605 Midterm Question with Correct
Answers
Managed Care - CORRECT ANSWER- 1) acts as the insurance company and the
providers of care.
2) Employs mechanisms to control (manage) utilization of medical services.
3) Determines the price at which the services are purchased and how much the
providers get paid.
4) Is the most dominant health care delivery system in the United States and available
to most Americans. This is includes both Health Maintenance Organizations (HMO) and
Preferred Provider Organizations (PPO).
5) Employers and government are the primary financiers of managed care.
6) An MCO functions like an insurance company.
- It promises to provide health care services contracted under the health plan to the
enrollees of the plan.
Enrollee - CORRECT ANSWER- a member; an individual covered under the plan
gatekeepers - CORRECT ANSWER- a healthcare professional (primary care, general
practitioner) who regulates access especially to hospitals and specialists
- managed care plans rely on gatekeepers to orchestrate and control the health care of
enrollees
Health plan - CORRECT ANSWER- -a contractual arrangement between the MCO and
the enrollee
-includes a list of covered health services to which enrollees are entitled
-uses selected providers, usually primary care, general practitioners (the "gatekeepers")
Tricare - CORRECT ANSWER- Financed by the military, and covers families,
dependents or retired military
VA health care system - CORRECT ANSWER- -Is available to retired veterans
-Focuses on hospital, mental health and long-term care
-Is one of the largest and oldest (1946) organized health systems in the world
*provide medial care, education and training, research, contingency support and
emergency management for the Department of Defense medical care system.
"safety net" providers - CORRECT ANSWER- provide care and services to the poor,
uninsured, minorities and immigrants living in disadvantaged communities
cost shifting - CORRECT ANSWER- -Medicaid, the primary financial source for the
safety net, does not allow much cost shifting
,-charges an insured patient more than it does an uninsured patient for the same
procedure. Those with health insurance pay for financial loss hospitals incur when
providing services to those without insurance
Market justice - CORRECT ANSWER- -"assume free market", market based demands,
peoples ability to pay, economic reward
-individual responsibility(pull up by boot straps)
-"freedom of individuals to be left alone"
-private solutions to social problems
Social Justice - CORRECT ANSWER- -social resource, active government involvement,
ability to pay inconsequential, equal access is viewed as basic right
-everyone entitled to basic package of benefits
-public solutions to social problems
-public health practitioners should work towards these social goals
National Health Insurance - CORRECT ANSWER- -Canada
-insures national population against the cost of health care
-private providers, coordinated by government
National Health Systems - CORRECT ANSWER- -Great Britain
-financed by tax supported national health insurance programs
-government owns/runs everything
Socialized Health Insurance Systems - CORRECT ANSWER- -Germany
-healthcare is financed through government mandated contributions by employers,
employees, and general taxed.
-private providers, government controll
Systems Framework - CORRECT ANSWER- -Organized approach to understanding
the components of the US health care delivery system.
- components designed to achieve common goals, organize approach
What Is Health? - CORRECT ANSWER- -It presupposes(precondition) the existence of
illness or disease.
-It emphasizes clinical diagnosis and medical interventions to:
-Treat disease or its symptoms.
-Have a clinical diagnosis and medical interventions.
Health - CORRECT ANSWER- Health is not merely the absence of disease (or injury),
but complete physical, mental, and social wellbeing.
bio-psycho-social model of health
health care system - CORRECT ANSWER- all the activities whose primary purpose is
to promote, restore, or maintain health.
,Holistic Health - CORRECT ANSWER- -Treats the whole person.
-Incorporates alternative therapies.
-Has physical, mental, social, and spiritual aspects.
Holistic concepts of health care, along with preventive and health promotional efforts,
need to be adopted to significantly improve the health of Americans.
Illness - CORRECT ANSWER- -Identified by a person's perception and evaluation of
how he/she is feeling. The hypochondriac is born.
-People are ill when they infer a diminished capacity to perform tasks and roles
expected by society.
Disease - CORRECT ANSWER- -Based on a professional evaluation.
-Requires therapeutic intervention.
Overall satisfaction - CORRECT ANSWER- -Overall satisfaction with life during and
following a person's encounter with the health care delivery system.
-An indicator of how satisfied a person was with the experiences while receiving health
care.
Goal: To have a positive effect on an individual's ability to function, meet obligations,
feel self-worth.
Interventions - CORRECT ANSWER- 1) Social or medical care policy. - welfare of
nation
2) Community-based interventions. -inequalities in a community
3) Health care interventions. - improve quality of services and reduce disparities across
groups
4) Individual interventions. - minimize negative social determinants in health status
four distinct time periods: - CORRECT ANSWER- -Preindustrial era
-Postindustrial era
-Corporate era
-Era of health care reform (still in its infancy)
Preindustrial Medical Institutions - CORRECT ANSWER- -Almshouses (poorhouses)
were run by the local government.
-Hospitals were few, and had deplorable sanitary conditions and poor ventilation.
-State governments operated asylums for patients with untreatable, chronic mental
illness.
-Pesthouses were operated to isolate people.
-Dispensaries were staffed by medical students or apprentices.
institutionalization - CORRECT ANSWER- -growth of hospitals
, -Advancements in medical science created the need to centralize expensive facilities
and equipment in an institution.
"voluntary health insurance" - CORRECT ANSWER- -private health insurance
Workers' Compensation - CORRECT ANSWER- -originally designed to make cash
payments to workers for wages lost because of job-related injuries and disease.
-Later became compensation for medical expenses, and death benefits for survivors
were added.
-Was a trial balloon for the idea of government-sponsored health insurance.
hospital insurance plan for teachers - CORRECT ANSWER- -In 1929, Justin Kimball
began a hospital insurance plan for teachers at Baylor University Hospital in Dallas,
Texas. It became the model for Blue Cross plans around the country.
-The AHA supported group hospital plans and coordinated them into a Blue Cross
network.
nontaxable employer provided health coverage - CORRECT ANSWER- -In 1954,
Congress made employer-provided health coverage nontaxable.
-This was equivalent to getting more salary without having to pay taxes.
three-part program was adopted to serve two distinct populations: Medicare Parts A and
B, and Medicaid - CORRECT ANSWER- -Medicare Part A was designed to use Social
Security funds to finance hospital care. (Medicare payroll tax)
-Medicare Part B was designed to cover physicians' services Through government-
subsidized insurance.
-The elderly would pay part of the premiums.
-Medicaid benefits vary from state to state.
-It is means-tested, and confines eligibility to those below an income level.
-Medicare has uniform national standards for eligibility and benefits.
-It covers anyone over the age of 65.
-In 1972, the program was expanded to include the disabled on Social Security and
those with ESRD, regardless of age.
Three main features of Corporate Era - CORRECT ANSWER- 1)Corporatization-
Medical care has become the domain of large corporations
2)Information revolution-Telemedicine, e-health
3)Globalization-Various cross-border activities
Era of Health Care Reform - CORRECT ANSWER- Major changes undertaken by the
government to expand health insurance to the uninsured and regulate the financing and
delivery of health care
