HCA 101 UPDATED FINAL PAPER QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔under traditional insurance, the four basic health delivery functions have been
fragmented - ✔✔-financiers
-insurers
-providers
-payers
...have often been different entities
✔✔the quantity of health care consumed refers to... - ✔✔utilization of health services
✔✔managed care is a system of health care delivery that... - ✔✔1) seeks to achieve
efficiencies by integrating the four functions of health care delivery discussed earlier
2) employs mechanisms to control utilization of medical services and primary fancier is
still the employer or the government as the case may be
3) determines the price at which the services are purchases and, consequently how
much the providers get paid
✔✔enrolleee - ✔✔refers to the individual covered under the plan
✔✔health plan - ✔✔contractual arrangment between the MCO and the enrollee -
including the collective array of covered health services that the enrollee is entitled to
✔✔external forces that shape the basic character of the health services delivery system
- ✔✔- political climate of a nation
- economic development
- technological progress
- social and cultural values
- physical enviornment, population characteristics such as demographic and health
trends and global influences
✔✔ten basic characteristics differentiate the US health care delivery system from that of
most other countries - ✔✔1. no central agency governs the system
2. access to health care services is selectively based on insurance coverage
3. health care is delivered under imperfect market conditions
4. third-party insurers act as intermediaries between the financing and delivery functions
5. the existence of multiple payers makes the system cumbersome
6 the balance power among various players prevents any single entity from domination
the system
7. legal risks influence practice behavior of physicians
8. development of new technology creates an automatic demand for its use
, 9. new service settings have evolved along a continuum
10. quality is no longer accepted as an unachievable goal
✔✔no central agency US - ✔✔US health care system is not adminstratively controlled
by a department or an agency of the government
✔✔other nations - ✔✔most have national health care programs in which every citizen is
entitled to receive a defined set of health care services
✔✔global budgets - ✔✔to control costs other nations use global budgets to determine
total health care expenditures on a national scale and to allocate resources within
budgetary limits
- availability of services as well as payments to providers is subject to such budgetary
constraints
- the governments of these nations also control the proliferation of health care services
especially costly medical technology
- system-wide controls over the allocation of resources determine to what extent
government-sponsored health care services are available to citizens
✔✔US means of financing and delivery - ✔✔- mainly a private system
- private financing, predominantly through employers accounts for 53% of total health
care expenditures
- the government finances the remaining 47%
✔✔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
SOLUTIONS GUARANTEE A+
✔✔under traditional insurance, the four basic health delivery functions have been
fragmented - ✔✔-financiers
-insurers
-providers
-payers
...have often been different entities
✔✔the quantity of health care consumed refers to... - ✔✔utilization of health services
✔✔managed care is a system of health care delivery that... - ✔✔1) seeks to achieve
efficiencies by integrating the four functions of health care delivery discussed earlier
2) employs mechanisms to control utilization of medical services and primary fancier is
still the employer or the government as the case may be
3) determines the price at which the services are purchases and, consequently how
much the providers get paid
✔✔enrolleee - ✔✔refers to the individual covered under the plan
✔✔health plan - ✔✔contractual arrangment between the MCO and the enrollee -
including the collective array of covered health services that the enrollee is entitled to
✔✔external forces that shape the basic character of the health services delivery system
- ✔✔- political climate of a nation
- economic development
- technological progress
- social and cultural values
- physical enviornment, population characteristics such as demographic and health
trends and global influences
✔✔ten basic characteristics differentiate the US health care delivery system from that of
most other countries - ✔✔1. no central agency governs the system
2. access to health care services is selectively based on insurance coverage
3. health care is delivered under imperfect market conditions
4. third-party insurers act as intermediaries between the financing and delivery functions
5. the existence of multiple payers makes the system cumbersome
6 the balance power among various players prevents any single entity from domination
the system
7. legal risks influence practice behavior of physicians
8. development of new technology creates an automatic demand for its use
, 9. new service settings have evolved along a continuum
10. quality is no longer accepted as an unachievable goal
✔✔no central agency US - ✔✔US health care system is not adminstratively controlled
by a department or an agency of the government
✔✔other nations - ✔✔most have national health care programs in which every citizen is
entitled to receive a defined set of health care services
✔✔global budgets - ✔✔to control costs other nations use global budgets to determine
total health care expenditures on a national scale and to allocate resources within
budgetary limits
- availability of services as well as payments to providers is subject to such budgetary
constraints
- the governments of these nations also control the proliferation of health care services
especially costly medical technology
- system-wide controls over the allocation of resources determine to what extent
government-sponsored health care services are available to citizens
✔✔US means of financing and delivery - ✔✔- mainly a private system
- private financing, predominantly through employers accounts for 53% of total health
care expenditures
- the government finances the remaining 47%
✔✔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
