PAD 5935-05 Health Care Finance



PAD 5935-05 Health Care Finance

Study Questions for the Midterm Exam

Topics covered:

1. Demographic characteristics of Florida and their impact on Florida’s Healthcare system.

2. Individual components of the health care system:

a. Doctors

1) What is the role of the physician in the health care system (How do his/her decisions affect the other components of the healthcare system?)

2) How does the physician affect patient expenditures?

3) Do most physicians practice independently, in small practices or in some other arrangement? Is this changing?

4) Who pays for most physician expenditures (public or private financing, etc.)?

5) How many doctors are there and how does this compare to previous years (in Florida and nationwide)?

6) What are some of the different ways that the government affects the number of physicians and the number of specialists?

7) How can the volume of physician services be limited (see Eastaugh)?

8) Is there a problem with the distribution of physicians geographically? What about by specialty?

9) What are the three basic ways that physicians can be reimbursed for their services and what are the strengths and weaknesses of each method?

b. Hospitals

1) What do the following terms mean: investor owned, proprietary, for-profit, exempt and nonprofit?

2) Who owns Florida’s hospitals?

3) How many patients are treated in Florida’s hospitals?

4) How many patients are Medicare patients?

5) What percentage of hospital costs are labor costs?

6) What do hospital revenues, expenses and net income look like? What percentage of hospital revenue comes from Medicare versus all other sources of revenue?

7) How much did it cost to care for Florida’s uninsured population in 1996?

8) What percentage of total expenses were for uncompensated care and how does that compare to the national average?

9) In 1996, how many hospitals had skilled nursing units? What is the benefit of having a skilled nursing unit? What percentage of total nursing home beds does this represent?

10) According to the FHA utilization statistics for 1992-96: Which payer had the most discharges? The most patient days? The highest average length of stay?

11) What type of RNs are needed the most overall? In the Panhandle? In the North region? In the West/Central region? In the Southern region?

c. HMOs (insurance)

1) What is an HMO?

2) What are the different types of HMOs?

3) How do HMOs try to control costs?

4) How are HMOs different than traditional indemnity insurance (in terms of benefits covered, patient choice, patient cost, etc.)?

5) Where do HMO revenues come from?

6) What kind of expenses do HMOs have to pay?

7) What must the relationship between revenues and expenses be for an HMO to earn a positive profit?

8) Describe the trends in the profitability of HMOs.

9) Do HMOs have profitability problems? Why?

10) Describe the trends in HMO enrollment.

11) How does government regulation of HMO rates affect HMO profitability?

12) What are the advantages and disadvantages to the patient of being in an HMO?

13) What are the advantages and disadvantages to an HMO of paying doctors a salary versus paying them in a fee for service manner?

14) What is capitation?

15) What is the optimal size of an HMO and what does that imply about where an HMO will offer its services?

d. Government programs (Medicare and Medicaid)

1) What are the main differences between Medicare and Medicaid (who is eligible, what are their sources of revenue, who determines their eligibility)?

2) Describe how the annual expenditures on Medicaid have grown in the state of Florida since it began.

3) How many people are enrolled in Medicaid?

4) Which patient group accounts for most of Medicaid’s expenditures in the state of Florida?

5) Which patient group is largest in the state of Florida?

6) What is the Medicaid Third Party Liability program and how much money has it recovered?

7) How many Floridians are Medicare beneficiaries (number and % of the total population) and how does this compare to other states?

8) What is a “Medicare dependent” hospital?

9) How would government regulation affect these hospitals?

e. Uninsured

1) How large is Florida’s uninsured population (number and as a % of the population)?

2) Why don’t people have coverage?

3) What is the effect of having an uninsured population?

4) Which groups of Florida’s population tend to be uninsured?

f. Long-term care

1) What percentage of nursing home expenditures are financed by various private and public means?

2) How do states control the number of nursing home beds?

3) What kinds of long-term care options are there?

4) What effect will the aging population have on the long-term care sector?

5) What percentage of nursing home expenses are paid by Medicaid?

6) What are the six “market segments” of nursing home and how many beds do they have?

7) How has nursing home spending increased from 1987?

8) What are the six classifications of home health care providers?

3. The interaction between the individual components of the healthcare system.

4. How does something like a Patients’ Bill of Rights affect the components of the healthcare system and expenditures on healthcare?

Suggestions:

Look at the “Assignments” at the end of the chapters in Cleverly.

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