HCA 540 FINAL EXAM QUESTIONS AND
COMPLETE ANSWERS
What are the five different types of health maintenance organizations HMOs - ANSWER
1. Staff Model
2. Group Model
3. IPA
4. Network Model
5. Mixed Model
Staff Model - ANSWER A type of closed panel HMO in which physicians are employees of
the HMO and they see patients in the HMO facility.
Group Model - ANSWER an HMO that contracts with a single multi-specialty medical
group to provide care to the HMOs membership. They can do work with HMO or
non-HMO members.
IPA - ANSWER a group of independent physicians who have their own offices and then
group together to service their HMO contracts. No pooling together.
Network Model - ANSWER an HMO model that contracts with multiple physicians groups
to provide service to the HMO members
Mixed Model - ANSWER can be a mixture of any of the other HMO models
Health Maintenance Organization (HMO) - ANSWER A health care system that assumes
or shares both financial and delivery risks associated with providing comprehensive
medical services to a voluntary enrolled population. this is in a certain geographical
area with a fixed or prepaid fee.
HIPAA - ANSWER was created in 1996 and worked on improving "portability" of
coverage in health insurance. Mandated coverage for women giving birth to have two
days over coverage or four if they have a C-section. Said that mental and physical health
should have the same status. Medical records should be accurate and belong to the
patient.
Prepaid Group Practice - ANSWER these first appeared in the 1890s that set a payment
to the physician to get a fee on a regular basis also called capitation. The fee was being
charged regardless if the service was being used.
Indemnity health insurance - ANSWER type of health insurance that was traditionally
, provided by blue cross blue shield and other commercial insurance companies before
MC. This is like typcal insurance where the person pays a premium and then is charges
by service not by a fee to the doctors.
Managed Care - ANSWER Type of delivery systems that combines financing and care
delivery to reduce costs while providing quality care. These include things like HMOs,
PPOs, and POSs.
the two principal modern organizations pioneers in the field of the 1930s in health
insurance?? - ANSWER HIP in New York City and Kaiser Permanente on the West Coast.
Why did HIP and Kaiser Permanente get resistance from the AMA and other medical
societies? - ANSWER It was based on the fact the physicians were getting paid a salary
rather than per service being done. Also because organized medicine did not like the
idea of providing medical under contracts negotiation between groups of physicians
and groups of patients. It would made the doctor a "wage slave"
Two main forms of PGP - ANSWER Staff and group model. Staff is based on a salary and
group is when the physicians form their own company.
What are the challenges that the HMOs had to face coming into the 21st century? -
ANSWER 1. the introduction of point of service (POS) plans allowing people to use
non-plan providers by paying an additional fee
2. increasing cooperation between HMOs and major health insurers such as BCBS.
3. Acceptance of workers compensation cases
4. Expansion of health promotion/disease prevention, work site safety, and employees
assistance programs.
When was the American Medical Association founded? - ANSWER in 1847 at the
academy of natural sciences in philidelphia.
What improvements were made in the civil war? - ANSWER surgery had improved and
the application of medicine made it easier to stop infectious diseases. The Abulance
Corps were made at this time. Therapuetic companies became big like Wyeth, Pfizer,
and Squibb.
When was the U.S. Nursing corp founded? - ANSWER it was founded in 1861 and made
nursing a profession.
When was the Association of Hospital Superintendents founded? - ANSWER in 1899
which then became the american hospital association
When did the international list of causes of death come out? - ANSWER 1900 by WHO
Public System - ANSWER this type of system would protect from "market ethos" health
care is a not a commodity and is a public good. disadvantages would be that this system
COMPLETE ANSWERS
What are the five different types of health maintenance organizations HMOs - ANSWER
1. Staff Model
2. Group Model
3. IPA
4. Network Model
5. Mixed Model
Staff Model - ANSWER A type of closed panel HMO in which physicians are employees of
the HMO and they see patients in the HMO facility.
Group Model - ANSWER an HMO that contracts with a single multi-specialty medical
group to provide care to the HMOs membership. They can do work with HMO or
non-HMO members.
IPA - ANSWER a group of independent physicians who have their own offices and then
group together to service their HMO contracts. No pooling together.
Network Model - ANSWER an HMO model that contracts with multiple physicians groups
to provide service to the HMO members
Mixed Model - ANSWER can be a mixture of any of the other HMO models
Health Maintenance Organization (HMO) - ANSWER A health care system that assumes
or shares both financial and delivery risks associated with providing comprehensive
medical services to a voluntary enrolled population. this is in a certain geographical
area with a fixed or prepaid fee.
HIPAA - ANSWER was created in 1996 and worked on improving "portability" of
coverage in health insurance. Mandated coverage for women giving birth to have two
days over coverage or four if they have a C-section. Said that mental and physical health
should have the same status. Medical records should be accurate and belong to the
patient.
Prepaid Group Practice - ANSWER these first appeared in the 1890s that set a payment
to the physician to get a fee on a regular basis also called capitation. The fee was being
charged regardless if the service was being used.
Indemnity health insurance - ANSWER type of health insurance that was traditionally
, provided by blue cross blue shield and other commercial insurance companies before
MC. This is like typcal insurance where the person pays a premium and then is charges
by service not by a fee to the doctors.
Managed Care - ANSWER Type of delivery systems that combines financing and care
delivery to reduce costs while providing quality care. These include things like HMOs,
PPOs, and POSs.
the two principal modern organizations pioneers in the field of the 1930s in health
insurance?? - ANSWER HIP in New York City and Kaiser Permanente on the West Coast.
Why did HIP and Kaiser Permanente get resistance from the AMA and other medical
societies? - ANSWER It was based on the fact the physicians were getting paid a salary
rather than per service being done. Also because organized medicine did not like the
idea of providing medical under contracts negotiation between groups of physicians
and groups of patients. It would made the doctor a "wage slave"
Two main forms of PGP - ANSWER Staff and group model. Staff is based on a salary and
group is when the physicians form their own company.
What are the challenges that the HMOs had to face coming into the 21st century? -
ANSWER 1. the introduction of point of service (POS) plans allowing people to use
non-plan providers by paying an additional fee
2. increasing cooperation between HMOs and major health insurers such as BCBS.
3. Acceptance of workers compensation cases
4. Expansion of health promotion/disease prevention, work site safety, and employees
assistance programs.
When was the American Medical Association founded? - ANSWER in 1847 at the
academy of natural sciences in philidelphia.
What improvements were made in the civil war? - ANSWER surgery had improved and
the application of medicine made it easier to stop infectious diseases. The Abulance
Corps were made at this time. Therapuetic companies became big like Wyeth, Pfizer,
and Squibb.
When was the U.S. Nursing corp founded? - ANSWER it was founded in 1861 and made
nursing a profession.
When was the Association of Hospital Superintendents founded? - ANSWER in 1899
which then became the american hospital association
When did the international list of causes of death come out? - ANSWER 1900 by WHO
Public System - ANSWER this type of system would protect from "market ethos" health
care is a not a commodity and is a public good. disadvantages would be that this system
