THEBRIGHT EXAM SOLUTIONS 8/20/2024 8:37 PM
U.S. Health Care Systems Exam Questions
With Correct Answers
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? If yes, you have access to medical
care. Access is not the same as health insurance coverage, although insurance coverage is a
strong predictor of access for primary care services.
Capitation - answer✔✔A reimbursement mechanism under which the provider is paid a set
monthly fee per enrollee (sometimes referred to as per member per month or PMPM rate),
regardless of whether or not an enrollee sees the provider and regardless of how often an enrollee
sees the provider.
Enrollee - answer✔✔A person enrolled in a health plan, especially in a managed care plan.
Integrated delivery system (IDS) - answer✔✔A network of organizations that provides or
arranges to provide a coordinated continuum of services to a defined population and is willing to
be held clinically and fiscally accountable for the outcomes and health status of the population
serviced.
Item-based pricing - answer✔✔Refers to the costs of ancillary services that often accompany
major procedures such as surgery. Package pricing: Bundling of fees for an entire package of
related services.
Long-term care - answer✔✔A variety of individualized, well-coordinated services that are
designed to promote the maximum possible independence for people with functional limitations.
These services are provided over an extended period to meet the patients' physical, mental,
social, and spiritual needs, while maximizing quality of life.
Managed care - answer✔✔A system that integrates the functions of financing, insurance,
delivery, and payment and uses mechanisms to control costs and utilization of services.
Market justice - answer✔✔A distributional principle according to which health care is most
equitably distributed through the market forces of supply and demand, rather than government
interventions. See social justice.
Medicaid - answer✔✔A joint federal-state program of health insurance for the poor.
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Medicare - answer✔✔A federal program of health insurance for the elderly, certain disabled
individuals, and people with end-stage renal disease.
Need - answer✔✔The amount of medical care that medical experts believe a person should have
to remain or become healthy.
Social justic - answer✔✔A distribution principle, according to which health care is most
equitably distributed by a government-run national health care program. See market justice.
Socialized medicine - answer✔✔Any large-scale government-sponsored expansion of health
insurance or intrusion in the private practice of medicine.
Children's Health Insurance Program (CHIP) - answer✔✔Provide low-income family with
children with health insurance coverage that covers access to health care services.
TRICARE - answer✔✔A program that is financed by the military. This insurance plan permits
the beneficiaries to receive care from both private and military medical care facilities.
Veterans Integrated Service Networks (VISNs) - answer✔✔Responsible for coordinating the
activities of the hospitals, outpatient clinics, nursing homes, and other facilities located within its
jurisdiction.
Acute condition - answer✔✔Relatively severe, episodic (of short duration), and often treatable.
It is subject to recovery, and treatment is generally provided in a hospital.
Behavioral factors - answer✔✔Individual lifestyles are also a key determinant of health. For
example, diet, exercise, a stress-free lifestyle, risky or unhealthy behaviors, and other individual
choices have been found to play a major role in most of the significant health problems of today.
Chronic condition - answer✔✔Less severe but of long and continuous duration. The patient may
not fully recover. The disease may be kept under control through appropriate medical treatment,
but if left untreated, the condition may lead to severe and life-threatening health problems.
Examples include asthma, diabetes, and hypertension.
Demand-side rationing - answer✔✔Prices and ability to pay ration the quantity and type of
health care services people consume.
Determinants of health - answer✔✔The leading determinants of health can be classified into four
main categories: environment, behavior and Lifestyle, heredity, and medical care.
Disease - answer✔✔Based on a medical professional's evaluation of a person's health state.
Environmental factors - answer✔✔Encompass the physical, socioeconomic, and sociopolitical
factors.
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Health care system - answer✔✔All of the activities aimed at promoting, restoring, or
maintaining health.
Health - answer✔✔A complete state of physical, mental, and social well-being, and not merely
the absence of disease or infirmity.
Healthy People 2020 - answer✔✔The overarching goals of Healthy People 2020 include:
attaining high-quality, longer lives free of preventable disease, injury, and premature death;
achieving health equity, eliminating disparities, and improving the health of all groups; creating
social and physical environments that promote good health for all; and promoting quality of life,
healthy development and health behaviors across all life stages
Heredity - answer✔✔the genetic makeup of an individual that could influence one's health
status.
Holistic medicine - answer✔✔A philosophy of health care that emphasizes the well-being of
every aspect of a person, including the physical, mental, social, and spiritual aspects of health.
Illness - answer✔✔Recognized by means of a person's own perceptions and evaluation of how
he or she feels.
Planned rationing or supply-side rationing - answer✔✔Refers to government means to limit the
availability of certain health care services by deciding, for instance, how technology will be
dispersed and who will be allowed access to certain types of high-tech services.
Public health system: Reflects an organized effort to deliver public health services within a
jurisdiction with the goal of improving health and well-being of the population.
Public health - answer✔✔A wide variety of activities undertaken by state and local governments
to ensure conditions that promote optimum health for society as a whole.
Quality of life - answer✔✔(1) Quality of life refers to factors considered important by patients,
such as environmental comfort, security, interpersonal relations, personal preferences, and
autonomy in making decisions when institutionalized. (2) It also includes overall satisfaction
with life, during and following a person's encounter with the health care delivery system.
Subacute condition - answer✔✔Between acute and chronic but has some acute features.
Subacute conditions can be post-acute-requiring further treatment after a brief stay in the
hospital. Examples include ventilator and head trauma care.
The medical model: Presupposes the existence of illness or disease, thereby emphasizing clinical
diagnosis and medical intervention in the treatment of disease or its symptoms.
almshouse - answer✔✔or a poorhouse, was an unspecialized institution existing during the 18th
and mid-19th centuries that mainly served general welfare functions, essentially providing
