Delivering Health Care In America Chapter 1 Exam Questions
And Correct Answers
Broad description of the System - ANSWER A multiplicity of financial arrangements that
enable individuals to pay for health care services. Numerous insurance agencies or
MCOs that employ varied mechanisms for insuring against risk.Multiple payers that
make their own determinations regarding how much to pay for each type of service.A
large array of setting where medical services are delivered; Numerous consulting firms
offering expertise in planning, cost containment, electronic systems, quality, and
restructuring of resources
Quad-function model - ANSWER Financing
Insurance
Delivery
Payment
Financing - ANSWER Employment based: employers finance health care Public
programs: Government is the financer
Insurance - ANSWER It's either private or public
Delivery - ANSWER Provision of health care by various providers Hospitals, clinics...
Provider - ANSWER Any entity that delivers health care services and can either
independently bill for those services or is tax supported.
Payment - ANSWER Deals with reimbursement to providers for services delivered.
Medicare - ANSWER Program for the elderly and certain disabled individuals
, Medicaid - ANSWER Program for the indigent
Children's Health Insurance Program (CHIP) - ANSWER Program for children of low
income families
Reasons for not having insurance - ANSWER Employers are not mandated to offer
health insurance to their employees Work settings, participation in health insurance
programs are voluntary. Employees opted not to enroll because they cannot afford
Premium cost sharing - ANSWER Employees pay a portion of the cost
Health Care Reform (Obama Care, ACA) - ANSWER Refers to the expansion of health
insurance to cover the uninsured
Affordable Care Act (ACA) - ANSWER Mandated to start covering children and young
adults below the age of 26 under their parents plan
- ANSWER All US citizens and legal residents must be covered by either public or
private insurance Relaxed the standards to qualify additional numbers of people for
Medicaid
Essential health benefits - ANSWER The law mandates insurance plans to cover a
variety of services referred to as Essential health benefits.
ACA failed - ANSWER To achieve Universal coverage that would enable all citizens and
legal residents to have health insurance.
Utilization - ANSWER The quantity of heath care consumed
Managed care - ANSWER Seeks to achieve efficiencies by integrating the four functions
of healthcare delivery
And Correct Answers
Broad description of the System - ANSWER A multiplicity of financial arrangements that
enable individuals to pay for health care services. Numerous insurance agencies or
MCOs that employ varied mechanisms for insuring against risk.Multiple payers that
make their own determinations regarding how much to pay for each type of service.A
large array of setting where medical services are delivered; Numerous consulting firms
offering expertise in planning, cost containment, electronic systems, quality, and
restructuring of resources
Quad-function model - ANSWER Financing
Insurance
Delivery
Payment
Financing - ANSWER Employment based: employers finance health care Public
programs: Government is the financer
Insurance - ANSWER It's either private or public
Delivery - ANSWER Provision of health care by various providers Hospitals, clinics...
Provider - ANSWER Any entity that delivers health care services and can either
independently bill for those services or is tax supported.
Payment - ANSWER Deals with reimbursement to providers for services delivered.
Medicare - ANSWER Program for the elderly and certain disabled individuals
, Medicaid - ANSWER Program for the indigent
Children's Health Insurance Program (CHIP) - ANSWER Program for children of low
income families
Reasons for not having insurance - ANSWER Employers are not mandated to offer
health insurance to their employees Work settings, participation in health insurance
programs are voluntary. Employees opted not to enroll because they cannot afford
Premium cost sharing - ANSWER Employees pay a portion of the cost
Health Care Reform (Obama Care, ACA) - ANSWER Refers to the expansion of health
insurance to cover the uninsured
Affordable Care Act (ACA) - ANSWER Mandated to start covering children and young
adults below the age of 26 under their parents plan
- ANSWER All US citizens and legal residents must be covered by either public or
private insurance Relaxed the standards to qualify additional numbers of people for
Medicaid
Essential health benefits - ANSWER The law mandates insurance plans to cover a
variety of services referred to as Essential health benefits.
ACA failed - ANSWER To achieve Universal coverage that would enable all citizens and
legal residents to have health insurance.
Utilization - ANSWER The quantity of heath care consumed
Managed care - ANSWER Seeks to achieve efficiencies by integrating the four functions
of healthcare delivery
