HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
1. Access to care Defined as the ability to obtain needed,
af- fordable, convenient, acceptable, and
ettec- tive personal health services in a
timely man- ner.
2. Administrative costs Costs associated with the management
of the financing, insurance, delivery,
and pay- ment functions. They include
expenditures for managing the
enrollment process, set- ting up
contracts with providers, processing
claims, monitoring utilization, making
denials and appeals, and marketing and
promotional expenses.
3. All-payer systems Centralized controls allow cost-
containment ettorts to sweep through
the entire health care delivery
system.
4. Clinical practice guidelines (also Explicit descriptions of preferred
called medical practice clinical processes for managing a
guidelines) clinical problem based on research
evidence, whenever pos- sible, and on
consensus in the absence of
evidence.
5. Cost-efficient When the benefit received is greater than
the cost incurred in providing the service.
In eco- nomic terms, additional services
beyond the optimal point produce
diminishing marginal returns.
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31
, HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
6. Cost shifting The ability of providers to make up for
lost revenues in one area by increasing
utilization or charging higher prices in
other areas that
2/
31
, HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
are free of controls. Providers are able to
shift costs when cost-control measures
are not ap- plied on a system-wide
basis.
7. Critical pathway A timeline that identifies planned medical
in- terventions along with expected
patient out- comes for a specific
diagnosis or class of medical
conditions, often defined by a diag-
nosis-related group.
8. Defensive medicine Tests and services that are not medically
jus- tified but rather are performed by
physicians to protect themselves
against potential mal- practice lawsuits.
9. Demand-side incentives Refer to cost-sharing mechanisms that
place a larger cost burden on
consumers, there- by encouraging
consumers to be more cost conscious in
selecting the insurance plan that best
serves their needs and more judicious
in their utilization of services.
10. Electronic health records (EHRs) Patients' medical records stored in a
digital
format that can be accessed on a computer
on a network.
11. Fraud Involves a knowing disregard of the
truth and typically occurs when billing
claims or cost reports are intentionally
falsified. Health care fraud has been
3/
31
, HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
identified as a major problem in the
Medicare and Medicaid pro- grams. It
may also occur when more services are
provided than are medically necessary
4/
31
Solutions
1. Access to care Defined as the ability to obtain needed,
af- fordable, convenient, acceptable, and
ettec- tive personal health services in a
timely man- ner.
2. Administrative costs Costs associated with the management
of the financing, insurance, delivery,
and pay- ment functions. They include
expenditures for managing the
enrollment process, set- ting up
contracts with providers, processing
claims, monitoring utilization, making
denials and appeals, and marketing and
promotional expenses.
3. All-payer systems Centralized controls allow cost-
containment ettorts to sweep through
the entire health care delivery
system.
4. Clinical practice guidelines (also Explicit descriptions of preferred
called medical practice clinical processes for managing a
guidelines) clinical problem based on research
evidence, whenever pos- sible, and on
consensus in the absence of
evidence.
5. Cost-efficient When the benefit received is greater than
the cost incurred in providing the service.
In eco- nomic terms, additional services
beyond the optimal point produce
diminishing marginal returns.
1/
31
, HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
6. Cost shifting The ability of providers to make up for
lost revenues in one area by increasing
utilization or charging higher prices in
other areas that
2/
31
, HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
are free of controls. Providers are able to
shift costs when cost-control measures
are not ap- plied on a system-wide
basis.
7. Critical pathway A timeline that identifies planned medical
in- terventions along with expected
patient out- comes for a specific
diagnosis or class of medical
conditions, often defined by a diag-
nosis-related group.
8. Defensive medicine Tests and services that are not medically
jus- tified but rather are performed by
physicians to protect themselves
against potential mal- practice lawsuits.
9. Demand-side incentives Refer to cost-sharing mechanisms that
place a larger cost burden on
consumers, there- by encouraging
consumers to be more cost conscious in
selecting the insurance plan that best
serves their needs and more judicious
in their utilization of services.
10. Electronic health records (EHRs) Patients' medical records stored in a
digital
format that can be accessed on a computer
on a network.
11. Fraud Involves a knowing disregard of the
truth and typically occurs when billing
claims or cost reports are intentionally
falsified. Health care fraud has been
3/
31
, HADM 3000 Chapter 12 Exam Latest Update With Complete
Solutions
identified as a major problem in the
Medicare and Medicaid pro- grams. It
may also occur when more services are
provided than are medically necessary
4/
31
