HSA CHAPTER 1-5 TEST
QUESTIONS AND
CORRECT ANSWERS
GRADED A+ 2025-2026
U.S. Health Care Delivery System - ANS-Broad definition: major components of the
system and processes that enable people to receive health care.
Restricted Definition: the act of providing health care to patients
What is U.S. Health Care Delivery - ANS-a constantly changing system of financing,
insurance, delivery and payment options that remain loosely coordinated
What makes up the U.S. health care delivery system - ANS-its a mixture of public
(government) run programs that finance and insure health care for select groups of
people who meet criteria and private sources (majority)
Primary Objectives of Health Care system - ANS-to enable all citizens to receive health
care services and to deliver services that are cost-effective and meet established
standards of quality
Why is U.S. Health Care system unique? - ANS--its not a system
-no universal health care financed by taxes
-no entitlement
-no other country operates like the U.S.
-critical issues related to cost, access and quality
,Scope and Size of System - ANS-health care workforce employs over 16.4 million
people
market-oriented economy - ANS-attracts a variety of private entrepreneurs that pursue
profits by facilitating the key functions of health care delivery.
blend of public and private involvement in the delivery of health care has resulted in
the following characteristics: - ANS-◦ Multiplicity of financial arrangements
◦ Numerous insurance agencies/MCOs that employ
various mechanisms for insuring against risk
◦ Multiple payers that make their own
determinations about the cost for each service
◦ Diverse settings where services are delivered
◦ Numerous consulting firms offering expertise in
planning, cost containment, electronic systems,
quality, and restructuring of resources
No Central Agency - ANS-duplication, overlap, inadequacy, inconsistency, and waste
Quad-Function Model - ANS-financing, insurance, delivery, payment
-financing
-insurance
-delivery
-payment - ANS--necessary to obtain health insurance or pay for health care services,
most are privately insured(employer-based), in public programs- government functions
as financer
-protects insured against financial catastrophe by providing expensive health care
services, MCO or insurance companies also function as a claims processor and
manages disbursements or funds to health care providers
-refers to the provision of health care services by various providers (physicians,
dentists, etc.)
, -deals with reimbursement to providers for services delivered, at the time of service a
patient is required to pay small out of pocket fee and remainder is covered by
insurance company
Differentiating Characteristics - ANS-1. No Central Agency: The U.S. has mostly private
financing and delivery and private financing through employees (55%) and government
(45%). Nobody monitors total expenses, private health care are independent of gov.,
government does set standards of participation through policy and regulation
Differentiating Characteristics - ANS-2. Partial Access: The ability to obtain health care
when needed
Differentiating Characteristics - ANS-3. Imperfect Market: In Private health care there is
consolidating, forming of alliances and an integrated delivery system. U.S. has a quasi
market where health care is partially managed by free markets
Differentiating Characteristics - ANS-3. Imperfect market continued: Item pricing
(obtain fees charged for service that cant be determined prior to procedure), package
pricing (bundled fee for a group of related services), capitation (all health care services
included one set fee per person), phantom providers (bill for services serpeatley),
supplier/provider-induced demand (physicians have influence on creating demand for
their financial benefit)
Differentiating Characteristics - ANS-4. Third-party insurers and payers: patient is first
party, provider is second party, intermediary is third party. There is a wall of
separation between financing and delivery.
Differentiating Characteristics - ANS-5. Multiple Payers: U.S. has many payers, company
can choose different plans. Billing and collection nightmare. System becomes
cumbersome.
-Single Payer: a national health care system that is usually the primary-payer
government
Differentiating Characteristics - ANS-6. Powering Balance
-multiple players: physicians, administration, insurance, government employers
QUESTIONS AND
CORRECT ANSWERS
GRADED A+ 2025-2026
U.S. Health Care Delivery System - ANS-Broad definition: major components of the
system and processes that enable people to receive health care.
Restricted Definition: the act of providing health care to patients
What is U.S. Health Care Delivery - ANS-a constantly changing system of financing,
insurance, delivery and payment options that remain loosely coordinated
What makes up the U.S. health care delivery system - ANS-its a mixture of public
(government) run programs that finance and insure health care for select groups of
people who meet criteria and private sources (majority)
Primary Objectives of Health Care system - ANS-to enable all citizens to receive health
care services and to deliver services that are cost-effective and meet established
standards of quality
Why is U.S. Health Care system unique? - ANS--its not a system
-no universal health care financed by taxes
-no entitlement
-no other country operates like the U.S.
-critical issues related to cost, access and quality
,Scope and Size of System - ANS-health care workforce employs over 16.4 million
people
market-oriented economy - ANS-attracts a variety of private entrepreneurs that pursue
profits by facilitating the key functions of health care delivery.
blend of public and private involvement in the delivery of health care has resulted in
the following characteristics: - ANS-◦ Multiplicity of financial arrangements
◦ Numerous insurance agencies/MCOs that employ
various mechanisms for insuring against risk
◦ Multiple payers that make their own
determinations about the cost for each service
◦ Diverse settings where services are delivered
◦ Numerous consulting firms offering expertise in
planning, cost containment, electronic systems,
quality, and restructuring of resources
No Central Agency - ANS-duplication, overlap, inadequacy, inconsistency, and waste
Quad-Function Model - ANS-financing, insurance, delivery, payment
-financing
-insurance
-delivery
-payment - ANS--necessary to obtain health insurance or pay for health care services,
most are privately insured(employer-based), in public programs- government functions
as financer
-protects insured against financial catastrophe by providing expensive health care
services, MCO or insurance companies also function as a claims processor and
manages disbursements or funds to health care providers
-refers to the provision of health care services by various providers (physicians,
dentists, etc.)
, -deals with reimbursement to providers for services delivered, at the time of service a
patient is required to pay small out of pocket fee and remainder is covered by
insurance company
Differentiating Characteristics - ANS-1. No Central Agency: The U.S. has mostly private
financing and delivery and private financing through employees (55%) and government
(45%). Nobody monitors total expenses, private health care are independent of gov.,
government does set standards of participation through policy and regulation
Differentiating Characteristics - ANS-2. Partial Access: The ability to obtain health care
when needed
Differentiating Characteristics - ANS-3. Imperfect Market: In Private health care there is
consolidating, forming of alliances and an integrated delivery system. U.S. has a quasi
market where health care is partially managed by free markets
Differentiating Characteristics - ANS-3. Imperfect market continued: Item pricing
(obtain fees charged for service that cant be determined prior to procedure), package
pricing (bundled fee for a group of related services), capitation (all health care services
included one set fee per person), phantom providers (bill for services serpeatley),
supplier/provider-induced demand (physicians have influence on creating demand for
their financial benefit)
Differentiating Characteristics - ANS-4. Third-party insurers and payers: patient is first
party, provider is second party, intermediary is third party. There is a wall of
separation between financing and delivery.
Differentiating Characteristics - ANS-5. Multiple Payers: U.S. has many payers, company
can choose different plans. Billing and collection nightmare. System becomes
cumbersome.
-Single Payer: a national health care system that is usually the primary-payer
government
Differentiating Characteristics - ANS-6. Powering Balance
-multiple players: physicians, administration, insurance, government employers
