US HEALTHCARE SYSTEMS EXAM 1 (CH 1-6) |
QUESTIONS AND ANSWERS | 2026 UPDATE | WITH
COMPLETE SOLUTION!!
What are the basic components of a Health Services Delivery System? Answer
- 1. Financing - how services are paid for
2. Insurance - protects against catastrophic risks
3. Delivery - provision of health care services by various providers
4. Payment - reimbursement to providers for services delivered
What are 5 key components of the Affordable Care Act (ACA)? Answer - 1.
Individual mandate
2. Insurance plans must cover "essential health benefits"
3. Insurance available for purchase on a web-based exchange
4. Expansion of Medicaid
5. Employer mandate to provide insurance for employees
What does managed care seek to achieve? Answer - 1. Seeks to achieve
efficiencies by integration of the 4 functions of health care.
2. Employs mechanisms to control utilization of medical services.
3. Determines the price at which the services are purchased and how much
providers get paid.
What is the iron triangle of healthcare delivery? Answer - Access, cost, quality
,Describe health care in the Pre-Industrial Era (Mid-18th to late 19th century)
Answer - The consumer was sovereign in the market and healthcare was
delivered under free market conditions.
Medical practice was in disarray, medical procedures were primitive, the
institutional core was missing, demand was unstable, and medical education
was substandard.
What are 5 reasons medical practice was insignificant during the Pre-Industrial
Era? Answer - 1. Medical practice was in disarray
2. Medical procedures were primitive
3. Institutional core was missing
4. Demand was unstable
5. Medical education was substandard
Why was demand for medical care unstable in the Pre-Industrial Era? Answer -
Opportunity cost of time spent and money spent traveling to the doctor were
too high. Demand was limited by economic conditions and the traditional
practice of medicine in rural eras.
Describe health care during the Post-Industrial Era (late 19th to late 20th
century). Answer - 1. Growth of professional sovereignty - as tech/meds
advanced, status of physicians rose.
2. Physicians succeeded in retaining private practice of medicine and resisting
national healthcare.
3. Employers took on a well-defined role in providing health care.
4. Growth of private health insurance.
5. Development of public health
,Why did physicians rise to positions of power in the 1920s? Answer - 1.
Urbanization
2. Science and technology / cultural authority
3. Institutionalization / pooling of resources
4. Dependency
5. Autonomy and organization (professional cohesiveness)
6. Licensing
7. Educational reform
Describe organized medicine. Answer - The concerted efforts of physicians
through the AMA which equated to professional cohesiveness.
What 3 factors prompted the general need for health insurance? Answer - 1.
Technological - advanced treatments that were desirable but expensive.
2. Social - desirability of medical treatments.
3. Economic - risk of catastrophic loss.
What 3 reasons led to the growth of employer-based health insurance?
Answer - 1. Wage freeze during WWII - employers offered insurance as a
benefit in lieu of more money.
2. 1948 Supreme Court ruling - employee benefits were legit part of union-
management negotiations.
3. 1954 IRS tax code revision - made employer-paid health insurance tax
deductible for employers, tax-exempt for employees.
Describe the 4 parts of Medicare. Answer - Part A - hospital and limited
nursing home coverage (automatic).
Part B - Covers physician bills. Pay separate from part A.
Part C (1997) - Medicare managed care.
, Part D (2006) - Prescription drugs.
Describe Medicaid. Answer - - Helps indigent populations pay for health care.
- Eligibility determined via a means test.
- A state run program, funded in part by federal government to match state
contributions (Kerr-Mills Act).
What is the role of medical technology in health care delivery? Answer - A tool
to improve the efficiency, effectiveness, safety, and patient health. Excessive
use of technology must be balanced with cost - what is the point of diminishing
returns?
What are some applications of IT and informatics in the delivery of health care?
Answer - - Decision support systems (Often embedded in EHR)
- Clinical information systems (Pharmacy data systems, Radiology & lab
reporting systems)
- Administrative information systems (Personnel management & scheduling)
What factors influence the creation, dissemination, and utilization of
technology? Answer - 1. Anthro-cultural beliefs and values
2. Medical specialization
3. Financing & payment
4. Technology-driven competition
5. Expenditures on research & development
6. Supply-side controls
7. Government policy
What is the government's role in technology diffusion? Answer - Government
funds 46% of medical technology R&D in the US. Aside from development, they
QUESTIONS AND ANSWERS | 2026 UPDATE | WITH
COMPLETE SOLUTION!!
