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JMU HTH 354 Exam 1 Review(updated)questions with answers
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JMU HTH 354 Exam 1 Review(updated)questions with answers
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JMU HTH 354 Exam 1Review(updated)questions with answers
Name the four basic functional components of the US healthcare delivery system. Which role does each
play in the delivery of healthcare? - correct answer ✔✔Quad function model:
1. Financing- how we purchase/ pay for healthcare
2. Insurance- protecting against catastrophic risk
3. Payment- deals with reimbursement, the insurer determines how much is paid for a certain service.
Funds for actual disbursement come from premiums paid to the insurance company.
4. Delivery- providers such as: physicians, hospitals, nursing homes, medical equipment etc...
What kind of insurance do most Americans have, and where do they get it from? - correct answer
✔✔Private insurance through their employers
United States Healthcare system: Intro (textbook) - correct answer ✔✔-no universal coverage
-little standardization results in fragmentation, duplication, inconsistency, and inefficiency
-some of the best clinical care
-most expensive in the world
Why is it that, despite public and private health insurance programs, some U.S citizens are without
healthcare coverage? - correct answer ✔✔Many Americans cannot afford to buy healthcare
What is managed care? - correct answer ✔✔Managed care is a system of health care delivery that 1)
seeks to achieve efficiencies by integrating the basic functions of health care delivery, 2) employs
mechanisms to control utilization of medical services and 3) determines the price at which the services
are purchased.
What are the 10 major characteristics of the US Healthcare system? - correct answer ✔✔1. No central
governing agency (most private system): government pays for public programs and regulates quality
2. Partial access
, 3. Imperfect market- "quasimarket" healthcare is partially managed by free markets; however, in a true
free market, patients and providers act independently. Prices are also set by supply and demand (not
fixed) unrestrained competition must occur
4. Third party insurers and payers- insurance functions as the intermediary between patients and
providers, most comply with policies, no control over price or quality.
5. Multiple payers- unlike a single payer system, where the government is the primary payer, the US has
multiple payers. Many different insurance plans and public programs; makes the system cumbersome
6. Power balancing- the key system players are: physicians, admin, insurance companies, large
employers, and the government. All of which have competing self interests. Barrier to achieve system-
wide reforms and const containment.
7. Litigation risks- private healthcare providers are highly susceptible to litigation. Risk of malpractice
lawsuits leads practitioners to practice defensive medicine.
8. High technology- US is a hotbed of research and innovation, and people equate high technology with
high quality. This creates a demand for new services despite the high costs.
9. Continuum of healthcare services- longterm care, urgent care etc...
10. Quest for quality- increasing pressure to meet quality standards
Discuss the intermediary role of insurance in the delivery of health care. - correct answer ✔✔the
insurance function introduces a third party into the transaction between the patient and the provider.
Health insurance insulates the consumer from the cost of health care. Providers are sometimes
restricted from delivering services that are non covered.
Who are the key players in the US health services system? Which main roles does the government play? -
correct answer ✔✔-The key players in the system are the physicians, administrators of health service
institutions, insurance executives, large employers, and the government. One positive effect of these
opposing forces is that they prevent any single entity from dominating the system. On the other hand,
they also make it difficult to achieve system wide reforms.
-The government is a major financier of health care delivery through the Medicare and Medicaid
programs. The government determines eligibility criteria as to who can receive services under these
programs; it also determines the reimbursement rates that providers will receive for rendering services
to Medicaid and Medicare patients. In order to render services to Medicare and Medicaid, these
organizations must comply with the standards of participation formulated by the government.
Elements of National Health Insurance: - correct answer ✔✔-government finances healthcare through
taxes
-care delivered by private providers with payment from the government
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