HSA 3111 Exam 2 Questions with Correct Answers Latest Update 2025/2026
The US health care system has been described as having imperfect market conditions even
though the delivery of services is largely - Answers In private hands. Health care is only partially
governed by free market forces.
What contributed to the growth of hospitals from 1930-1980: - Answers hill burton act, health
insurance, and technological advances
What was the main contributor to the growth of hospitals in the 1940s? - Answers Hill burton
act
What triggered the downsizing phase in the US hospital industry during the 1980s? - Answers
Prospective payment system
Prospective payment system/prospective reimbursement - Answers uses certain
preestablished criteria to determine in advance the amount of reimbursement. Ex. Medicare
uses this to reimburse inpatient hospital acute care services under Medicare Part A.
Diagnosis-related groups (DRGs) - Answers method used to pay for inpatient services. There is
a prospective bundle price according to principal diagnosis at the time of admission. Price
determined on clinical diagnosis but additional factors can create differences in reimbursement
for the same DRG like differences in wage levels between geographic areas, urban vs rural
hospital, whether or not the institution is a teaching hospital. HAS FORCED HOSPITALS TO
CONTROL THEIR COSTS. If the total cost of services is less than the DRG based reimbursement
amount, the hospital keeps the difference as profit.
ambulatory payment classifications (APCs) - Answers associated with Medicare's Outpatient
Prospective Payment System (OPPS) for services provided by hospital outpatient departments.
The APC divides all outpatient services into more than 300 groups and reimbursement rates are
associated with each group. Medicare implemented the OPPS to pay for facility services like
nursing, recovery care, anesthetics, drugs and other supplies in freestanding (nonhospital)
ambulatory surgery centers
Resource Utilization groups (RUGs) - Answers how Medicare pays skilled nursing facilities (SNF)
on the basis of RUGs. In a DRG there is a fixed reimbursement amount associated with each
DRG but RUG categories are used for determining an SNF's overall severity of health conditions
requiring medical and nursing intervention. The total clinical severity in a facility is a case mix.
Based on an evaluation of each patient's medical and nursing needs the patient is classified into
one of 66 RUGs. The case mix of an institution is used to determine a fixed per diem amount- an
all inclusive bundled rate. The higher the case mix score, the higher the reimbursement.
home health resource groups (HHRGs) - Answers the PPS for home health care pays a fixed,
predetermined rate for each 60-day episode of care, regardless of the specific services
delivered. All services provided by a home health agency are essentially bundled under one
, payment made on a per-patient basis. The Outcomes and Assessment Information Set (OASIS)
is used to rate each patient's functional status and clinical severity level. The assessment is
translated into points which determine the patient's HHRG. Payment is based on the patient's
HHRG category. There are 153 groups based on clinical severity, functional status, and need for
rehab therapy.
Retrospective Payment systems/ Retrospective reimbursement - Answers based on costs that
were directly related to length of stay, services rendered, and the cost of providing the services,
providers had no incentive to control costs. Has been largely replaced by prospective methods
of reimbursement
Which is NOT a predisposing vulnerability framework (demographics) - Answers Homelessness
Which of the following is NOT one of the three domains in the Donabedian model? - Answers
Risk
Donabedian proposed 3 domains in which health care quality should be examined what are they?
- Answers structure, process, and outcomes.
Structure - Answers the foundation of the quality of health care. "The relatively stable
characteristics of the providers of care, of the tools and resources they have at their disposal,
and of the physical and organizational settings in which they work." Structure measures indicate
the extent to which health care organizations are capable of providing adequate levels of care.
Structure provides an indirect measure of quality under the assumption that a good structure
enables health care delivery professionals to employ good processes that would lead to good
outcomes. Initiative to improve structure is electronic health records.
Process - Answers the specific way in which care is provided. (Ex. correct diagnostic tests,
correct prescriptions, accurate drug administration, pharm care, waiting time to see physician)
Initiatives toward process development and improvement are clinical practice guidelines, cost
efficiency, critical pathways, and risk management. Surgery!
Outcomes - Answers the effects or final results obtained from utilizing the structure and
processes of health care delivery. Viewed as the bottom line measure of the effectiveness of
health care. Positive outcomes suggest recovery from disease and improvement in health.
What are all three factors of the Donabedian model used to ensure? - Answers All important in
measuring quality
What type of care represents most of the care needed by the US population: - Answers Primary
Consumer behavior that leads to high utilization of health care: - Answers Moral Hazard
In what ways are we trying to help primary care in our country? - Answers Training nurses in
community health and geriatrics allowing nurses to prescribe medications. Let nurses prescribe
The US health care system has been described as having imperfect market conditions even
though the delivery of services is largely - Answers In private hands. Health care is only partially
governed by free market forces.
