DELIVERING HEALTH CARE IN AMERICA CH.12 HPEX 300 | QUESTIONS AND ANSWERS |
2026 UPDATE | 100% CORRECT
Access - (answer)The ability of persons needing health services to obtain appropriate care in a timely
manner.
-can you get medical care when you need it?
-access is not the same as health insurance coverage
Administrative costs - (answer)Costs that are incidental to the delivery of health services. they are not
only associated with the billing and the collection of claims for services delivered, but also include
numerous other costs, such as time and effort incurred by employers for the selection of insurance
carriers, costs incurred by insurance and managed care organizations to market their products and time
and effort involved in the negotiation of rates.
Certificate of Need - (answer)planning agency over expansion of medical facilities-for example,
determination of whether a new facility should be opened in a certain location, whether an existing
facility should be expanded or whether a hospital should be allowed to purchase major equipment.
Clinical practice guidelines - (answer)also know as medical practice guideline in the form of scientifically
established protocols, representing preferred processes in the medical practice
Competition - (answer)the rivalry among sellers to attract customers while lowering costs
cost efficiency - (answer)Also known as cost effectiveness; a state in which the benefit received from a
service is greater that the cost incurred to provide that service.
Critical Pathways - (answer)Outcome-based, patient-centered case management tools that are
interdisciplinary, facilitating coordination of care among multiple clinical departments and caregivers. A
critical pathway identifies planned medical interventions in a given case, along with expected outcomes.
defensive medicine - (answer)Excessive medical tests and procedures performed as a protection against
malpractice lawsuits, otherwise regarded as unnecessary.
, DELIVERING HEALTH CARE IN AMERICA CH.12 HPEX 300 | QUESTIONS AND ANSWERS |
2026 UPDATE | 100% CORRECT
Fruad - (answer)intentional filing of false billing claims or cost reports and provision of services that are
not medically necessary.
Health Planning - (answer)Decisions made by government to limit health care resources, such as hospital
beds and diffusion of costly technology.
Health related quality of life - (answer)in a composite sense, a person's own perception of health, ability
to function, role limitations from physical or emotional problems and personal happiness during or
subsequent to disease experience
Institutional-related quality of life - (answer)a patients quality of life while confined in an institution as
an patient.
include comfort factors emotional well being and environment
Outcomes - (answer)the end result of health care delivery; often viewed as the bottom-line measure of
the effectiveness of the health care delivery system
Overutilization (overuse) - (answer)Utilization of medical services, the cost of which exceeds the benefit
to consumers or the risks of which outweigh potential benefits.
Peer Review - (answer)process of medical review of utilization and quality when it is carried out directly
or under the supervision of physicians
Quality - (answer)the degree to which services for individuals and populations increase the likelihood of
desired health outcomes and are consistent with the current professional; knowledge
quality assessment - (answer)Process of defining quality and deciding how quality is to be measured
according to established standards.
2026 UPDATE | 100% CORRECT
Access - (answer)The ability of persons needing health services to obtain appropriate care in a timely
manner.
-can you get medical care when you need it?
-access is not the same as health insurance coverage
Administrative costs - (answer)Costs that are incidental to the delivery of health services. they are not
only associated with the billing and the collection of claims for services delivered, but also include
numerous other costs, such as time and effort incurred by employers for the selection of insurance
carriers, costs incurred by insurance and managed care organizations to market their products and time
and effort involved in the negotiation of rates.
Certificate of Need - (answer)planning agency over expansion of medical facilities-for example,
determination of whether a new facility should be opened in a certain location, whether an existing
facility should be expanded or whether a hospital should be allowed to purchase major equipment.
Clinical practice guidelines - (answer)also know as medical practice guideline in the form of scientifically
established protocols, representing preferred processes in the medical practice
Competition - (answer)the rivalry among sellers to attract customers while lowering costs
cost efficiency - (answer)Also known as cost effectiveness; a state in which the benefit received from a
service is greater that the cost incurred to provide that service.
Critical Pathways - (answer)Outcome-based, patient-centered case management tools that are
interdisciplinary, facilitating coordination of care among multiple clinical departments and caregivers. A
critical pathway identifies planned medical interventions in a given case, along with expected outcomes.
defensive medicine - (answer)Excessive medical tests and procedures performed as a protection against
malpractice lawsuits, otherwise regarded as unnecessary.
, DELIVERING HEALTH CARE IN AMERICA CH.12 HPEX 300 | QUESTIONS AND ANSWERS |
2026 UPDATE | 100% CORRECT
Fruad - (answer)intentional filing of false billing claims or cost reports and provision of services that are
not medically necessary.
Health Planning - (answer)Decisions made by government to limit health care resources, such as hospital
beds and diffusion of costly technology.
Health related quality of life - (answer)in a composite sense, a person's own perception of health, ability
to function, role limitations from physical or emotional problems and personal happiness during or
subsequent to disease experience
Institutional-related quality of life - (answer)a patients quality of life while confined in an institution as
an patient.
include comfort factors emotional well being and environment
Outcomes - (answer)the end result of health care delivery; often viewed as the bottom-line measure of
the effectiveness of the health care delivery system
Overutilization (overuse) - (answer)Utilization of medical services, the cost of which exceeds the benefit
to consumers or the risks of which outweigh potential benefits.
Peer Review - (answer)process of medical review of utilization and quality when it is carried out directly
or under the supervision of physicians
Quality - (answer)the degree to which services for individuals and populations increase the likelihood of
desired health outcomes and are consistent with the current professional; knowledge
quality assessment - (answer)Process of defining quality and deciding how quality is to be measured
according to established standards.
