HCA 101 ACTUAL FINALS 2026/2027 QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔when does demand creation occur - ✔✔- when physicians prescribe medical care
beyond what is clinically necessary
✔✔drawbacks of current system - ✔✔- obstruct information-seeking efforts
ex: item based pricing
✔✔package pricing - ✔✔refers to a bundled fee for a package or related services
✔✔single payer system - ✔✔- what the national health care system is sometimes called
because there is one primary payer, the government
- in US however has a multiplicity of health plans, multiple payers often represent a
billing and collection nightmare for the providers of services
✔✔why do multiple payers make the system more cumbersome... - ✔✔1. extremely
difficulty for providers to keep tabs on the numerous health plans
2. providers must hire claims processors to bill for services and monitor receipt of
payments, billing practices are not standardized and each payer establishes its own
format
3. payments can be denied for not precisely following the requirements set by each
payer
4. denied claims necessitate rebilling
5. when only partial payment is received some health plans may allow the provider to
balance bill the patient for the amount the health plan did not pa. other plans prohibit
balance billing . even when the balance billing option is available to the provider, it
triggers a new cycle of billings and collection efforts
6. providers must sometimes engage in lengthy collection efforts including writing
collection letters, turning delinquent accounts over to collection agencies and finally
writing off as bad debt amounts that cannot be collected
7. government programs have complex regulations for determining whether payment is
made for services actually delivered. medicare for example requires that each provider
maintain lengthy documentation on services provided
✔✔US spending on administrative costs - ✔✔- costs associated with billing, collections,
bad debts and maintaining medical records - than the national health care systems in
other countries
✔✔national health insurance (NHI) - ✔✔ex: canada
- the government finances health care through general taxes, but the actual care is
delivered by private providers
, - NHI requires a tighter consolidation of the financing, insurance, and payment functions
coordinated by the government
✔✔national health system (NHS) - ✔✔ex: great britain
- in addition to financing a tax supported NHI program, the government manages the
infastructure for the delivery of medical care
- the government operates most of the medical institutions
✔✔socialized health insurance (SHI) - ✔✔ex: germany
- government mandated contributions by employers and employees finance health care
- private providers deliver health care services
- private not-for-profit insurance companies are responsible for collection the
contributions and paying physicians and hospitals
✔✔ health care in other countries - ✔✔national health insurance programs run by the
government and financed through general taxes
- people in these countries are entitled to receive health care services
✔✔health care in the US - ✔✔- not every american is covered by health insurance
- different people obtain health care through different means
✔✔basic functional components of health care in US - ✔✔financing
insurance
delivery
payment
✔✔the government finances public insurance through: - ✔✔medicae, medicaid, and the
childrens health insurance program for a significant protion of the low-income, elderly,
disabled and pediatic populations
✔✔insurance arrangements for many publicly insured people are made through private
entities such as: - ✔✔health maintenance organizations (HMOs) and health care
services are rendered by private physicians and hospitals
✔✔the blend of public and private involvement in the delivery of health care has
resulted in: - ✔✔1. multiplicity of financial arrangements that enable individuals to pay
for health care services
SOLUTIONS GUARANTEE A+
✔✔when does demand creation occur - ✔✔- when physicians prescribe medical care
beyond what is clinically necessary
✔✔drawbacks of current system - ✔✔- obstruct information-seeking efforts
ex: item based pricing
✔✔package pricing - ✔✔refers to a bundled fee for a package or related services
✔✔single payer system - ✔✔- what the national health care system is sometimes called
because there is one primary payer, the government
- in US however has a multiplicity of health plans, multiple payers often represent a
billing and collection nightmare for the providers of services
✔✔why do multiple payers make the system more cumbersome... - ✔✔1. extremely
difficulty for providers to keep tabs on the numerous health plans
2. providers must hire claims processors to bill for services and monitor receipt of
payments, billing practices are not standardized and each payer establishes its own
format
3. payments can be denied for not precisely following the requirements set by each
payer
4. denied claims necessitate rebilling
5. when only partial payment is received some health plans may allow the provider to
balance bill the patient for the amount the health plan did not pa. other plans prohibit
balance billing . even when the balance billing option is available to the provider, it
triggers a new cycle of billings and collection efforts
6. providers must sometimes engage in lengthy collection efforts including writing
collection letters, turning delinquent accounts over to collection agencies and finally
writing off as bad debt amounts that cannot be collected
7. government programs have complex regulations for determining whether payment is
made for services actually delivered. medicare for example requires that each provider
maintain lengthy documentation on services provided
✔✔US spending on administrative costs - ✔✔- costs associated with billing, collections,
bad debts and maintaining medical records - than the national health care systems in
other countries
✔✔national health insurance (NHI) - ✔✔ex: canada
- the government finances health care through general taxes, but the actual care is
delivered by private providers
, - NHI requires a tighter consolidation of the financing, insurance, and payment functions
coordinated by the government
✔✔national health system (NHS) - ✔✔ex: great britain
- in addition to financing a tax supported NHI program, the government manages the
infastructure for the delivery of medical care
- the government operates most of the medical institutions
✔✔socialized health insurance (SHI) - ✔✔ex: germany
- government mandated contributions by employers and employees finance health care
- private providers deliver health care services
- private not-for-profit insurance companies are responsible for collection the
contributions and paying physicians and hospitals
✔✔ health care in other countries - ✔✔national health insurance programs run by the
government and financed through general taxes
- people in these countries are entitled to receive health care services
✔✔health care in the US - ✔✔- not every american is covered by health insurance
- different people obtain health care through different means
✔✔basic functional components of health care in US - ✔✔financing
insurance
delivery
payment
✔✔the government finances public insurance through: - ✔✔medicae, medicaid, and the
childrens health insurance program for a significant protion of the low-income, elderly,
disabled and pediatic populations
✔✔insurance arrangements for many publicly insured people are made through private
entities such as: - ✔✔health maintenance organizations (HMOs) and health care
services are rendered by private physicians and hospitals
✔✔the blend of public and private involvement in the delivery of health care has
resulted in: - ✔✔1. multiplicity of financial arrangements that enable individuals to pay
for health care services
