MHA 707 EXAM C 2026 REVISION NOTES AND
STRUCTURED HEALTHCARE LEADERSHIP
OVERVIEW GUIDE
◉ why did BCBS use community rating. Answer: data was too poor
to do anything else
◉ community rating refers to. Answer: insurance pricing whereby
everyone in same geographic area pays the same premium
-regardless of their health status, age, gender, family composition,
occupation, health behaviors such as smoking, or claims history
◉ Experience Rating. Answer: tailors policies and premiums to a
particular group or individual
-premiums are based on the insured person's prior claims, health
status, and risk of future claims as indicated by his or her age,
gender, health behaviors, and so forth
◉ between 1965 and 1999. Answer: congress passed legislation for
three groups not covered by employer-based insurance
-medicare for 65+
-medicaid for uninsured, low income
-CHIP for uninsured, moderate income
,◉ 1986. Answer: two fed health policies enacted to solve problems
related to health care coverage
-EMTALA
-HIPAA
◉ Emergency medical treatment and labor act (EMTALA). Answer:
prohibited "dumping" by medicare participating hospitals with
active emergency rooms
◉ Health insurance portability and accountability act (HIPAA) -
1996. Answer: brought about a number of significant improvements
in access to health coverage by mandating:
-continuity or "portability" of coverage in the private health
insurance markets
-health insurance coverage for at least a two day hospital stay for
women who give birth vaginally and four days for cesarean
deliveries -sponsored by texas senator phil gramm
-mental health was given the same status as physical health by the
HIPAA legislation
◉ HIPAA and privacy. Answer: -data within the medical record
belongs to the patient
-patients have the right to ensure that the info contained in their
record is accurate
, -patients can petition their provider to change incorrect info
◉ hospitals developed as heart of HC delivery system in. Answer:
20th century
◉ community hospitals built with. Answer: federal funds through
Hill-Burton Act
◉ voluntary, nonprofit hospitals built by. Answer: private sector
◉ hospitals built by. Answer: military for members, vets, and fam
◉ public hospitals built by. Answer: gov entities for the poor (usually
local gov)
◉ 1900-1930. Answer: ~0.3% of GDP
◉ 1960. Answer: 1.3% GDP = 4x, four-fold, 400%
◉ 1980. Answer: 4.1% GDP= 3x since 1960, 13.6x since 1930
◉ -expansion of capitation and rise of managed care,
STRUCTURED HEALTHCARE LEADERSHIP
OVERVIEW GUIDE
◉ why did BCBS use community rating. Answer: data was too poor
to do anything else
◉ community rating refers to. Answer: insurance pricing whereby
everyone in same geographic area pays the same premium
-regardless of their health status, age, gender, family composition,
occupation, health behaviors such as smoking, or claims history
◉ Experience Rating. Answer: tailors policies and premiums to a
particular group or individual
-premiums are based on the insured person's prior claims, health
status, and risk of future claims as indicated by his or her age,
gender, health behaviors, and so forth
◉ between 1965 and 1999. Answer: congress passed legislation for
three groups not covered by employer-based insurance
-medicare for 65+
-medicaid for uninsured, low income
-CHIP for uninsured, moderate income
,◉ 1986. Answer: two fed health policies enacted to solve problems
related to health care coverage
-EMTALA
-HIPAA
◉ Emergency medical treatment and labor act (EMTALA). Answer:
prohibited "dumping" by medicare participating hospitals with
active emergency rooms
◉ Health insurance portability and accountability act (HIPAA) -
1996. Answer: brought about a number of significant improvements
in access to health coverage by mandating:
-continuity or "portability" of coverage in the private health
insurance markets
-health insurance coverage for at least a two day hospital stay for
women who give birth vaginally and four days for cesarean
deliveries -sponsored by texas senator phil gramm
-mental health was given the same status as physical health by the
HIPAA legislation
◉ HIPAA and privacy. Answer: -data within the medical record
belongs to the patient
-patients have the right to ensure that the info contained in their
record is accurate
, -patients can petition their provider to change incorrect info
◉ hospitals developed as heart of HC delivery system in. Answer:
20th century
◉ community hospitals built with. Answer: federal funds through
Hill-Burton Act
◉ voluntary, nonprofit hospitals built by. Answer: private sector
◉ hospitals built by. Answer: military for members, vets, and fam
◉ public hospitals built by. Answer: gov entities for the poor (usually
local gov)
◉ 1900-1930. Answer: ~0.3% of GDP
◉ 1960. Answer: 1.3% GDP = 4x, four-fold, 400%
◉ 1980. Answer: 4.1% GDP= 3x since 1960, 13.6x since 1930
◉ -expansion of capitation and rise of managed care,
