Health Care Financing and Payment

Employer-sponsored insurance is the primary source of health insurance in the United States, covering approximately 60% of the population.

Medicare is a government program that provides health insurance to people aged 65 and older, as well as to certain younger people with disabilities.

Medicaid is a government program that provides health insurance to low-income individuals and families.

CHIP is a government program that provides health insurance to children from low-income families.

TRICARE is a government program that provides health insurance to active-duty military personnel, their families, and retirees.

Copay is the term for the amount of money that a patient pays out-of-pocket for healthcare services.

Deductible is the term for the amount of money that a patient must pay before their health insurance begins to cover the cost of their healthcare services.

Coinsurance is the term for the percentage of the cost of healthcare services that a patient is responsible for paying after they have met their deductible.

Premium is the term for the monthly fee that a patient pays to their health insurance company.

Risk pooling is the term for the process of transferring the financial risk of healthcare costs from one party to another.

Capitation is the term for the system in which healthcare providers are paid a fixed amount for each patient, regardless of the amount of care that the patient receives.

Pay-for-performance is the term for the system in which healthcare providers are paid based on the quality of care that they provide.

Value-based care is the term for the system in which healthcare providers are paid based on the value of the care that they provide.