NURS 6211 FINAL EXAM PREP
Finance and Economics in Helathcare
Delivery
ANSWERED
2023/2024
, 1. What is the difference between cost-effectiveness analysis and cost-benefit analysis in healthcare? Give
an example of each.
- Cost-effectiveness analysis compares the costs and outcomes of different interventions in terms of a
common measure, such as quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs).
Cost-benefit analysis converts both costs and outcomes into monetary values and compares the net benefits
of different interventions. For example, a cost-effectiveness analysis might compare the cost per QALY of
screening for breast cancer versus no screening, while a cost-benefit analysis might compare the total
monetary benefits (such as reduced mortality, morbidity, and healthcare costs) and costs (such as screening,
diagnosis, and treatment costs) of screening versus no screening.
2. What are the main sources of revenue for hospitals in the United States? How do they affect the financial
performance and incentives of hospitals?
- The main sources of revenue for hospitals in the United States are Medicare, Medicaid, private insurance,
and self-pay patients. The revenue mix affects the financial performance and incentives of hospitals because
different payers have different reimbursement rates, payment methods, and quality measures. For example,
Medicare and Medicaid typically pay lower rates than private insurance, but also impose more regulations
and penalties for poor quality. Private insurance may pay higher rates, but also negotiate discounts and
contracts with hospitals. Self-pay patients may have no or limited ability to pay, but also represent a
potential source of charity care or bad debt.
3. What are the main types of healthcare markets? How do they differ in terms of competition, regulation,
and efficiency?
- The main types of healthcare markets are product markets (such as pharmaceuticals, medical devices, and
health insurance), provider markets (such as hospitals, physicians, and nurses), and factor markets (such as
labor, capital, and land). They differ in terms of competition, regulation, and efficiency because of the
characteristics of healthcare products and services, such as asymmetric information, externalities, moral
hazard, adverse selection, and market power. For example, product markets may face less competition due
to patents, entry barriers, or monopolies; provider markets may face more regulation due to licensure,
accreditation, or quality standards; and factor markets may face more inefficiency due to labor shortages,
wage rigidities, or capital constraints.
4. What are the main types of health insurance plans in the United States? How do they differ in terms of
coverage, cost-sharing, provider network, and utilization management?
- The main types of health insurance plans in the United States are fee-for-service (FFS), preferred provider
organization (PPO), health maintenance organization (HMO), point-of-service (POS), high-deductible
Finance and Economics in Helathcare
Delivery
ANSWERED
2023/2024
, 1. What is the difference between cost-effectiveness analysis and cost-benefit analysis in healthcare? Give
an example of each.
- Cost-effectiveness analysis compares the costs and outcomes of different interventions in terms of a
common measure, such as quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs).
Cost-benefit analysis converts both costs and outcomes into monetary values and compares the net benefits
of different interventions. For example, a cost-effectiveness analysis might compare the cost per QALY of
screening for breast cancer versus no screening, while a cost-benefit analysis might compare the total
monetary benefits (such as reduced mortality, morbidity, and healthcare costs) and costs (such as screening,
diagnosis, and treatment costs) of screening versus no screening.
2. What are the main sources of revenue for hospitals in the United States? How do they affect the financial
performance and incentives of hospitals?
- The main sources of revenue for hospitals in the United States are Medicare, Medicaid, private insurance,
and self-pay patients. The revenue mix affects the financial performance and incentives of hospitals because
different payers have different reimbursement rates, payment methods, and quality measures. For example,
Medicare and Medicaid typically pay lower rates than private insurance, but also impose more regulations
and penalties for poor quality. Private insurance may pay higher rates, but also negotiate discounts and
contracts with hospitals. Self-pay patients may have no or limited ability to pay, but also represent a
potential source of charity care or bad debt.
3. What are the main types of healthcare markets? How do they differ in terms of competition, regulation,
and efficiency?
- The main types of healthcare markets are product markets (such as pharmaceuticals, medical devices, and
health insurance), provider markets (such as hospitals, physicians, and nurses), and factor markets (such as
labor, capital, and land). They differ in terms of competition, regulation, and efficiency because of the
characteristics of healthcare products and services, such as asymmetric information, externalities, moral
hazard, adverse selection, and market power. For example, product markets may face less competition due
to patents, entry barriers, or monopolies; provider markets may face more regulation due to licensure,
accreditation, or quality standards; and factor markets may face more inefficiency due to labor shortages,
wage rigidities, or capital constraints.
4. What are the main types of health insurance plans in the United States? How do they differ in terms of
coverage, cost-sharing, provider network, and utilization management?
- The main types of health insurance plans in the United States are fee-for-service (FFS), preferred provider
organization (PPO), health maintenance organization (HMO), point-of-service (POS), high-deductible
