DELIVERING HEALTH CARE IN AMERICA CHAPTER 1
QUESTIONS AND ANSWERS
Broad description of the System - CORRECT ANSWER✅✅A multiplicity of financial arrangements that
enable individuals to pay for health care services. Numerous insurance agencies or MCOs that employ
varied mechanisms for insuring against risk.Multiple payers that make their own determinations
regarding how much to pay for each type of service.A large array of setting where medical services are
delivered; Numerous consulting firms offering expertise in planning, cost containment, electronic
systems, quality, and restructuring of resources
Quad-function model - CORRECT ANSWER✅✅Financing
Insurance
Delivery
Payment
Financing - CORRECT ANSWER✅✅Employment based: employers finance health care Public programs:
Government is the financer
Insurance - CORRECT ANSWER✅✅It's either private or public
Delivery - CORRECT ANSWER✅✅Provision of health care by various providers Hospitals, clinics...
Provider - CORRECT ANSWER✅✅Any entity that delivers health care services and can either
independently bill for those services or is tax supported.
Payment - CORRECT ANSWER✅✅Deals with reimbursement to providers for services delivered.
Medicare - CORRECT ANSWER✅✅Program for the elderly and certain disabled individuals
Medicaid - CORRECT ANSWER✅✅Program for the indigent
, Children's Health Insurance Program (CHIP) - CORRECT ANSWER✅✅Program for children of low income
families
Reasons for not having insurance - CORRECT ANSWER✅✅Employers are not mandated to offer health
insurance to their employees Work settings, participation in health insurance programs are voluntary.
Employees opted not to enroll because they cannot afford
Premium cost sharing - CORRECT ANSWER✅✅Employees pay a portion of the cost
Health Care Reform (Obama Care, ACA) - CORRECT ANSWER✅✅Refers to the expansion of health
insurance to cover the uninsured
Affordable Care Act (ACA) - CORRECT ANSWER✅✅Mandated to start covering children and young
adults below the age of 26 under their parents plan
- CORRECT ANSWER✅✅All US citizens and legal residents must be covered by either public or private
insurance Relaxed the standards to qualify additional numbers of people for Medicaid
Essential health benefits - CORRECT ANSWER✅✅The law mandates insurance plans to cover a variety
of services referred to as Essential health benefits.
ACA failed - CORRECT ANSWER✅✅To achieve Universal coverage that would enable all citizens and
legal residents to have health insurance.
Utilization - CORRECT ANSWER✅✅The quantity of heath care consumed
Managed care - CORRECT ANSWER✅✅Seeks to achieve efficiencies by integrating the four functions of
healthcare delivery
Employs mechanisms to control utilization of medical services - CORRECT ANSWER✅✅
QUESTIONS AND ANSWERS
Broad description of the System - CORRECT ANSWER✅✅A multiplicity of financial arrangements that
enable individuals to pay for health care services. Numerous insurance agencies or MCOs that employ
varied mechanisms for insuring against risk.Multiple payers that make their own determinations
regarding how much to pay for each type of service.A large array of setting where medical services are
delivered; Numerous consulting firms offering expertise in planning, cost containment, electronic
systems, quality, and restructuring of resources
Quad-function model - CORRECT ANSWER✅✅Financing
Insurance
Delivery
Payment
Financing - CORRECT ANSWER✅✅Employment based: employers finance health care Public programs:
Government is the financer
Insurance - CORRECT ANSWER✅✅It's either private or public
Delivery - CORRECT ANSWER✅✅Provision of health care by various providers Hospitals, clinics...
Provider - CORRECT ANSWER✅✅Any entity that delivers health care services and can either
independently bill for those services or is tax supported.
Payment - CORRECT ANSWER✅✅Deals with reimbursement to providers for services delivered.
Medicare - CORRECT ANSWER✅✅Program for the elderly and certain disabled individuals
Medicaid - CORRECT ANSWER✅✅Program for the indigent
, Children's Health Insurance Program (CHIP) - CORRECT ANSWER✅✅Program for children of low income
families
Reasons for not having insurance - CORRECT ANSWER✅✅Employers are not mandated to offer health
insurance to their employees Work settings, participation in health insurance programs are voluntary.
Employees opted not to enroll because they cannot afford
Premium cost sharing - CORRECT ANSWER✅✅Employees pay a portion of the cost
Health Care Reform (Obama Care, ACA) - CORRECT ANSWER✅✅Refers to the expansion of health
insurance to cover the uninsured
Affordable Care Act (ACA) - CORRECT ANSWER✅✅Mandated to start covering children and young
adults below the age of 26 under their parents plan
- CORRECT ANSWER✅✅All US citizens and legal residents must be covered by either public or private
insurance Relaxed the standards to qualify additional numbers of people for Medicaid
Essential health benefits - CORRECT ANSWER✅✅The law mandates insurance plans to cover a variety
of services referred to as Essential health benefits.
ACA failed - CORRECT ANSWER✅✅To achieve Universal coverage that would enable all citizens and
legal residents to have health insurance.
Utilization - CORRECT ANSWER✅✅The quantity of heath care consumed
Managed care - CORRECT ANSWER✅✅Seeks to achieve efficiencies by integrating the four functions of
healthcare delivery
Employs mechanisms to control utilization of medical services - CORRECT ANSWER✅✅
