N419 EXAM 1 UNIT 3: ORGANIZATIONAL STRUCTURES
AND HEALTHCARE ENVIRONMENT EXAM 2025
· On March 23, 2010 The Patient Protection and Affordable Care Act became law
· The Health care ________ act has been the single thing in the last decade that has impacted
our healthcare system the most - correct answers ✔✔reform
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Universal Program
o Consumer co-payments are negligible
o Physician choice unlimited unlike the US
o Physician receives payments on a negotiated fee for service
o Hospital receives global budget payments (get one large lumpsum to manage their budget)
o Private HI (health insurance) for covered services are illegal
§ You cannot have private insurance in Canada - correct answers ✔✔Canada
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Most insurance have some type of UR (utilization review)
§ Preadmission criteria that you have to meet in order to qualify for admission into a hospital or
qualify for a certain procedure
,§ Concurrent review of LOS—constantly looking at medical necessity and the reason you have to
stay in the hospital (do you meet the criteria for remaining hospitalization)
§ Mandatory 2nd opinion for surgery
o Greatest strength—both of these things are part of the reason why our healthcare is so
expensive
§ Advanced state of technology
§ Pharmaceutical innovation - correct answers ✔✔US
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Weaknesses
§ US has twice the administrative costs d/t government mandates & diversity of insurers
§ Spend more on technology and duplication of services
· Everyone wants to have the greatest and latest; well, it is a supply and demand thing and if you
are in an area that does not need, for example MRI machines, some machines may be sitting
and not used a lot. You will pay millions and millions of dollars for this type of technology. It is
wasteful costs - correct answers ✔✔US
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Weaknesses
§ Litigation influences practice - 350% more lawsuits in US than Canada
· Malpractice lawsuits cost over $28 billion, plus defensive medicine consumes 9% of HC
expenses (they are covering themselves—they want to order that extra diagnostic just to make
sure its not the worst-case scenario—ex: HA could be a migraine or an aneurysm but the doctor
,is going to want to get a head CT because if you diagnose wrong then you fear a lawsuit) -
correct answers ✔✔US
What are the 2 major types of healthcare organizations? - correct answers ✔✔federal
government and non-federal
What major type of healthcare organization (federal government and non-federal) is described
below:
o VA hospital
o Military hospitals
o Federal Prisons
o Indian Health (part of DHH) - correct answers ✔✔federal government
The following are other major types of healthcare _______:
· Home Health (very important part of healthcare continuum)
· Hospice
o Follow the growth and you will know where the money is in healthcare; there are so many
Hospice companies that have popped up
o Reimbursement is good because we know patients dying in the hospital is not smart use of
healthcare dollars. We do end of life very poorly in the US so that is an opportunity for us
o There is some abuse out there with people opening Hospice companies and patients get
discharged from Hospice and this should be rare
· Dialysis Centers
· Nurse Managed Clinics
, · Outpatient Clinics - Public Health
· Physician Offices - correct answers ✔✔organizations
The following are other major types of healthcare _______:
· Home Health (very important part of healthcare continuum)
Hospice
· Dialysis Centers
· Nurse Managed Clinics
· Outpatient Clinics - Public Health
· Physician Offices - correct answers ✔✔organizations
The following are components of the healthcare ______:
· Providers
o Physicians/LIP
§ Hospitalists
· Nurses, PT, OT, other healthcare professionals (everyone that lays a hand on the patient)
· Hospitals
· Insurers and payers
· Education and research
· Suppliers
· Professional associations/organizations
o AMA is very powerful
· Regulatory bodies/agencies (ex: TJC, CMS, etc.) - correct answers ✔✔system
AND HEALTHCARE ENVIRONMENT EXAM 2025
· On March 23, 2010 The Patient Protection and Affordable Care Act became law
· The Health care ________ act has been the single thing in the last decade that has impacted
our healthcare system the most - correct answers ✔✔reform
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Universal Program
o Consumer co-payments are negligible
o Physician choice unlimited unlike the US
o Physician receives payments on a negotiated fee for service
o Hospital receives global budget payments (get one large lumpsum to manage their budget)
o Private HI (health insurance) for covered services are illegal
§ You cannot have private insurance in Canada - correct answers ✔✔Canada
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Most insurance have some type of UR (utilization review)
§ Preadmission criteria that you have to meet in order to qualify for admission into a hospital or
qualify for a certain procedure
,§ Concurrent review of LOS—constantly looking at medical necessity and the reason you have to
stay in the hospital (do you meet the criteria for remaining hospitalization)
§ Mandatory 2nd opinion for surgery
o Greatest strength—both of these things are part of the reason why our healthcare is so
expensive
§ Advanced state of technology
§ Pharmaceutical innovation - correct answers ✔✔US
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Weaknesses
§ US has twice the administrative costs d/t government mandates & diversity of insurers
§ Spend more on technology and duplication of services
· Everyone wants to have the greatest and latest; well, it is a supply and demand thing and if you
are in an area that does not need, for example MRI machines, some machines may be sitting
and not used a lot. You will pay millions and millions of dollars for this type of technology. It is
wasteful costs - correct answers ✔✔US
When talking about the comparison of healthcare in the US and Canada, which of these
countries is described below when talking about healthcare? **do not need to memorize
specifics; more of comparison to help understand how healthcare systems differ**
o Weaknesses
§ Litigation influences practice - 350% more lawsuits in US than Canada
· Malpractice lawsuits cost over $28 billion, plus defensive medicine consumes 9% of HC
expenses (they are covering themselves—they want to order that extra diagnostic just to make
sure its not the worst-case scenario—ex: HA could be a migraine or an aneurysm but the doctor
,is going to want to get a head CT because if you diagnose wrong then you fear a lawsuit) -
correct answers ✔✔US
What are the 2 major types of healthcare organizations? - correct answers ✔✔federal
government and non-federal
What major type of healthcare organization (federal government and non-federal) is described
below:
o VA hospital
o Military hospitals
o Federal Prisons
o Indian Health (part of DHH) - correct answers ✔✔federal government
The following are other major types of healthcare _______:
· Home Health (very important part of healthcare continuum)
· Hospice
o Follow the growth and you will know where the money is in healthcare; there are so many
Hospice companies that have popped up
o Reimbursement is good because we know patients dying in the hospital is not smart use of
healthcare dollars. We do end of life very poorly in the US so that is an opportunity for us
o There is some abuse out there with people opening Hospice companies and patients get
discharged from Hospice and this should be rare
· Dialysis Centers
· Nurse Managed Clinics
, · Outpatient Clinics - Public Health
· Physician Offices - correct answers ✔✔organizations
The following are other major types of healthcare _______:
· Home Health (very important part of healthcare continuum)
Hospice
· Dialysis Centers
· Nurse Managed Clinics
· Outpatient Clinics - Public Health
· Physician Offices - correct answers ✔✔organizations
The following are components of the healthcare ______:
· Providers
o Physicians/LIP
§ Hospitalists
· Nurses, PT, OT, other healthcare professionals (everyone that lays a hand on the patient)
· Hospitals
· Insurers and payers
· Education and research
· Suppliers
· Professional associations/organizations
o AMA is very powerful
· Regulatory bodies/agencies (ex: TJC, CMS, etc.) - correct answers ✔✔system
