HCA 101 EXAMS 2026/2027 SCRIPTED QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔what does private delivery of health care mean - ✔✔means that majority of hospitals
and physician clinics are private businesses, independent from the government
- no central agency monitors total expenditures through global budgets or controls the
availability and utilization of services
- BUT the federal and state governments play an important role in health care delivery -
the determine public-sector expenditures and reimbursement rates for services provided
to medicare, medicaid and CHIP beneficiaries
✔✔standards of participation - ✔✔- government formulates standards of participation
through health policy and regulation, meaning providers must comply with the standards
establishes by the government to be certified to provide services to medicare, medicaid,
and CHIP beneficiaries
- certification standards are also regarded as minimum standards of quality in most
sectors of the health care industry
✔✔access - ✔✔means the ability of an individual to obtain health care services when
needed, which is not the same thing as having health insurance
✔✔americans can access health care services if they... - ✔✔1) have health insurance
through their employers
2) are covered under a government health care program
3) can afford to buy insurance with their own private funds
4) are able to pay for services privately or
5) can obtain charity or sbsidized care
✔✔federally supported health centers ... - ✔✔provide physician services to anyone
regardless of ability to pay
- are located in only certain geographic areas and provide limited specialized services
- under US law hospital emergency departments are required to evaluate a patients
condition and render medically needed services for which the hospital does not receive
any direct payments unless the patient is able to pay
- uninsured americans therefore are able to obtain medical care for acute illness
✔✔primary care - ✔✔uninsured generally have to forego continual basic routine care
, ✔✔universal access - ✔✔- countries with national health care programs provide
universal coverage
- however access to services when needed may be restricted because no health care
system has the capacity to deliver on demand every type of service for their citizens
-hence universal access - the ability of all citizens to obtain health care when needed -
remains mostly a theoretical concept
✔✔main goal of ACA - ✔✔- to increase access and make it more affordable
✔✔american health care a free market??? - ✔✔- not quite a free market
- best described as a quasi market or an imperfect market
✔✔determination of prices - ✔✔- prices are negotiated between the payers and
providers
- prices are determined by the payers, such as MCOs, medicare, medicaid
- bc prices are set by agencies external to the market they are not governed by the
unencumbered forces of supply and demand
✔✔what does health insurance cover - ✔✔covers basic and routine services that are
predictable
✔✔moral hazard - ✔✔that once enrollees have purchased health insurance they will
use health care services to a greater extent than if they were to pay for these services
out of pocket
✔✔two factors limit the ability of patients to make decisions - ✔✔1) decisions about the
utilization of health care are often determined by need rather than by price based
demand
2) the delivery of health care can result in demand creation
✔✔when does demand creation occur - ✔✔- when physicians prescribe medical care
beyond what is clinically necessary
✔✔drawbacks of current system - ✔✔- obstruct information-seeking efforts
ex: item based pricing
✔✔package pricing - ✔✔refers to a bundled fee for a package or related services
✔✔single payer system - ✔✔- what the national health care system is sometimes called
because there is one primary payer, the government
- in US however has a multiplicity of health plans, multiple payers often represent a
billing and collection nightmare for the providers of services
SOLUTIONS GUARANTEE A+
✔✔what does private delivery of health care mean - ✔✔means that majority of hospitals
and physician clinics are private businesses, independent from the government
- no central agency monitors total expenditures through global budgets or controls the
availability and utilization of services
- BUT the federal and state governments play an important role in health care delivery -
the determine public-sector expenditures and reimbursement rates for services provided
to medicare, medicaid and CHIP beneficiaries
✔✔standards of participation - ✔✔- government formulates standards of participation
through health policy and regulation, meaning providers must comply with the standards
establishes by the government to be certified to provide services to medicare, medicaid,
and CHIP beneficiaries
- certification standards are also regarded as minimum standards of quality in most
sectors of the health care industry
✔✔access - ✔✔means the ability of an individual to obtain health care services when
needed, which is not the same thing as having health insurance
✔✔americans can access health care services if they... - ✔✔1) have health insurance
through their employers
2) are covered under a government health care program
3) can afford to buy insurance with their own private funds
4) are able to pay for services privately or
5) can obtain charity or sbsidized care
✔✔federally supported health centers ... - ✔✔provide physician services to anyone
regardless of ability to pay
- are located in only certain geographic areas and provide limited specialized services
- under US law hospital emergency departments are required to evaluate a patients
condition and render medically needed services for which the hospital does not receive
any direct payments unless the patient is able to pay
- uninsured americans therefore are able to obtain medical care for acute illness
✔✔primary care - ✔✔uninsured generally have to forego continual basic routine care
, ✔✔universal access - ✔✔- countries with national health care programs provide
universal coverage
- however access to services when needed may be restricted because no health care
system has the capacity to deliver on demand every type of service for their citizens
-hence universal access - the ability of all citizens to obtain health care when needed -
remains mostly a theoretical concept
✔✔main goal of ACA - ✔✔- to increase access and make it more affordable
✔✔american health care a free market??? - ✔✔- not quite a free market
- best described as a quasi market or an imperfect market
✔✔determination of prices - ✔✔- prices are negotiated between the payers and
providers
- prices are determined by the payers, such as MCOs, medicare, medicaid
- bc prices are set by agencies external to the market they are not governed by the
unencumbered forces of supply and demand
✔✔what does health insurance cover - ✔✔covers basic and routine services that are
predictable
✔✔moral hazard - ✔✔that once enrollees have purchased health insurance they will
use health care services to a greater extent than if they were to pay for these services
out of pocket
✔✔two factors limit the ability of patients to make decisions - ✔✔1) decisions about the
utilization of health care are often determined by need rather than by price based
demand
2) the delivery of health care can result in demand creation
✔✔when does demand creation occur - ✔✔- when physicians prescribe medical care
beyond what is clinically necessary
✔✔drawbacks of current system - ✔✔- obstruct information-seeking efforts
ex: item based pricing
✔✔package pricing - ✔✔refers to a bundled fee for a package or related services
✔✔single payer system - ✔✔- what the national health care system is sometimes called
because there is one primary payer, the government
- in US however has a multiplicity of health plans, multiple payers often represent a
billing and collection nightmare for the providers of services
