Page | 1
CHAPTER 2 THE HEALTH CARE DELIVERY
SYSTEM 2026 REAL QUESTIONS WITH
EXPERTLY VERIFIED ANSWERS.
The federal government, the biggest consumer of health care,
which paid for Medicare and Medicaid, created
__________________to review the quality, quantity, and cost of
hospital care - correct answer -professional standards review
organizations (PSROs)
Medicare-qualified hospitals had physician-
supervised_________________to review the admissions and to
identify and eliminate overuse of diagnostic and treatment
services ordered by physicians caring for patients on Medicare. -
correct answer -utilization review (UR) committees
One of the most significant factors that influenced payment for
health care was the __________________. Established by
Congress in 1983, the PPS eliminated cost-based
reimbursement. Hospitals serving patients who received Medicare
benefits were no longer able to charge whatever a patient's care
cost. - correct answer -prospective payment system (PPS)
, Page | 2
Instead, the PPS grouped inpatient hospital services for Medicare
patients into__________________. Each group has a fixed
reimbursement amount with adjustments based on case severity,
rural/urban/regional costs, and teaching costs. Hospitals receive a
set dollar amount for each patient based on the assigned DRG,
regardless of the patient's length of stay or use of services.
Many use ________ in the rehabilitation setting. - correct answer
-diagnosis-related groups (DRGs)
__________________ means that the providers receive a fixed
amount per patient or enrollee of a health care plan.
__________________ aims to build a payment plan for select
diagnoses or surgical procedures that consists of the best
standards of care at the lowest cost. - correct answer -Capitation
use ______________ in long-term care.
When patients are hospitalized for lengthy periods, hospitals have
to absorb the portion of costs that are not reimbursed. This simply
adds more pressure to ensure that patients are managed
effectively and discharged as soon as is reasonably possible. -
correct answer -resource utilization groups (RUGs)
, Page | 3
*describes health care systems in which the provider or health
care system receives a predetermined capitated payment for
each patient enrolled in the program.
*The focus of care of the organization shifts from individual illness
care to prevention, early intervention, and outpatient care.
*If people stay healthy, the cost of medical care declines.
*focus on containing or reducing costs, increasing patient
satisfaction, and improving the health or functional status of
individuals - correct answer -Managed care
The MCO contracts with physicians who usually are not members
of groups and whose practices include fee-for-service and
capitated patients. - correct answer -Independent practice
association (IPA)
*Larger health care systems have _____________ that include a
set of providers and services organized to deliver a continuum of
care to a population of patients at a capitated cost in a particular
setting.
*Reduces duplication of services across levels or settings of care
to ensure that patients receive care in the most appropriate
settings. - correct answer -integrated delivery networks (IDNs)
• Prenatal and well-baby care
, Page | 4
• Nutrition counseling
• Family planning
• Exercise classes - correct answer -Primary Care
• Adult screenings for blood pressure, cholesterol, tobacco use,
and cancer
• Pediatric screenings for hearing, vision, autism, and
developmental disorders
• HIV screening for adults at higher risk
• Wellness visits
• Immunizations
• Diet counseling
• Mental health counseling and crisis prevention
• Community legislation (seat belts, car seats for children, bike
helmets) - correct answer -Preventive Care
• Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
CHAPTER 2 THE HEALTH CARE DELIVERY
SYSTEM 2026 REAL QUESTIONS WITH
EXPERTLY VERIFIED ANSWERS.
The federal government, the biggest consumer of health care,
which paid for Medicare and Medicaid, created
__________________to review the quality, quantity, and cost of
hospital care - correct answer -professional standards review
organizations (PSROs)
Medicare-qualified hospitals had physician-
supervised_________________to review the admissions and to
identify and eliminate overuse of diagnostic and treatment
services ordered by physicians caring for patients on Medicare. -
correct answer -utilization review (UR) committees
One of the most significant factors that influenced payment for
health care was the __________________. Established by
Congress in 1983, the PPS eliminated cost-based
reimbursement. Hospitals serving patients who received Medicare
benefits were no longer able to charge whatever a patient's care
cost. - correct answer -prospective payment system (PPS)
, Page | 2
Instead, the PPS grouped inpatient hospital services for Medicare
patients into__________________. Each group has a fixed
reimbursement amount with adjustments based on case severity,
rural/urban/regional costs, and teaching costs. Hospitals receive a
set dollar amount for each patient based on the assigned DRG,
regardless of the patient's length of stay or use of services.
Many use ________ in the rehabilitation setting. - correct answer
-diagnosis-related groups (DRGs)
__________________ means that the providers receive a fixed
amount per patient or enrollee of a health care plan.
__________________ aims to build a payment plan for select
diagnoses or surgical procedures that consists of the best
standards of care at the lowest cost. - correct answer -Capitation
use ______________ in long-term care.
When patients are hospitalized for lengthy periods, hospitals have
to absorb the portion of costs that are not reimbursed. This simply
adds more pressure to ensure that patients are managed
effectively and discharged as soon as is reasonably possible. -
correct answer -resource utilization groups (RUGs)
, Page | 3
*describes health care systems in which the provider or health
care system receives a predetermined capitated payment for
each patient enrolled in the program.
*The focus of care of the organization shifts from individual illness
care to prevention, early intervention, and outpatient care.
*If people stay healthy, the cost of medical care declines.
*focus on containing or reducing costs, increasing patient
satisfaction, and improving the health or functional status of
individuals - correct answer -Managed care
The MCO contracts with physicians who usually are not members
of groups and whose practices include fee-for-service and
capitated patients. - correct answer -Independent practice
association (IPA)
*Larger health care systems have _____________ that include a
set of providers and services organized to deliver a continuum of
care to a population of patients at a capitated cost in a particular
setting.
*Reduces duplication of services across levels or settings of care
to ensure that patients receive care in the most appropriate
settings. - correct answer -integrated delivery networks (IDNs)
• Prenatal and well-baby care
, Page | 4
• Nutrition counseling
• Family planning
• Exercise classes - correct answer -Primary Care
• Adult screenings for blood pressure, cholesterol, tobacco use,
and cancer
• Pediatric screenings for hearing, vision, autism, and
developmental disorders
• HIV screening for adults at higher risk
• Wellness visits
• Immunizations
• Diet counseling
• Mental health counseling and crisis prevention
• Community legislation (seat belts, car seats for children, bike
helmets) - correct answer -Preventive Care
• Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
