HIM 200 EXAM 1 (STUDY GUIDE) ACTUAL QUESTIONS
WITH COMPLETE SOLUTIONS.
What is the goal of managed care? Answer - provide health care services
contracted under the health plan to the enrollees of the plan
What is Tricare? Answer - a health care program of the United States
Department of Defense Military Health System.
What's the difference between Medicare and Medicaid? Answer - Medicare:
one of the largest sources of public health insurance in the U.S. serving the
elderly, the disabled, and those with end-stage renal disease. managed by the
Centers for Medicare and Medicaid Services (CMS) within the DHHS, medicare
offers coverage for hospital care, post-discharge nursing care, hospice care,
outpatient services, and prescription drugs.
Medicaid: third largest source of health insurance in the U.S., insuring
approximately 19% of the U.S. population and providing coverage for low-
income adults, children, the elderly, and the disabled. also the largest provider
of long-term care to the elderly and this disabled, and has significantly
expanded under the ACA.
What is CHIP? Answer - Children's Health Insurance Program: created in 1997
to provide insurance to children in uninsured families. it expanded coverage to
children in families that have modest incomes, but do not qualify for Medicaid.
,What is IDS and ACO? Answer - IDS- Integrated Delivery Systems: a network of
health care providers and organizations that provides coordinated health care
to a population and is responsible for the health outcomes and health status of
the population. established in the early 2000s. IDS aim to deliver a range of
services.
ACO- Accountable Care Organization: a new model of integrated organization.
Expected to respond to new payment incentives and be held accountable for
better quality outcomes at lower cost under the new Medicare Shared Savings
Program.
Understand the ACA Answer - Affordable Care Act: increases health insurance
coverage for the uninsured and implements reforms to the health insurance
market. encourages physicians and hospitals to integrate and coordinate
services, which is expected to make health care more cost-effective and of
higher quality.
10 Characteristics of the U.S. Healthcare System. Answer - 1. no central
governing agency and little integration and coordination.
2. technology-driven delivery system focusing on acute care
3. high cost, unequal access, and average outcome
4. delivery of health care under imperfect market conditions
5. government as subsidiary to the private sector
6. fusion of market Justin and social justice
7. multiple players and balance of power
8. quest for integration and accountability
9. access of health care services selectively based on insurance coverage
10. legal risks influencing practice behaviors
, What is Health? Answer - under medical model. the absence of illness or
disease. Optimal health exists when a persons free of symptoms and does not
require treatment.
What is WHO? Answer - World Health Organization: WHO's definition of
health is a complete state of physical, mental, and social well-being, and not
merely the absence of disease of infirmity. WHO defines health care system as
all activities aimed at promoting, restoring, or maintaining health.
What is holistic medicine? Answer - seeks to treat the whole person. Holistic
health incorporates the spiritual dimension in addition to the physical, mental,
and social aspects of optimal health, and provides the most complete
understanding of health.
Examples of health determinants. Answer - physical activity,
overweight/obesity, tobacco use, substance abuse, responsible sexual behavior,
mental health, injury and violence, environmental quality, immunization, and
access to health care.
What is acute, chronic, subacute? Answer - Acute Condition- relatively sever,
episodic (short duration) and often treatable. subject to recovery and
treatment is generally provided in a hospital. ex. sudden interruption of kidney
function a myocardial infarction (heart attack).
Chronic Condition- less severe but of long, continuous duration. patient may
not fully recover. may be kept under control through appropriate medical
treatment but if left untreated, may lead to severe, life-threatening health
problems. ex. asthma, diabetes, hypertension.
Subacute Condition- lies between the acute and chronic extremes on the
disease severity continuum, but also has acute features. can post acute,
WITH COMPLETE SOLUTIONS.
What is the goal of managed care? Answer - provide health care services
contracted under the health plan to the enrollees of the plan
What is Tricare? Answer - a health care program of the United States
Department of Defense Military Health System.
What's the difference between Medicare and Medicaid? Answer - Medicare:
one of the largest sources of public health insurance in the U.S. serving the
elderly, the disabled, and those with end-stage renal disease. managed by the
Centers for Medicare and Medicaid Services (CMS) within the DHHS, medicare
offers coverage for hospital care, post-discharge nursing care, hospice care,
outpatient services, and prescription drugs.
Medicaid: third largest source of health insurance in the U.S., insuring
approximately 19% of the U.S. population and providing coverage for low-
income adults, children, the elderly, and the disabled. also the largest provider
of long-term care to the elderly and this disabled, and has significantly
expanded under the ACA.
What is CHIP? Answer - Children's Health Insurance Program: created in 1997
to provide insurance to children in uninsured families. it expanded coverage to
children in families that have modest incomes, but do not qualify for Medicaid.
,What is IDS and ACO? Answer - IDS- Integrated Delivery Systems: a network of
health care providers and organizations that provides coordinated health care
to a population and is responsible for the health outcomes and health status of
the population. established in the early 2000s. IDS aim to deliver a range of
services.
ACO- Accountable Care Organization: a new model of integrated organization.
Expected to respond to new payment incentives and be held accountable for
better quality outcomes at lower cost under the new Medicare Shared Savings
Program.
Understand the ACA Answer - Affordable Care Act: increases health insurance
coverage for the uninsured and implements reforms to the health insurance
market. encourages physicians and hospitals to integrate and coordinate
services, which is expected to make health care more cost-effective and of
higher quality.
10 Characteristics of the U.S. Healthcare System. Answer - 1. no central
governing agency and little integration and coordination.
2. technology-driven delivery system focusing on acute care
3. high cost, unequal access, and average outcome
4. delivery of health care under imperfect market conditions
5. government as subsidiary to the private sector
6. fusion of market Justin and social justice
7. multiple players and balance of power
8. quest for integration and accountability
9. access of health care services selectively based on insurance coverage
10. legal risks influencing practice behaviors
, What is Health? Answer - under medical model. the absence of illness or
disease. Optimal health exists when a persons free of symptoms and does not
require treatment.
What is WHO? Answer - World Health Organization: WHO's definition of
health is a complete state of physical, mental, and social well-being, and not
merely the absence of disease of infirmity. WHO defines health care system as
all activities aimed at promoting, restoring, or maintaining health.
What is holistic medicine? Answer - seeks to treat the whole person. Holistic
health incorporates the spiritual dimension in addition to the physical, mental,
and social aspects of optimal health, and provides the most complete
understanding of health.
Examples of health determinants. Answer - physical activity,
overweight/obesity, tobacco use, substance abuse, responsible sexual behavior,
mental health, injury and violence, environmental quality, immunization, and
access to health care.
What is acute, chronic, subacute? Answer - Acute Condition- relatively sever,
episodic (short duration) and often treatable. subject to recovery and
treatment is generally provided in a hospital. ex. sudden interruption of kidney
function a myocardial infarction (heart attack).
Chronic Condition- less severe but of long, continuous duration. patient may
not fully recover. may be kept under control through appropriate medical
treatment but if left untreated, may lead to severe, life-threatening health
problems. ex. asthma, diabetes, hypertension.
Subacute Condition- lies between the acute and chronic extremes on the
disease severity continuum, but also has acute features. can post acute,
