HAN300 MIDTERM EXAM QUESTIONS
AND ANSWERS 100% PASS 2026/2027
Administrative costs - ANS costs associated with billing, collections, bad debts, and
maintaining medical records
Balance bill - ANS when only partial payment is received, some health plans may allow the
provider to the patient for the amount the health plan did not pay. this triggers a new cycle of
billings and collection efforts
Defense medicine - ANS practitioners protect themselves against the possibility of litigation
by prescribing additional diagnostic tests, scheduling return check up visits, and maintaining
copious documentation; many of these efforts may be unnecessary and costly and inefficient
Demand - ANS the quantity of health care purchased is driven by the prices prevailing in the
free market
Enrollee - ANS the individual covered under the plan
Free Market - ANS multiple patients (buyers) and providers (sellers) act independently and
patients can choose to receive services from any provider. providers neither collude to fix prices
nor are prices fixed by an external agency. prices are governed by the forces of supply and
demand; US system is a quasi market/imperfect market. not completely free market.
@2026 ALLRIGHTS RESERVED 1
,Global budget - ANS other developed nations have national health care programs to give
every citizen a defined set of health care services; to control costs, these systems use --- to
determine total health care expenditures on a national scale and to allocate resources within
budgetary limits
Health care Reform - ANS the expansion of health insurance to cover the uninsured
Health plan - ANS the contractual arrangement between the MCO and the enrollee -
including the collective array of covered health services that the enrollee is entitled to
Managed care - ANS a system of health care delivery that:
-seeks to achieve efficiencies by integrating the four functions of health care delivery discussed
earlier
-employs mechanisms to manage utilization of medical services
-determines the price at which the services are purchased and, consequently, how much the
providers get paid; the primary financier is still the employer or the government
Medicaid - ANS program for the indigent (poor), jointly administered by the federal
government and state government
Medicare - ANS program for the elderly and certain disabled individuals
Moral Hazard - ANS Consumer behavior that leads to a higher utilization of health care
services because people are covered by insurance.
National Health Insurance (NIH) - ANS A tax-supported national health care program in which
services are financed by the government but are rendered by private providers. Ex) Canada: the
@2026 ALLRIGHTS RESERVED 2
, government finances health care through general taxes, but the actual care is delivered by
private providers; requires a tighter consolidation of the financing, insurance, and payment
functions coordinated by the government; delivery is characterized by detached private
arrangements
National Health System (NHS) - ANS A tax-supported national health care program in which
the government finances and also controls the service infrastructure. Ex) United Kingdom: in
addition to financing a tax supported NHI program, the government manages the infrastructure
for the delivery of medical care; gov operates most of the medical institutions; most health care
providers are either government employees or are tightly organized in a publicly managed
infrastructure
Need - ANS the amount of medical care that medical experts believe a person should have to
remain or become healthy; decisions about the utilization of health care are often determined
by need rather than by price based demand.
package pricing - ANS a bundled fee for a package of related services. Ex- one all inclusive
price for surgeon's fees, hospital facilities, supplies, diagnostics, pathology, anesthesia, and post-
surgical follow-up
Phantom Providers - ANS function in an adjunct capacity, bill for their services separately. Ex)
anesthesiologists, nurse anesthetists, pathologists
Premium cost sharing - ANS most employers require their employees to pay a portion of the
cost of the insurance premium.
Primary Care - ANS continual basic and routine care provided in an office or clinic by a
provider (physician, nurse, or other health care professional) who takes responsibility for
coordinating all aspects of a patient's health care needs; an approach to health care delivery
that is the patients first contact with the healthcare delivery system and the first element of a
continuing healthcare process.
@2026 ALLRIGHTS RESERVED 3
AND ANSWERS 100% PASS 2026/2027
Administrative costs - ANS costs associated with billing, collections, bad debts, and
maintaining medical records
Balance bill - ANS when only partial payment is received, some health plans may allow the
provider to the patient for the amount the health plan did not pay. this triggers a new cycle of
billings and collection efforts
Defense medicine - ANS practitioners protect themselves against the possibility of litigation
by prescribing additional diagnostic tests, scheduling return check up visits, and maintaining
copious documentation; many of these efforts may be unnecessary and costly and inefficient
Demand - ANS the quantity of health care purchased is driven by the prices prevailing in the
free market
Enrollee - ANS the individual covered under the plan
Free Market - ANS multiple patients (buyers) and providers (sellers) act independently and
patients can choose to receive services from any provider. providers neither collude to fix prices
nor are prices fixed by an external agency. prices are governed by the forces of supply and
demand; US system is a quasi market/imperfect market. not completely free market.
@2026 ALLRIGHTS RESERVED 1
,Global budget - ANS other developed nations have national health care programs to give
every citizen a defined set of health care services; to control costs, these systems use --- to
determine total health care expenditures on a national scale and to allocate resources within
budgetary limits
Health care Reform - ANS the expansion of health insurance to cover the uninsured
Health plan - ANS the contractual arrangement between the MCO and the enrollee -
including the collective array of covered health services that the enrollee is entitled to
Managed care - ANS a system of health care delivery that:
-seeks to achieve efficiencies by integrating the four functions of health care delivery discussed
earlier
-employs mechanisms to manage utilization of medical services
-determines the price at which the services are purchased and, consequently, how much the
providers get paid; the primary financier is still the employer or the government
Medicaid - ANS program for the indigent (poor), jointly administered by the federal
government and state government
Medicare - ANS program for the elderly and certain disabled individuals
Moral Hazard - ANS Consumer behavior that leads to a higher utilization of health care
services because people are covered by insurance.
National Health Insurance (NIH) - ANS A tax-supported national health care program in which
services are financed by the government but are rendered by private providers. Ex) Canada: the
@2026 ALLRIGHTS RESERVED 2
, government finances health care through general taxes, but the actual care is delivered by
private providers; requires a tighter consolidation of the financing, insurance, and payment
functions coordinated by the government; delivery is characterized by detached private
arrangements
National Health System (NHS) - ANS A tax-supported national health care program in which
the government finances and also controls the service infrastructure. Ex) United Kingdom: in
addition to financing a tax supported NHI program, the government manages the infrastructure
for the delivery of medical care; gov operates most of the medical institutions; most health care
providers are either government employees or are tightly organized in a publicly managed
infrastructure
Need - ANS the amount of medical care that medical experts believe a person should have to
remain or become healthy; decisions about the utilization of health care are often determined
by need rather than by price based demand.
package pricing - ANS a bundled fee for a package of related services. Ex- one all inclusive
price for surgeon's fees, hospital facilities, supplies, diagnostics, pathology, anesthesia, and post-
surgical follow-up
Phantom Providers - ANS function in an adjunct capacity, bill for their services separately. Ex)
anesthesiologists, nurse anesthetists, pathologists
Premium cost sharing - ANS most employers require their employees to pay a portion of the
cost of the insurance premium.
Primary Care - ANS continual basic and routine care provided in an office or clinic by a
provider (physician, nurse, or other health care professional) who takes responsibility for
coordinating all aspects of a patient's health care needs; an approach to health care delivery
that is the patients first contact with the healthcare delivery system and the first element of a
continuing healthcare process.
@2026 ALLRIGHTS RESERVED 3
