US HEALTHCARE SYSTEMS: EXAM 1 UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

US HEALTHCARE SYSTEMS: EXAM 1 UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS

Question:
1. "System" (definition)
Answer:
A group of related things/parts that work together as a whole

Question:
2. 2 objectives of an acceptable healthcare system
Answer:
1) Enable all citizens to obtain needed health services 2) Ensure cost-effective services that meet quality
standards

Question:
3. 4 basic components of a healthcare system
Answer:
Financing, Payment, Insurance, Delivery

Question:
4. Financing: private sources
Answer:
Employer-based and privately purchased insurance

Question:
5. Financing: public sources
Answer:
Medicare (elderly), Medicaid (poor), CHIP (children)

Question:
6. What did the ACA require?
Answer:
All US citizens/legal residents be covered by public or private insurance

Question:
7. Reasons people remained uninsured despite an employer-based system
Answer:
Small businesses can't get affordable group rates, participation may be voluntary, unemployment

Question:
8. Managed Care (definition)
Answer:
A system of healthcare delivery that achieves efficiency by integrating financing, insurance, payment, and
delivery

,Question:
9. 2 things managed care does
Answer:
1) Controls utilization of medical services 2) Determines price of services/provider payment

Question:
10. Examples of Managed Care Organizations (MCOs)
Answer:
HMO, PPO

Question:
11. The 10 basic American healthcare system characteristics (overview)
Answer:
No central agency, partial access, imperfect market, third-party insurers, multiple payers, power balancing,
litigation risk, high technology, continuum of services, quest for quality

Question:
12. "No central agency" characteristic
Answer:
Health care is mostly privately financed/delivered; government mainly sets standards and reimbursement
rates for Medicare/Medicaid/CHIP

Question:
13. "Partial access" characteristic
Answer:
Access to care is selectively based on insurance coverage; universal access does NOT exist in the US

Question:
14. What can the uninsured typically access vs. forego?
Answer:
Can obtain care for acute illness but usually forego basic/routine care

Question:
15. "Imperfect market" characteristic
Answer:
The US has a "quasi-market" only partially governed by free-market forces of supply and demand

Question:
16. Conditions required for a true free market
Answer:
Unrestrained competition, patients informed about service availability, patients bear the cost of services

Question:
17. Item-based pricing
Answer:
Fees charged for a specific service (e.g., a surgeon's fee)

, Question:
18. Phantom providers
Answer:
Providers who bill for services separately

Question:
19. Package pricing
Answer:
A single bundled fee for a group of related services

Question:
20. Roles of patient, provider, and intermediary
Answer:
Patient = first party, Provider = second party, Insurer/intermediary = third party (a "wall" between
financing and delivery)

Question:
21. Single payer system (definition)
Answer:
A national healthcare system that is usually the primary payer

Question:
22. Effect of having multiple payers in the US
Answer:
Makes billing/collection cumbersome and the system more complex

Question:
23. Key players in power balancing
Answer:
Physicians, administrators, insurance companies, large employers, government, intermediaries — whose
self-interests are often at odds

Question:
24. Why is the US called a "litigious society"?
Answer:
High risk of malpractice lawsuits leads physicians to practice defensive medicine

Question:
25. Effect of rapid technology development on demand
Answer:
New technology creates automatic demand for its use, driving up costs

Question:
26. Continuum of services: 3 categories of medical care
Answer:
Curative, Restorative, Preventative