HCD 303 - Module 4 Exam 100% Solved Correctly

HCD 303 - Module 4 Exam 100% Solved Correctly What is healthcare financing? - Answer- - It is the function of a system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people, individually and collectively, in the health system What is one of the key leverage points that exists within healthcare financing that can be used to improve healthcare delivery? - Answer- - To align incentives between patients and providers Which country spends the highest percent of their GDP on healthcare? - Answer- - United States Which of the following is considered to be forms of 'bundled payments'? - Answer- - DRGs Which payment model reimburses organizations and/or providers based upon the number of days treatment was given? - Answer- - Per Diem What does the term prospective mean? - Answer- It is when the reimbursement amount for a service or group of services are set in advance Which of the following accurately describe aspects of the U.S. DRG payment model? Select all that apply. - Answer- - A prospective payment model - Covers costs from admission to discharge - Follows a patient for 30-days post-discharge Which of the following are key distinctions between the DRG payment model and the EDRG payment model? Select all that apply. - Answer- - DRG will only ever follow a patient for 30-days, while EDRG follows a patient for up to 5 years, - DRG does not include physician services, while EDRG does include physician services in the bundled price Which payment model provides the least financial risk for providers and the most financial risk for payers? - Answer- - Fee-for-service Which payment model provides the least financial risk for payers and the most financial risk for providers? - Answer- - Capitation What payment model was dubbed pay-for-process by physicians and played a significant role in what would ultimately become the opioid epidemic? - Answer- - Pay-for-performance What are some of the key aspects of the innovative care delivery design that occurred in Valencia, Spain? (Hint: visit the required readings from this week). - Answer- - Implemented capitation payments throughout the entire region - Public financing to a completely private healthcare organization - Payments were NOT risk-adjusted What population did CareMore enroll into its innovative, capitation-based, care delivery programs? (Hint: visit the required readings from this week). - Answer- - Medicare Advantage patients Japan's health care system "imposes virtually no controls over access to treatment" due to which of the following? (Hint: visit the required readings from this week) - Answer- - No gatekeepers/ Fee-for-Service reimbursement What percentage of the federal budget is attributed to healthcare in Germany? - Answer- - 4.3% In Germany, healthcare spending accounts for what percentage of the GDP? - Answer- - 11% In regards to healthcare expenditures by source of payment, how much of all expenditures are made payable through Statutory Health Insurance plans? - Answer- - 63% What is the primary means by which money is accumulated within the healthcare system in Germany? - Answer- - Since the system in Germany is highly privatized money is accumulated by the sickness funds through payroll deduction How are primary care physicians paid in Germany? - Answer- - A mix of payment models including fee-for-service with a uniform fee schedule and bonus for chronic disease management programs What is a uniform-fee schedule? - Answer- - It refers to the amount of services that each provider can administer within each quarter What payment model is utilized to pay specialists in Germany? - Answer- - A mix of payment models including fee-for-service with a uniform fee schedule and bonus for chronic disease management programs What payment model is utilized to reimburse hospitals in Germany? - Answer- - Diagnosis-related groups At what level are reimbursement payment amounts set in Germany? - Answer- - Regional because the system in Germany is decentralized