HSA 452 EXAM 1 STUDY GUIDE WITH
ALL CORRECT & 100% VERIFIED
ANSWERS|ACTUAL COMPLETE EXAM|
ALREADY GRADED A+
1–10: U.S. Healthcare System Overview
1. What is the defining characteristic of the U.S. healthcare
system compared to other developed nations?
Answer: It lacks universal coverage and relies heavily on private
insurance.
Rationale: Most developed countries have single-payer or
mandatory public insurance; the U.S. has a multi-payer, mixed
public-private system.
2. Which law created Medicare and Medicaid?
Answer: Social Security Amendments of 1965.
Rationale: President Johnson signed it; Medicare for
elderly/disabled, Medicaid for low-income.
3. What is the primary source of health insurance for
Americans under 65?
Answer: Employer-sponsored insurance (ESI).
Rationale: About half of non-elderly get ESI; it’s tax-advantaged
and voluntary for employers.
4. The “Iron Triangle” of healthcare refers to:
Answer: Cost, quality, access.
,Rationale: Improving one often worsens another; a central
framework in health administration.
5. What is a “safety-net hospital”?
Answer: A hospital that serves a disproportionate share of
uninsured/Medicaid patients.
Rationale: Often public or non-profit; rely on DSH payments and
subsidies.
6. Which U.S. population group is covered by both Medicare
and Medicaid (“dual eligible”)?
Answer: Low-income elderly and disabled persons.
Rationale: Medicare is primary; Medicaid covers premiums,
cost-sharing, and long-term care.
7. What does SCHIP (now CHIP) stand for?
Answer: Children’s Health Insurance Program.
Rationale: Created in 1997; covers children in families with
incomes too high for Medicaid but too low for private.
8. What is a “single-payer” system?
Answer: One public entity finances care but delivery may remain
private.
Rationale: Example: Canada; U.S. has multi-payer with Medicare as
near-single-payer for elderly.
9. The Veterans Health Administration (VHA) is best described
as:
Answer: A government-run, integrated delivery system.
Rationale: Directly employs providers and owns hospitals;
separate from Medicare.
, 10. Which amendment to the U.S. Constitution has been cited
as a barrier to a federal mandate to purchase insurance?
Answer: 10th Amendment (states’ rights).
Rationale: NFIB v. Sebelius (2012) upheld individual mandate as a
tax, but limited Medicaid expansion.
11–20: Financing & Reimbursement
11. What is “fee-for-service” (FFS) reimbursement?
Answer: Payment for each service provided (e.g., office visit,
procedure).
Rationale: Encourages volume; contrasts with capitation or
bundled payments.
12. Define “capitation.”
Answer: Fixed monthly payment per enrolled patient regardless of
services used.
Rationale: Shifts risk to provider; common in HMOs.
13. What is a “bundled payment”?
Answer: Single payment for an episode of care (e.g., hip
replacement + 90 days).
Rationale: Promotes coordination; used in Medicare’s BPCI
initiative.
14. The “Resource-Based Relative Value Scale” (RBRVS) is
used by Medicare to pay:
Answer: Physicians.
ALL CORRECT & 100% VERIFIED
ANSWERS|ACTUAL COMPLETE EXAM|
ALREADY GRADED A+
1–10: U.S. Healthcare System Overview
1. What is the defining characteristic of the U.S. healthcare
system compared to other developed nations?
Answer: It lacks universal coverage and relies heavily on private
insurance.
Rationale: Most developed countries have single-payer or
mandatory public insurance; the U.S. has a multi-payer, mixed
public-private system.
2. Which law created Medicare and Medicaid?
Answer: Social Security Amendments of 1965.
Rationale: President Johnson signed it; Medicare for
elderly/disabled, Medicaid for low-income.
3. What is the primary source of health insurance for
Americans under 65?
Answer: Employer-sponsored insurance (ESI).
Rationale: About half of non-elderly get ESI; it’s tax-advantaged
and voluntary for employers.
4. The “Iron Triangle” of healthcare refers to:
Answer: Cost, quality, access.
,Rationale: Improving one often worsens another; a central
framework in health administration.
5. What is a “safety-net hospital”?
Answer: A hospital that serves a disproportionate share of
uninsured/Medicaid patients.
Rationale: Often public or non-profit; rely on DSH payments and
subsidies.
6. Which U.S. population group is covered by both Medicare
and Medicaid (“dual eligible”)?
Answer: Low-income elderly and disabled persons.
Rationale: Medicare is primary; Medicaid covers premiums,
cost-sharing, and long-term care.
7. What does SCHIP (now CHIP) stand for?
Answer: Children’s Health Insurance Program.
Rationale: Created in 1997; covers children in families with
incomes too high for Medicaid but too low for private.
8. What is a “single-payer” system?
Answer: One public entity finances care but delivery may remain
private.
Rationale: Example: Canada; U.S. has multi-payer with Medicare as
near-single-payer for elderly.
9. The Veterans Health Administration (VHA) is best described
as:
Answer: A government-run, integrated delivery system.
Rationale: Directly employs providers and owns hospitals;
separate from Medicare.
, 10. Which amendment to the U.S. Constitution has been cited
as a barrier to a federal mandate to purchase insurance?
Answer: 10th Amendment (states’ rights).
Rationale: NFIB v. Sebelius (2012) upheld individual mandate as a
tax, but limited Medicaid expansion.
11–20: Financing & Reimbursement
11. What is “fee-for-service” (FFS) reimbursement?
Answer: Payment for each service provided (e.g., office visit,
procedure).
Rationale: Encourages volume; contrasts with capitation or
bundled payments.
12. Define “capitation.”
Answer: Fixed monthly payment per enrolled patient regardless of
services used.
Rationale: Shifts risk to provider; common in HMOs.
13. What is a “bundled payment”?
Answer: Single payment for an episode of care (e.g., hip
replacement + 90 days).
Rationale: Promotes coordination; used in Medicare’s BPCI
initiative.
14. The “Resource-Based Relative Value Scale” (RBRVS) is
used by Medicare to pay:
Answer: Physicians.