What are the basic components of a Health Services Delivery System? Answer
- 1. Financing - how services are paid for
2. Insurance - protects against catastrophic risks
3. Delivery - provision of health care services by various providers
4. Payment - reimbursement to providers for services delivered
What are 5 key components of the Affordable Care Act (ACA)? Answer - 1.
Individual mandate
2. Insurance plans must cover "essential health benefits"
3. Insurance available for purchase on a web-based exchange
4. Expansion of Medicaid
5. Employer mandate to provide insurance for employees
What does managed care seek to achieve? Answer - 1. Seeks to achieve
efficiencies by integration of the 4 functions of health care.
2. Employs mechanisms to control utilization of medical services.
3. Determines the price at which the services are purchased and how much
providers get paid.
What is the iron triangle of healthcare delivery? Answer - Access, cost, quality
,Describe health care in the Pre-Industrial Era (Mid-18th to late 19th century)
Answer - The consumer was sovereign in the market and healthcare was
delivered under free market conditions.
Medical practice was in disarray, medical procedures were primitive, the
institutional core was missing, demand was unstable, and medical education
was substandard.
What are 5 reasons medical practice was insignificant during the Pre-Industrial
Era? Answer - 1. Medical practice was in disarray
2. Medical procedures were primitive
3. Institutional core was missing
4. Demand was unstable
5. Medical education was substandard
Why was demand for medical care unstable in the Pre-Industrial Era? Answer -
Opportunity cost of time spent and money spent traveling to the doctor were
too high. Demand was limited by economic conditions and the traditional
practice of medicine in rural eras.
Describe health care during the Post-Industrial Era (late 19th to late 20th
century). Answer - 1. Growth of professional sovereignty - as tech/meds
advanced, status of physicians rose.
2. Physicians succeeded in retaining private practice of medicine and resisting
national healthcare.
3. Employers took on a well-defined role in providing health care.
4. Growth of private health insurance.
5. Development of public health
,Why did physicians rise to positions of power in the 1920s? Answer - 1.
Urbanization
2. Science and technology / cultural authority
3. Institutionalization / pooling of resources
4. Dependency
5. Autonomy and organization (professional cohesiveness)
6. Licensing
7. Educational reform
Describe organized medicine. Answer - The concerted efforts of physicians
through the AMA which equated to professional cohesiveness.
What 3 factors prompted the general need for health insurance? Answer - 1.
Technological - advanced treatments that were desirable but expensive.
2. Social - desirability of medical treatments.
3. Economic - risk of catastrophic loss.
What 3 reasons led to the growth of employer-based health insurance?
Answer - 1. Wage freeze during WWII - employers offered insurance as a
benefit in lieu of more money.
2. 1948 Supreme Court ruling - employee benefits were legit part of union-
management negotiations.
3. 1954 IRS tax code revision - made employer-paid health insurance tax
deductible for employers, tax-exempt for employees.
Describe the 4 parts of Medicare. Answer - Part A - hospital and limited
nursing home coverage (automatic).
Part B - Covers physician bills. Pay separate from part A.
Part C (1997) - Medicare managed care.
, Part D (2006) - Prescription drugs.
Describe Medicaid. Answer - - Helps indigent populations pay for health care.
- Eligibility determined via a means test.
- A state run program, funded in part by federal government to match state
contributions (Kerr-Mills Act).
What is the role of medical technology in health care delivery? Answer - A tool
to improve the efficiency, effectiveness, safety, and patient health. Excessive
use of technology must be balanced with cost - what is the point of diminishing
returns?
What are some applications of IT and informatics in the delivery of health care?
Answer - - Decision support systems (Often embedded in EHR)
- Clinical information systems (Pharmacy data systems, Radiology & lab
reporting systems)
- Administrative information systems (Personnel management & scheduling)
What factors influence the creation, dissemination, and utilization of
technology? Answer - 1. Anthro-cultural beliefs and values
2. Medical specialization
3. Financing & payment
4. Technology-driven competition
5. Expenditures on research & development
6. Supply-side controls
7. Government policy
What is the government's role in technology diffusion? Answer - Government
funds 46% of medical technology R&D in the US. Aside from development, they
