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QUESTION

allocative efficiency risk-aversion gatekeeper episode-based payments AFP technical efficiency agency problem deductible economic surplus PPO

  1. allocative efficiency
  2. risk-aversion
  3. gatekeeper
  4. episode-based payments
  5. AFP
  6. technical efficiency
  7. agency problem
  8. deductible
  9. economic surplus
  10. PPO
  11. utilization review
  12. QALYs
  13. community rating
  14. for-fee-service
  15. adverse selection
  16. moral hazard
  17. monopoly power
  18. capitation
  19. economies of scale
  20. provider network
  21. closed HMO
  22. WTP
  23. coinsurance rate
  24. supply side cost sharing

FOR EACH STATEMENT CHOOSE THE RIGHT CONCEPT

  1. The natural market price for insurance is higher for older policyholders because they tend to consume more medical services than the young.
  2. Under Jane's health plan, she has to pay the first $1000 in annual medical expenses out-of-pocket before her coverage helps out.
  3. Administrative activities performed by managed care organizations to reduce the utilization of high-cost/low-value care.
  4. Under Jim's HMO plan, he can't go directly to a specialist. Jim has to see his primary care physician first and ask for a referral.
  5. This usually exists while new drugs are under patent protection.
  6. Consumers are generally willing-to-pay more for insurance that the expected loss they face from a particular risk.
  7. The most basic type of network-based health coverage. (Hint: not T.)
  8. The treatment choice that maximizes the difference between the patient's willingness-to-pay and the cost of producing that treatment. (Two concepts apply; indicate both.)
  9. Payments that incent providers to eliminate unnecessary services. (Three concepts apply; indicate all three.) 
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