HCD 303 Final Exam Study Guide With complete
solu on| RATED A+ 2026
System
a set of connected things or parts forming a complex whole
Quality
how good or bad something is
Access
a person's ability to get care or coverage
Cost
cost
Universal Coverage
all residents have coverage
Social Solidarity
the principle that governments have an obliga on to ensure that every ci zen has access to all
social services including healthcare
Subsidiarity
the principle belief that ma er of government responsibility should be handled at the lowest
level of government that makes opera onal sense
General Reciprocity
the principle belief in giving to something knowing that you may not get an immediate returned
benefi fif
Centralized
Organized at the federal level
Decentralized
Organized at the regional or state level
,Public Health Services/Insurance
public, government run
Private Health Services/Insurance
private, privately run
Only those who make over ~$70,000/year qualify
The premium is set by your performance on an individual health assessment
Copayment
The set dollar amount that you must pay at the point of service
Coinsurance
The set percentage of the bill that must be paid at the point of service
Deduc ble
The amount that must be paid out-of-pocket annually, before insurance coverage kicks in
Sickness Funds
~130 sickness funds today (although this number is con nually dropping)
Covers ~ 86% of the country's popula on
Membership is mandatory
Must pay a legally mandated premium of 14.6% of their income (through payroll deduc on)
Split between employer and employee
Percent of premium is determined by income
~11% of the popula on opts out of the SHI and opts for Private Health Insurance (PHI)
Percent of premium is determined by health assessment and is risk-adjusted
Safety Net
Children under 18 years of age exempt from all cost-sharing
Adults:
Annual cap equal to 2% of household income
Annual cap lowered to 1% of household income for qualifying chronically ill people
Unemployed contribute to SHI in propor on to their unemployment en tlements; For long term
unemployed government contributes on their behalf
Cost Sharing
Cost Sharing (all USD):
Outpa ent Prescrip ons: $6.40 - $12.70
,Inpa ent Stay: $10.00/day (first 28 days/yr)
Rehabilita on Stay: $10.00/day (first 28 days/yr)
Deduc bles: vary by sickness fund plan
Preventa ve services do not count towards deduc ble
Subsidy
government assistance
Health Financing
it is the func on of a system concerned with the mobiliza on, accumula on, and alloca on of
money to cover the health needs of the people, individually and collec vely, in the health
system
Health Spending as % of GDP
The percent of money spent on healthcare every year, in rela on to the total amount spent
throughout all industries in the same year
Fee-for-service (FFS)
A payment model where all healthcare services, products, and prescrip on medica ons are
unbundled and paid for separately.
incen ve: Overtreatment, Provide more services, tes ng, and treatments that are billable
through an ICD-code.
Per Diem
payment model that reimburses organiza ons and/or providers based upon the number of days
treatment was given
Pay-for-performance
A payment model that reimburses healthcare organiza ons and physicians who achieve,
improve, or exceed their performance on specified quality and cost measures, as well as other
benchmarks.
incen ve: Measure of performance metrics, Incen ves can be financial or non-financial,
Adherence to process
Salary
, Physicians are paid a predetermined salary based upon their level of exper se and experience.
incen ve: No incen ve for overtreatment, Provide the best treatment, regardless of ICD-code to
the pa ent, There is also no direct incen ve to work hard.
Bundled payments (DRG, EDGR, Reference Pricing)
DRG - A prospec ve payment model in which hospitals are reimbursed with a fixed fee
regardless of the actual costs. Includes hospital expenses only. ACA required 30-day readmission
penalty
DRG Incen ve - Reduce length of stay, Discharge appropriately, Keep costs to a minimum
EDRG - An EDRG is another form of a bundled payment.
The bundled payment = hospital + all physician payments + longer period of me (e.g. 6 - 12
months aHer hospitaliza on).
The EDRG acts as a forcing func on - encouraging physician and hospital collabora on on
improving both pa ent outcomes and cost.
Reference Pricing - Reference Price = the payment amount now going to medical centers with
high quality and low cost
Medical centers can charge more than reference price
Pa ents told which medical centers charge more than reference price
If pa ent chooses higher cost medical centers, pa ent pays the difference between reference
price and medical center price
Capita on
A prospec ve payment model where the hospital or provider is paid a contracted rate per-
member-per-month, regardless of the number of services provided.
