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PHMD 5250 Exam 3 Questions And Correct Answers
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PHMD 5250 Exam 3 Questions And Correct Answerswhat is the primary purpose of for-profit organizations? - ANSWER to provide a financial
return on a shareholder's investment
are most corporations and privately-held businesses for-profit or not-for-profit? -
ANSWER for-profit
name 4 examples of for-profit organizations in pharmacy - ANSWER 1) community
pharmacies
2) long-term care, home health care
3) pharmaceutical industry
4) some hospitals
what is the primary purpose of not-for-profit organizations? - ANSWER to provide
services to a community that may not otherwise obtain them from for-profit
organizations
are most government or charity-owned facilities for-profit or not-for-profit? - ANSWER
not-for-profit
give 5 examples of not-for-profit organizations in pharmacy - ANSWER 1) most hospitals
2) ambulatory clinics
3) community health centers
4) government health facilities
5) most educational institutions
is it ok for a not-for-profit organization to not make a profit? why or why not? - ANSWER
,no - all organizations must bring in more money than they spend to remain operating
what can for-profit organizations do with their profits? give 3 examples - ANSWER spend
however owners see fit
1) dividends to stockholders
2) bonuses to employees
3) reinvest to develop new goods/services
profits made by for-profit organizations are generally _______. is this the same for
not-for-profit organizations? - ANSWER taxed, no (not taxed)
what 4 things must not-for-profit organizations do with their profits? - ANSWER 1)
reinvest them into the organization itself
2) develop new goods/services
3) build buildings
4) hire people
in what 4 ways are health care services paid for? - ANSWER 1) private insurance
2) public insurance (Medicare, Medicaid)
3) self pay
4) worker's compensation
what are the 4 basic characteristics of insurance? - ANSWER 1) pooling of losses
2) payment only for random losses
3) risk transfer
4) indemnification
,describe pooling of losses in insurance. what does this allow for? - ANSWER - losses are
spread over a large group of people, so each individual realizes the average loss of the
pool rather than the actual loss incurred
- allows for relatively accurate prediction of future losses of the group due to the size of
members in the risk pool
describe payment only for random losses in insurance - ANSWER - a random loss is one
that is unforeseen and unexpected and occurs because of chance
- insurance is based on the premise that payments are made for losses that are random
describe risk transfer in insurance - ANSWER the risk is transferred from an insured to
an insurer, which is typically in a better financial position to bear the risk than the
insured because of large numbers of members in the risk pool
describe indemnification in insurance - ANSWER - reimbursement to the insured if a loss
occurs
- ex. when the insurer pays the insured, or the provider, in whole or in part for the
services rendered related to their illness or injury
what are the two main challenges with establishing risk pools? - ANSWER 1) adverse
selection
2) moral hazard
describe the adverse selection challenge associated with establishing risk pools. what
was done to avoid this challenge? - ANSWER - individuals who are more likely to need
health services are more likely to purchase health care
- if adverse selection goes unchecked, costs can be driven up for all members in the risk
pool
- might cause healthier members to seek more affordable insurance elsewhere,
compounding the issue
- ACA requires insurers to take on patients regardless of preexisting conditions
, describe the moral hazard challenge associated with establishing risk pools. what was
done to avoid this challenge? - ANSWER - individuals are most likely to use unneeded
health services when they are not paying the full cost of those services
- copayments and coinsurance can be utilized to reduce premiums to employers and to
prevent over-utilization of healthcare services
if consumers were responsible for paying for their healthcare services, how would they
choose providers? what type of incentive for providers will this create? - ANSWER -
choose providers based on cost and quality
- providers will offer less expensive services
if third-party payers were responsible for paying in full for healthcare services, what
problem would this create? - ANSWER individuals would skimp on preventative care
services which may create problems down the road leading to higher costs in the future
describe the 2 types of private insurance - ANSWER 1) blue cross/blue shield: cross
(hospitals), shield (physicians)
2) commercial: issued by insurance companies
describe self insurance. who makes a good candidate for this type of insurance? -
ANSWER - self insurers make the decision to bear the risks associated with health care
costs and set aside funds
- not good candidate unless very wealthy or a large company
describe Medicare public insurance. what are the other 4 types of public insurance? -
ANSWER - 65 and older
- A: hospital care
- B: physician services, ambulatory surgery and services
- C: managed care plan from private insurer
- D: prescription drug coverage
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