PHR 933- BLOCK 2 | ACE EVERY QUIZ | CONFIDENCE
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System of laws, regulations, courses of action and funding priorities concerning a topic
promulgated by a governmental entity or its representatives - Answer: public policy
Branch of public policy specifically for decisions, plans, and actions that are undertaken to
achieve specific health care goals within society - Answer: Health Policy
Branch of health policy that deals with development, provision, and use of medications within a
health care system - Answer: pharmaceutical policy
What is the policy process - Answer: problem identification, policy formulation, policy
adoption, policy implementation, policy evaluation
What are the 4 models of financing health care - Answer: out of pocket payment, individual
private insurance, employment based private insurance, and government financing
Payment is made directly from patient to provider - Answer: out of pocket payment
Individuals pay a monthly premium to a third party, who then pays the provider for service,
known as reimbursement - Answer: individual private insurance
Individuals enroll in a public health plan, which is funded by taxpayer dollars, the public plan
then provides varying amounts of payment to the provider - Answer: government financing
Hospital insurance plan for the elderly, mostly financed through social security taxes from
employers and employees - Answer: medicare part A
Insurance for Physician Services, paid for by federal taxes and monthly premiums from
beneficiaries - Answer: medicare part B
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
, Medicare Benefits paid through a private health plan and Serves as an alternative to Part A -
Answer: medicare part C
Stand alone prescription drug plan - Answer: medicare part D
Program run by states, funded by federal and state taxes, which pays for care of certain low
income groups - Answer: medicaid
Covers uninsured children in families with income ≤ 200% of federal poverty level and Children
in families making too much for medicaid but not enough for a private/employer plan - Answer:
state children's health insurance program
PDP - Answer: prescription drug plan
MAPD - Answer: medicare advantage prescription drug plan
What covers both rx meds and is a part C plan - Answer: MAPD
Individuals pay a premium based directly on who they are and their risk factors regarding health
- Answer: experience rating
Individuals pay a premium based upon the average cost of all other individuals insured by the
same plan - Answer: community rating
Key players in the medication distribution process when a patient gets a medication paid by a
third party payer - Answer: patient, insurer, PBM, pharmacy, wholesaler, drugmaker
Who is the pharmacy benefit manager - Answer: PBM
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
BACKED BY ACCURACY!
System of laws, regulations, courses of action and funding priorities concerning a topic
promulgated by a governmental entity or its representatives - Answer: public policy
Branch of public policy specifically for decisions, plans, and actions that are undertaken to
achieve specific health care goals within society - Answer: Health Policy
Branch of health policy that deals with development, provision, and use of medications within a
health care system - Answer: pharmaceutical policy
What is the policy process - Answer: problem identification, policy formulation, policy
adoption, policy implementation, policy evaluation
What are the 4 models of financing health care - Answer: out of pocket payment, individual
private insurance, employment based private insurance, and government financing
Payment is made directly from patient to provider - Answer: out of pocket payment
Individuals pay a monthly premium to a third party, who then pays the provider for service,
known as reimbursement - Answer: individual private insurance
Individuals enroll in a public health plan, which is funded by taxpayer dollars, the public plan
then provides varying amounts of payment to the provider - Answer: government financing
Hospital insurance plan for the elderly, mostly financed through social security taxes from
employers and employees - Answer: medicare part A
Insurance for Physician Services, paid for by federal taxes and monthly premiums from
beneficiaries - Answer: medicare part B
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
, Medicare Benefits paid through a private health plan and Serves as an alternative to Part A -
Answer: medicare part C
Stand alone prescription drug plan - Answer: medicare part D
Program run by states, funded by federal and state taxes, which pays for care of certain low
income groups - Answer: medicaid
Covers uninsured children in families with income ≤ 200% of federal poverty level and Children
in families making too much for medicaid but not enough for a private/employer plan - Answer:
state children's health insurance program
PDP - Answer: prescription drug plan
MAPD - Answer: medicare advantage prescription drug plan
What covers both rx meds and is a part C plan - Answer: MAPD
Individuals pay a premium based directly on who they are and their risk factors regarding health
- Answer: experience rating
Individuals pay a premium based upon the average cost of all other individuals insured by the
same plan - Answer: community rating
Key players in the medication distribution process when a patient gets a medication paid by a
third party payer - Answer: patient, insurer, PBM, pharmacy, wholesaler, drugmaker
Who is the pharmacy benefit manager - Answer: PBM
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