What contributed to the growth of hospitals from 1930-1980: - Answers hill burton act, health
insurance, and technological advances
What was the main contributor to the growth of hospitals in the 1940s? - Answers Hill burton
act
What triggered the downsizing phase in the US hospital industry during the 1980s? - Answers
Prospective payment system
Prospective payment system/prospective reimbursement - Answers uses certain
preestablished criteria to determine in advance the amount of reimbursement. Ex. Medicare
uses this to reimburse inpatient hospital acute care services under Medicare Part A.
Diagnosis-related groups (DRGs) - Answers method used to pay for inpatient services. There is
a prospective bundle price according to principal diagnosis at the time of admission. Price
determined on clinical diagnosis but additional factors can create differences in reimbursement
for the same DRG like differences in wage levels between geographic areas, urban vs rural
hospital, whether or not the institution is a teaching hospital. HAS FORCED HOSPITALS TO
CONTROL THEIR COSTS. If the total cost of services is less than the DRG based reimbursement
amount, the hospital keeps the difference as profit.
ambulatory payment classifications (APCs) - Answers associated with Medicare's Outpatient
Prospective Payment System (OPPS) for services provided by hospital outpatient departments.
The APC divides all outpatient services into more than 300 groups and reimbursement rates are
associated with each group. Medicare implemented the OPPS to pay for facility services like
nursing, recovery care, anesthetics, drugs and other supplies in freestanding (nonhospital)
ambulatory surgery centers
Resource Utilization groups (RUGs) - Answers how Medicare pays skilled nursing facilities (SNF)
on the basis of RUGs. In a DRG there is a fixed reimbursement amount associated with each
DRG but RUG categories are used for determining an SNF's overall severity of health conditions
requiring medical and nursing intervention. The total clinical severity in a facility is a case mix.
Based on an evaluation of each patient's medical and nursing needs the patient is classified into
one of 66 RUGs. The case mix of an institution is used to determine a fixed per diem amount- an
all inclusive bundled rate. The higher the case mix score, the higher the reimbursement.
home health resource groups (HHRGs) - Answers the PPS for home health care pays a fixed,
predetermined rate for each 60-day episode of care, regardless of the specific services
delivered. All services provided by a home health agency are essentially bundled under one
, payment made on a per-patient basis. The Outcomes and Assessment Information Set (OASIS)
is used to rate each patient's functional status and clinical severity level. The assessment is
translated into points which determine the patient's HHRG. Payment is based on the patient's
HHRG category. There are 153 groups based on clinical severity, functional status, and need for
rehab therapy.
Retrospective Payment systems/ Retrospective reimbursement - Answers based on costs that
were directly related to length of stay, services rendered, and the cost of providing the services,
providers had no incentive to control costs. Has been largely replaced by prospective methods
of reimbursement
Which is NOT a predisposing vulnerability framework (demographics) - Answers Homelessness
Which of the following is NOT one of the three domains in the Donabedian model? - Answers
Risk
Donabedian proposed 3 domains in which health care quality should be examined what are they?
- Answers structure, process, and outcomes.
Structure - Answers the foundation of the quality of health care. "The relatively stable
characteristics of the providers of care, of the tools and resources they have at their disposal,
and of the physical and organizational settings in which they work." Structure measures indicate
the extent to which health care organizations are capable of providing adequate levels of care.
Structure provides an indirect measure of quality under the assumption that a good structure
enables health care delivery professionals to employ good processes that would lead to good
outcomes. Initiative to improve structure is electronic health records.
Process - Answers the specific way in which care is provided. (Ex. correct diagnostic tests,
correct prescriptions, accurate drug administration, pharm care, waiting time to see physician)
Initiatives toward process development and improvement are clinical practice guidelines, cost
efficiency, critical pathways, and risk management. Surgery!
Outcomes - Answers the effects or final results obtained from utilizing the structure and
processes of health care delivery. Viewed as the bottom line measure of the effectiveness of
health care. Positive outcomes suggest recovery from disease and improvement in health.
What are all three factors of the Donabedian model used to ensure? - Answers All important in
measuring quality
What type of care represents most of the care needed by the US population: - Answers Primary
Consumer behavior that leads to high utilization of health care: - Answers Moral Hazard
In what ways are we trying to help primary care in our country? - Answers Training nurses in
community health and geriatrics allowing nurses to prescribe medications. Let nurses prescribe