Rates are typically (but not always) risk-adjusted
Incen ve: Keep the pa ent healthy and living their daily lives in their own home, keep pa ent
out of the hospital/clinic, freedom to provide non-tradi onal healthcare services
Components of a healthcare system
people, parts, inter-rela onships, and culture
US rankings in:
1. WHO report
2. Bloomberg Business report
3. Commonwealth Fund report
solu on| RATED A+ 2026
System
a set of connected things or parts forming a complex whole
Quality
how good or bad something is
Access
a person's ability to get care or coverage
Cost
cost
Universal Coverage
all residents have coverage
Social Solidarity
the principle that governments have an obliga on to ensure that every ci zen has access to all
social services including healthcare
Subsidiarity
the principle belief that ma er of government responsibility should be handled at the lowest
level of government that makes opera onal sense
General Reciprocity
the principle belief in giving to something knowing that you may not get an immediate returned
benefi fif
Centralized
Organized at the federal level
Decentralized
Organized at the regional or state level
,Public Health Services/Insurance
public, government run
Private Health Services/Insurance
private, privately run
Only those who make over ~$70,000/year qualify
The premium is set by your performance on an individual health assessment
Copayment
The set dollar amount that you must pay at the point of service
Coinsurance
The set percentage of the bill that must be paid at the point of service
Deduc ble
The amount that must be paid out-of-pocket annually, before insurance coverage kicks in
Sickness Funds
~130 sickness funds today (although this number is con nually dropping)
Covers ~ 86% of the country's popula on
Membership is mandatory
Must pay a legally mandated premium of 14.6% of their income (through payroll deduc on)
Split between employer and employee
Percent of premium is determined by income
~11% of the popula on opts out of the SHI and opts for Private Health Insurance (PHI)
Percent of premium is determined by health assessment and is risk-adjusted
Safety Net
Children under 18 years of age exempt from all cost-sharing
Adults:
Annual cap equal to 2% of household income
Annual cap lowered to 1% of household income for qualifying chronically ill people
Unemployed contribute to SHI in propor on to their unemployment en tlements; For long term
unemployed government contributes on their behalf
Cost Sharing
Cost Sharing (all USD):
Outpa ent Prescrip ons: $6.40 - $12.70
,Inpa ent Stay: $10.00/day (first 28 days/yr)
Rehabilita on Stay: $10.00/day (first 28 days/yr)
Deduc bles: vary by sickness fund plan
Preventa ve services do not count towards deduc ble
Subsidy
government assistance
Health Financing
it is the func on of a system concerned with the mobiliza on, accumula on, and alloca on of
money to cover the health needs of the people, individually and collec vely, in the health
system
Health Spending as % of GDP
The percent of money spent on healthcare every year, in rela on to the total amount spent
throughout all industries in the same year
Fee-for-service (FFS)
A payment model where all healthcare services, products, and prescrip on medica ons are
unbundled and paid for separately.
incen ve: Overtreatment, Provide more services, tes ng, and treatments that are billable
through an ICD-code.
Per Diem
payment model that reimburses organiza ons and/or providers based upon the number of days
treatment was given
Pay-for-performance
A payment model that reimburses healthcare organiza ons and physicians who achieve,
improve, or exceed their performance on specified quality and cost measures, as well as other
benchmarks.
incen ve: Measure of performance metrics, Incen ves can be financial or non-financial,
Adherence to process
Salary
, Physicians are paid a predetermined salary based upon their level of exper se and experience.
incen ve: No incen ve for overtreatment, Provide the best treatment, regardless of ICD-code to
the pa ent, There is also no direct incen ve to work hard.
Bundled payments (DRG, EDGR, Reference Pricing)
DRG - A prospec ve payment model in which hospitals are reimbursed with a fixed fee
regardless of the actual costs. Includes hospital expenses only. ACA required 30-day readmission
penalty
DRG Incen ve - Reduce length of stay, Discharge appropriately, Keep costs to a minimum
EDRG - An EDRG is another form of a bundled payment.
The bundled payment = hospital + all physician payments + longer period of me (e.g. 6 - 12
months aHer hospitaliza on).
The EDRG acts as a forcing func on - encouraging physician and hospital collabora on on
improving both pa ent outcomes and cost.
Reference Pricing - Reference Price = the payment amount now going to medical centers with
high quality and low cost
Medical centers can charge more than reference price
Pa ents told which medical centers charge more than reference price
If pa ent chooses higher cost medical centers, pa ent pays the difference between reference
price and medical center price
Capita on
A prospec ve payment model where the hospital or provider is paid a contracted rate per-
member-per-month, regardless of the number of services provided.
Rates are typically (but not always) risk-adjusted
Incen ve: Keep the pa ent healthy and living their daily lives in their own home, keep pa ent
out of the hospital/clinic, freedom to provide non-tradi onal healthcare services
Components of a healthcare system
people, parts, inter-rela onships, and culture
US rankings in:
1. WHO report
2. Bloomberg Business report
3. Commonwealth Fund report
