PAM435Quiz5solutions-Fall2003 - New York State College of...

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New York State College of Human Ecology A Statutory College of the State University Cornell University, Ithaca, N.Y. 14853-4401 Department of Policy Analysis and Management PAM 435 – The U.S. Healthcare System Professor Roger Battistella Quiz #5 (Last One!!)—November 13, 2003 Name (Please Print)___________________________________________ Student ID #______________ 1. Define the medical loss ratio for insurance companies. (6 pts.) The proportion of premiums that are spent on medical expenses. 2. According to Rhonda Rundle’s article in the March 12, 2002 Wall Street Journal , what condition results in higher healthcare costs than smoking? (3 pts.) Obesity. 3. What is the difference between illness and disease? (6 pts.) Illness is self perceived while disease is determined/validated by a physician.
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Unformatted text preview: 4. What distinguishes a staff model from a group model HMO? (6 pts.) A staff model HMO employs its own salaried physicians. A group model HMO contracts with a multispecialty group practice, and separately with one or more hospitals to provide comprehensive services to its members. 5. Identify 2 barriers to progress in improving quality of healthcare that were detailed in lecture. (4 pts.) • Sanctions/malpractice risk • Lack of EMR implementation • Volume of Rxs, off label prescribing • Lack of data on drug interactions • Lack of physician order entry programs • Non-representativeness of clinical trial populations • Lead time in clinical trials...
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