amount of necessary life insurance?a. The Human Life Value Method.b. The Financial Needs Method.c. The Ways and Means Method.d. The Capitalization of Earnings Method.
Q: Scarcity is a major cause of many of today's healthcare system problems. True False
Fun with cost-sharing. An important distinction in health insurance is between the list price (PL) and out-of-pocket price (PP) of a medical good or service. The list price is the official price that the provider charges the insurance company, while the out-of-pocket price is the price that the insurance customer faces. Sometimes, the out-of-pocket price depends on the list price. (a) Draw a set of axes with list price PL on the y-axis and quantity Q on the x-axis (you will want to make your graph nice and big, because we will be adding several demand curves). Suppose a consumer's demand for a particular medical procedure is as follows: Q = 100 - PP. Draw her demand curve in PL - Q space under the assumption of no insurance and label it D1. You will have to think about the relationship between PL and PP to draw it correctly. Now assume the same consumer is fully insured. Think about how this affects the relationship between PL and PP and draw a full-insurance demand curve in…
An important distinction in health insurance is between the list price (PL) and out-of-pocket price (PP) of a medical good or service. The list price is the official price that the provider charges the insurance company, while the out-of-pocket price is the price that the insurance customer faces. Sometimes, the out-of-pocket price depends on the list price. d. Now assume the consumer is part of a partial insurance plan with a coinsurance provision. Her insurance pays 50% of all medical expenses. Consider again the relationship between PL and PP and plot a coinsurance plan demand curve in PL - Q space. Label this curve D3. e. Finally, assume the consumer is part of a partial insurance plan with a copayment provision. Her insurance pays all expenses above and beyond her copayment of $25 for each unit of Q. Consider again the relationship between PL and PP and plot a copayment-plan demand curve in PL - Q space. Label this curve D4.
Question content area Part 1 The potential market represents all active duty military members, allveterans, and their families. Assume that according to the United States Department of Defense, as ofDecember 31, last year there were 1 comma 361 comma 597 active duty personnel in all armed services.The veteran population totaled 21 million last year. Assuming the average cost of life insurance is $750 peryear and that potential customers purchase one policy per year, use the chain ratio method to calculatethe market potential for life insurance in the military market. Hint: see the Market Potential and SalesEstimates section of Appendix 3 Marketing by the Numbers in your textbook. Part 2 The number of buyersin the market can be estimated as 22,361, 597. (Round to the nearest whole number.) Part 3 Themarket demand is estimated as $16.77 million. (Round to the nearest whole number.)
The size of the uninsured and underinsured population in the United States has become an indication of the access problems in the US healthcare system.TrueFalse Health economics can be defined as An examination of factors that impact healthcare An explanation of theories, models and tools that can be applied to understand costs, access, and quality One way to understand how best to compare and contrast alternatives Help healthcare leaders understand the costs and consequences of options All of the above
Discuss some of the trade-offs and the challenges of a move to an enterprise-levelanalytics solution for companies and their individual end users who might have grownaccustomed to working with their own customised solutions for generating data.Back your discussion with i) critical review of relevant literature, ii) the case of NationwideInsurance (Support Case presented in the next section of this assessment brief)
Which of the following statements regarding a nonresident insurance producer is CORRECT? 1.The producer must hold a similar license in the state of residence. 2. Policies the producer writes in Illinois must be countersigned. 3.The producer must complete pre-licensing and continuing education courses in texas. 4.The producer must maintain a minimum surety bond of $10,000.