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QUIZ 1
HSA 312 – 01
MANAGED CARE AND HEALTH INSURANCE - THE BEGINNING THROUGH THE MANAGED CARE BACKLASH OF THE LATE 1990s
MANAGED HEALTH CARE
SPRING 2020 L. EITEL
NOTE: THESE QUESTIONS ADDRESS KEY POINTS ABOUT U.S. HEALTH INSURANCE FROM 1929-2000. THIS COVERS MATERIAL THROUGH MID-MARCH 2020.
FROM THE BIRTH OF EMPLOYER-BASED GROUP HEALTH INSURANCE;
TO THE FULL DEVELOPMENT OF THAT INSURANCE IN INDEMNITY AND SERVICE PLANS;
TO THE CRISIS OF HEALTH CARE EXPENDITURES IN THE 1970’S AND 1980’S;
TO THE TRANSITION TO MANAGED CARE;
AND THE MANAGED CARE BACKLASH OF THE LATE 1990s.
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QUESTION 1: DIFFERENT APPROACHES TO HEALTH INSURANCE FOR PERSONAL HEALTH CARE SERVICES:
INDEMNITY AND SERVICE HEALTH INSURANCE PLANS:
USING ATTACHED READING 1, ANSWER THE FOLLOWING:
PART 1: 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?
PART 2: Briefly describe 2 ways in which these plans made sure that health plan enrollees would have to pay for some health services out-of-pocket: In other words, give 2 examples of enrollee Cost Sharing, and briefly define them.
PART 3: 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? What was their overall attitude toward third-party interference in the decisions made by physicians and patients?
USING READING 1.C., PAGES 1-3, ATTACHED, ANSWER THE FOLLOWING:
What was the major reason the Federal government, and eventually employers, Blue Cross/Blue Shield plans, and commercial insurance companies sought to move private group health insurance from an Indemnity/Service Plan Model to a Managed Care Model between 1975 and 1996?
USING READING 2., PAGE 6., ATTACHED, ANSWER THE FOLLOWING:
Indicate the three (3) main ways in which the HMO Act of 1973 made it possible for Managed Health Insurance plans to spread beyond their regional strong holds on the East and West coasts.
USING READING 1.C., ATTACHED, ANSWER THE FOLLOWING:
Between 1988 and 1996, which forms of health insurance became prevalent: Indemnity and Service Health Insurance Plans OR Managed Health Insurance Plans?
QUESTION 2: WHAT IS MANAGED CARE?
USING READING 2.A., ATTACHED, ANSWER THE FOLLOWING:
PART A.: What is one (1) of the main definitions of Managed Care? Describe briefly.
PART B.: How do Managed Health Insurance plans define the scope of their Risk Management
responsibilities differently from Indemnity and Service plans?
QUESTION 3: MANAGED HEALTH INSURANCE PLANS: COMPARING HEALTH MAINTENANCE ORGANIZATIONS (HMOs) AND PREFERRED PROVIDER ORGANIZATIONS (PPOs):
NOTE: In the 1990s, and even today, HMO health insurance plans are considered more restrictive than Preferred Provider Organizations.
USING ATTACHED READINGS 2 (PAGES 8 – 10), READING 3, AND READING 4:
PART A: Describe briefly 2 of the main ways in which HMOs manage and direct the medical care delivered to enrolled plan members.
PART B: Describe briefly 2 ways in which PPOs differ from HMOs.
QUESTION 4: MANAGED CARE IN THE 1990s AND THE MANAGED CARE BACKLASH.
USING READING 2 (PAGES 9 – 10), READING 2.B., AND READING 5., ANSWER THE FOLLOWING:
PART A: Briefly describe two (2) of the restrictive techniques used by some of the most restrictive Managed Care Health Plans of the 1990s to influence and/or control provider and patient choices about the type and source of medical treatment.
PART B: Briefly describe two (2) positive accomplishments of Managed Health Insurance Plans in the 1990s.
PART C: Briefly describe ONE Provider complaint that formed the basis of the Managed Care Backlash.
PART D: Briefly describe ONE Health Plan Member complaint that formed the basis of the Managed Care Backlash.
QUESTION 5: WHAT IS SPECIAL ABOUT THE NATURE OF AND THE DEMAND FOR PERSONAL HEALTH CARE GOODS AND SERVICES – WHY CAN WE NOT JUST PAY FOR THEM AS INDIVIDUALS, BUT NEED GROUP HEALTH INSURANCE TO ENABLE US TO PAY FOR THOSE SERVICES WHEN WE NEED THEM?
USING READING 6, ANSWER THE FOLLOWING:
Give and briefly explain two (2) reasons why Personal Health Care Services are different as indicated above.
QUESTION 6: LARGE GROUPS AS THE PROPER BASIS FOR FINANCIALLY STABLE HEALTH INSURANCE PLANS.
USING READING 6, ANSWER THE FOLLOWING:
Why can it be argued that large groups are the only acceptable basis for sustainable group health insurance plans? This is clearly the case for both employer-based group health insurance and public health insurance programs like Medicare and Medicaid.
