CHAPTER 2 THE HEALTH CARE
DELIVERY SYSTEM EXAM QUESTIONS
AND ANSWERS 100% PASS 2026
EDITION
Professional standards review organizations (PSROs) - ANS The federal government, the
biggest consumer of health care, which paid for Medicare and Medicaid, created
__________________to review the quality, quantity, and cost of hospital care
utilization review (UR) committees - ANS Medicare-qualified hospitals had physician-
supervised_________________to review the admissions and to identify and eliminate overuse
of diagnostic and treatment services ordered by physicians caring for patients on Medicare.
prospective payment system (PPS) - ANS One of the most significant factors that influenced
payment for health care was the __________________. Established by Congress in 1983, the
PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare
benefits were no longer able to charge whatever a patient's care cost.
diagnosis-related groups (DRGs) - ANS Instead, the PPS grouped inpatient hospital services
for Medicare patients into__________________. Each group has a fixed reimbursement amount
with adjustments based on case severity, rural/urban/regional costs, and teaching costs.
Hospitals receive a set dollar amount for each patient based on the assigned DRG, regardless of
the patient's length of stay or use of services.
Many use ________ in the rehabilitation setting.
1
@2026 EDITION ALLRIGHTS RESERVED
,Capitation - ANS __________________ means that the providers receive a fixed amount per
patient or enrollee of a health care plan.
__________________ aims to build a payment plan for select diagnoses or surgical procedures
that consists of the best standards of care at the lowest cost.
resource utilization groups (RUGs) - ANS use ______________ in long-term care.
When patients are hospitalized for lengthy periods, hospitals have to absorb the portion of costs
that are not reimbursed. This simply adds more pressure to ensure that patients are managed
effectively and discharged as soon as is reasonably possible.
Managed care - ANS *describes health care systems in which the provider or health care
system receives a predetermined capitated payment for each patient enrolled in the program.
*The focus of care of the organization shifts from individual illness care to prevention, early
intervention, and outpatient care.
*If people stay healthy, the cost of medical care declines.
*focus on containing or reducing costs, increasing patient satisfaction, and improving the health
or functional status of individuals
Independent practice association (IPA) - ANS The MCO contracts with physicians who usually
are not members of groups and whose practices include fee-for-service and capitated patients.
integrated delivery networks (IDNs) - ANS *Larger health care systems have _____________
that include a set of providers and services organized to deliver a continuum of care to a
population of patients at a capitated cost in a particular setting.
*Reduces duplication of services across levels or settings of care to ensure that patients receive
care in the most appropriate settings.
Primary Care - ANS • Prenatal and well-baby care
2
@2026 EDITION ALLRIGHTS RESERVED
, • Nutrition counseling
• Family planning
• Exercise classes
Preventive Care - ANS • Adult screenings for blood pressure, cholesterol, tobacco use, and
cancer
• Pediatric screenings for hearing, vision, autism, and developmental disorders
• HIV screening for adults at higher risk
• Wellness visits
• Immunizations
• Diet counseling
• Mental health counseling and crisis prevention
• Community legislation (seat belts, car seats for children, bike helmets)
. Primary Care (Health Promotion) - ANS • Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
• Patient-centered medical home
Secondary Acute Care - ANS • Urgent care; hospital emergency care
• Acute medical-surgical care: ambulatory care, outpatient surgery, hospital
• Radiological procedures
Emergency care
3
@2026 EDITION ALLRIGHTS RESERVED
DELIVERY SYSTEM EXAM QUESTIONS
AND ANSWERS 100% PASS 2026
EDITION
Professional standards review organizations (PSROs) - ANS The federal government, the
biggest consumer of health care, which paid for Medicare and Medicaid, created
__________________to review the quality, quantity, and cost of hospital care
utilization review (UR) committees - ANS Medicare-qualified hospitals had physician-
supervised_________________to review the admissions and to identify and eliminate overuse
of diagnostic and treatment services ordered by physicians caring for patients on Medicare.
prospective payment system (PPS) - ANS One of the most significant factors that influenced
payment for health care was the __________________. Established by Congress in 1983, the
PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare
benefits were no longer able to charge whatever a patient's care cost.
diagnosis-related groups (DRGs) - ANS Instead, the PPS grouped inpatient hospital services
for Medicare patients into__________________. Each group has a fixed reimbursement amount
with adjustments based on case severity, rural/urban/regional costs, and teaching costs.
Hospitals receive a set dollar amount for each patient based on the assigned DRG, regardless of
the patient's length of stay or use of services.
Many use ________ in the rehabilitation setting.
1
@2026 EDITION ALLRIGHTS RESERVED
,Capitation - ANS __________________ means that the providers receive a fixed amount per
patient or enrollee of a health care plan.
__________________ aims to build a payment plan for select diagnoses or surgical procedures
that consists of the best standards of care at the lowest cost.
resource utilization groups (RUGs) - ANS use ______________ in long-term care.
When patients are hospitalized for lengthy periods, hospitals have to absorb the portion of costs
that are not reimbursed. This simply adds more pressure to ensure that patients are managed
effectively and discharged as soon as is reasonably possible.
Managed care - ANS *describes health care systems in which the provider or health care
system receives a predetermined capitated payment for each patient enrolled in the program.
*The focus of care of the organization shifts from individual illness care to prevention, early
intervention, and outpatient care.
*If people stay healthy, the cost of medical care declines.
*focus on containing or reducing costs, increasing patient satisfaction, and improving the health
or functional status of individuals
Independent practice association (IPA) - ANS The MCO contracts with physicians who usually
are not members of groups and whose practices include fee-for-service and capitated patients.
integrated delivery networks (IDNs) - ANS *Larger health care systems have _____________
that include a set of providers and services organized to deliver a continuum of care to a
population of patients at a capitated cost in a particular setting.
*Reduces duplication of services across levels or settings of care to ensure that patients receive
care in the most appropriate settings.
Primary Care - ANS • Prenatal and well-baby care
2
@2026 EDITION ALLRIGHTS RESERVED
, • Nutrition counseling
• Family planning
• Exercise classes
Preventive Care - ANS • Adult screenings for blood pressure, cholesterol, tobacco use, and
cancer
• Pediatric screenings for hearing, vision, autism, and developmental disorders
• HIV screening for adults at higher risk
• Wellness visits
• Immunizations
• Diet counseling
• Mental health counseling and crisis prevention
• Community legislation (seat belts, car seats for children, bike helmets)
. Primary Care (Health Promotion) - ANS • Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
• Patient-centered medical home
Secondary Acute Care - ANS • Urgent care; hospital emergency care
• Acute medical-surgical care: ambulatory care, outpatient surgery, hospital
• Radiological procedures
Emergency care
3
@2026 EDITION ALLRIGHTS RESERVED
