HSM chapter 1 || Smart Study Guide: Focused Notes &
Verified Answers!!
The U.S has a unique health care delivery system...what are some aspects of that system
correct answers 1. Americans are nit automatically covered
2. A true system does not exist
3. The health care system is fragmented
4. It continues to undergo periodic changes
Over view of the scope and size of the system correct answers 16.8 million people
8 million health practitioners and technical occupations
6 million individuals in health care support occupations
13,944 hospitals
15,600 nursing homes
14,500 substance abuse treatment facilities
1,375 health centers
180 medical and osteopathic schools
1,500+ nursing programs
Characteristics of the U.S system correct answers 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
Inefficiencies in the system correct answers 1. Little standardization
2. Missing dimensions in system planning
3. Direction
4. Coordination from a central agency
Inefficiencies have created correct answers Duplication
Overlap
Inadequacy
Inconsistency
Waste
Cost control leads to... correct answers Financial manipulation
An acceptable health care delivery system should have two primary objectives...what are they
correct answers 1. Enable all citizens to obtain needed health care services
2. Ensure cost-effective services and meet quality standards
The U.S leads the world in... correct answers Medical technology
Medical training
Research
Sophisticated institutions, products, and processes of health care delivery
, Financing and insurance mechanisms correct answers Employer-based health insurance
(private)
Privately purchased health insurance (private)
Government programs (public)
-Medicare (Elderly and certain disabled people)
-Medicaid and CHIP (Indigent, poor (if meet eligibility criteria), children)
Delivery and payment correct answers Provider: any entity that delivers health care services
and either independently bills for those services or is supported through tax revenues
Reimbursement: payment to providers for services delivered
-insurer determine show much is paid for a certain service
Reasons employment based systems left some uninsured correct answers 1. Small businesses
cannot get group insurance at affordable rates and are unable to offer insurance
2. Participation in insurance programs may be voluntary
3. Economic crises may necessitate companies to lay off employees to remain solvent - those
unemployed will lose insurance coverage
Affordable care act correct answers Required all U.D citizens and legal residents to be
covered by public or private insurance
Role of managed care correct answers Managed care is a system of health care delivery that:
1. Seeks to achieve efficiency by integrating the four functions of health care delivery
2. Employs mechanisms to control (manage) utilization of medical services
3. Determines the price of services and how much the providers are paid
Major characteristics of the U.S health care system correct answers 1. Political climate
2. Economic development
3. Technological progress
4. Social and cultural values
5. Physical environment
6. Population characteristics
7. Global influences
Ten basic characteristics differentiate the U.S health care delivery system correct answers 1.
No central agency governs the system
2. Access to health care services is selectively based on insurance coverage
3. Health care is delivered under imperfect market conditions
4. Third-party insurers act as intermediaries between the financing and delivery functions
5. The existence of multiple payers make the system cumbersome
6. The balance of power among players any single entity from dominating the system
7. Legal risks influence practice behavior and physicians
8. Development of new technology creates an automatic demand for its use
9. New service settings have evolved along a continuum
10. Quality and value are fast becoming the hallmarks of care delivery
1. No central agency correct answers - most developed nations have health care
- the U.S has mostly private financing and delivery
- private health care, hospitals, and physicians are independent of government
- no one monitors total expenses through global budgets and utilization
Verified Answers!!
The U.S has a unique health care delivery system...what are some aspects of that system
correct answers 1. Americans are nit automatically covered
2. A true system does not exist
3. The health care system is fragmented
4. It continues to undergo periodic changes
Over view of the scope and size of the system correct answers 16.8 million people
8 million health practitioners and technical occupations
6 million individuals in health care support occupations
13,944 hospitals
15,600 nursing homes
14,500 substance abuse treatment facilities
1,375 health centers
180 medical and osteopathic schools
1,500+ nursing programs
Characteristics of the U.S system correct answers 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
Inefficiencies in the system correct answers 1. Little standardization
2. Missing dimensions in system planning
3. Direction
4. Coordination from a central agency
Inefficiencies have created correct answers Duplication
Overlap
Inadequacy
Inconsistency
Waste
Cost control leads to... correct answers Financial manipulation
An acceptable health care delivery system should have two primary objectives...what are they
correct answers 1. Enable all citizens to obtain needed health care services
2. Ensure cost-effective services and meet quality standards
The U.S leads the world in... correct answers Medical technology
Medical training
Research
Sophisticated institutions, products, and processes of health care delivery
, Financing and insurance mechanisms correct answers Employer-based health insurance
(private)
Privately purchased health insurance (private)
Government programs (public)
-Medicare (Elderly and certain disabled people)
-Medicaid and CHIP (Indigent, poor (if meet eligibility criteria), children)
Delivery and payment correct answers Provider: any entity that delivers health care services
and either independently bills for those services or is supported through tax revenues
Reimbursement: payment to providers for services delivered
-insurer determine show much is paid for a certain service
Reasons employment based systems left some uninsured correct answers 1. Small businesses
cannot get group insurance at affordable rates and are unable to offer insurance
2. Participation in insurance programs may be voluntary
3. Economic crises may necessitate companies to lay off employees to remain solvent - those
unemployed will lose insurance coverage
Affordable care act correct answers Required all U.D citizens and legal residents to be
covered by public or private insurance
Role of managed care correct answers Managed care is a system of health care delivery that:
1. Seeks to achieve efficiency by integrating the four functions of health care delivery
2. Employs mechanisms to control (manage) utilization of medical services
3. Determines the price of services and how much the providers are paid
Major characteristics of the U.S health care system correct answers 1. Political climate
2. Economic development
3. Technological progress
4. Social and cultural values
5. Physical environment
6. Population characteristics
7. Global influences
Ten basic characteristics differentiate the U.S health care delivery system correct answers 1.
No central agency governs the system
2. Access to health care services is selectively based on insurance coverage
3. Health care is delivered under imperfect market conditions
4. Third-party insurers act as intermediaries between the financing and delivery functions
5. The existence of multiple payers make the system cumbersome
6. The balance of power among players any single entity from dominating the system
7. Legal risks influence practice behavior and physicians
8. Development of new technology creates an automatic demand for its use
9. New service settings have evolved along a continuum
10. Quality and value are fast becoming the hallmarks of care delivery
1. No central agency correct answers - most developed nations have health care
- the U.S has mostly private financing and delivery
- private health care, hospitals, and physicians are independent of government
- no one monitors total expenses through global budgets and utilization
