DELIVERING HEALTHCARE IN AMERICA CHAPTER 12
QUESTIONS AND ANSWERS
Access - CORRECT ANSWER✅✅The ability of persons needing health services to obtain appropriate care
in a timely manner.
-can you get medical care when you need it?
-access is not the same as health insurance coverage
Administrative costs - CORRECT ANSWER✅✅Costs that are incidental to the delivery of health services.
they are not only associated with the billing and the collection of claims for services delivered, but also
include numerous other costs, such as time and effort incurred by employers for the selection of
insurance carriers, costs incurred by insurance and managed care organizations to market their products
and time and effort involved in the negotiation of rates.
Certificate of Need - CORRECT ANSWER✅✅planning agency over expansion of medical facilities-for
example, determination of whether a new facility should be opened in a certain location, whether an
existing facility should be expanded or whether a hospital should be allowed to purchase major
equipment.
Clinical practice guidelines - CORRECT ANSWER✅✅also know as medical practice guideline in the form
of scientifically established protocols, representing preferred processes in the medical practice
Competition - CORRECT ANSWER✅✅the rivalry among sellers to attract customers while lowering costs
cost efficiency - CORRECT ANSWER✅✅Also known as cost effectiveness; a state in which the benefit
received from a service is greater that the cost incurred to provide that service.
Critical Pathways - CORRECT ANSWER✅✅Outcome-based, patient-centered case management tools
that are interdisciplinary, facilitating coordination of care among multiple clinical departments and
caregivers. A critical pathway identifies planned medical interventions in a given case, along with
expected outcomes.
, defensive medicine - CORRECT ANSWER✅✅Excessive medical tests and procedures performed as a
protection against malpractice lawsuits, otherwise regarded as unnecessary.
Fruad - CORRECT ANSWER✅✅intentional filing of false billing claims or cost reports and provision of
services that are not medically necessary.
Health Planning - CORRECT ANSWER✅✅Decisions made by government to limit health care resources,
such as hospital beds and diffusion of costly technology.
Health related quality of life - CORRECT ANSWER✅✅in a composite sense, a person's own perception
of health, ability to function, role limitations from physical or emotional problems and personal
happiness during or subsequent to disease experience
Institutional-related quality of life - CORRECT ANSWER✅✅a patients quality of life while confined in an
institution as an patient.
include comfort factors emotional well being and environment
Outcomes - CORRECT ANSWER✅✅the end result of health care delivery; often viewed as the bottom-
line measure of the effectiveness of the health care delivery system
Overutilization (overuse) - CORRECT ANSWER✅✅Utilization of medical services, the cost of which
exceeds the benefit to consumers or the risks of which outweigh potential benefits.
Peer Review - CORRECT ANSWER✅✅process of medical review of utilization and quality when it is
carried out directly or under the supervision of physicians
Quality - CORRECT ANSWER✅✅the degree to which services for individuals and populations increase
the likelihood of desired health outcomes and are consistent with the current professional; knowledge
quality assessment - CORRECT ANSWER✅✅Process of defining quality and deciding how quality is to be
measured according to established standards.
QUESTIONS AND ANSWERS
Access - CORRECT ANSWER✅✅The ability of persons needing health services to obtain appropriate care
in a timely manner.
-can you get medical care when you need it?
-access is not the same as health insurance coverage
Administrative costs - CORRECT ANSWER✅✅Costs that are incidental to the delivery of health services.
they are not only associated with the billing and the collection of claims for services delivered, but also
include numerous other costs, such as time and effort incurred by employers for the selection of
insurance carriers, costs incurred by insurance and managed care organizations to market their products
and time and effort involved in the negotiation of rates.
Certificate of Need - CORRECT ANSWER✅✅planning agency over expansion of medical facilities-for
example, determination of whether a new facility should be opened in a certain location, whether an
existing facility should be expanded or whether a hospital should be allowed to purchase major
equipment.
Clinical practice guidelines - CORRECT ANSWER✅✅also know as medical practice guideline in the form
of scientifically established protocols, representing preferred processes in the medical practice
Competition - CORRECT ANSWER✅✅the rivalry among sellers to attract customers while lowering costs
cost efficiency - CORRECT ANSWER✅✅Also known as cost effectiveness; a state in which the benefit
received from a service is greater that the cost incurred to provide that service.
Critical Pathways - CORRECT ANSWER✅✅Outcome-based, patient-centered case management tools
that are interdisciplinary, facilitating coordination of care among multiple clinical departments and
caregivers. A critical pathway identifies planned medical interventions in a given case, along with
expected outcomes.
, defensive medicine - CORRECT ANSWER✅✅Excessive medical tests and procedures performed as a
protection against malpractice lawsuits, otherwise regarded as unnecessary.
Fruad - CORRECT ANSWER✅✅intentional filing of false billing claims or cost reports and provision of
services that are not medically necessary.
Health Planning - CORRECT ANSWER✅✅Decisions made by government to limit health care resources,
such as hospital beds and diffusion of costly technology.
Health related quality of life - CORRECT ANSWER✅✅in a composite sense, a person's own perception
of health, ability to function, role limitations from physical or emotional problems and personal
happiness during or subsequent to disease experience
Institutional-related quality of life - CORRECT ANSWER✅✅a patients quality of life while confined in an
institution as an patient.
include comfort factors emotional well being and environment
Outcomes - CORRECT ANSWER✅✅the end result of health care delivery; often viewed as the bottom-
line measure of the effectiveness of the health care delivery system
Overutilization (overuse) - CORRECT ANSWER✅✅Utilization of medical services, the cost of which
exceeds the benefit to consumers or the risks of which outweigh potential benefits.
Peer Review - CORRECT ANSWER✅✅process of medical review of utilization and quality when it is
carried out directly or under the supervision of physicians
Quality - CORRECT ANSWER✅✅the degree to which services for individuals and populations increase
the likelihood of desired health outcomes and are consistent with the current professional; knowledge
quality assessment - CORRECT ANSWER✅✅Process of defining quality and deciding how quality is to be
measured according to established standards.
