HFMA Business of Health Care Exam | Questions
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Update 2026
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Terms in this set (329)
02.-HEALTHCARE FINANCE : iew of Health care in the U.S. is not a simple relationship
US Healthcare SOvervystem between a sick or injured person (referred to as the
patient) and a party rendering medical care such
as a physician or hospital (referred to as providers).
There are a myriad of participants in the delivery of
medical care, most of which are not directly
involved with treating an illness or injury. These
participants include insurers, regulators, and
suppliers.
Three key players in the healthcare Patient, Insurer and Provider
industry.
The broadest classification is Facility Providers: Examples of facility providers
between facility and professional include hospitals, skilled nursing facilities, assisted
providers. living facilities, home health agencies, and
ambulatory surgery centers.
Professional Providers: Professional providers
include physicians, pharmacists, nurses, and allied
health professionals (APPs) such as physical
therapists, clinical social workers, and others.
,At the most basic level, physicians Primary Care: Primary care physicians are usually
are classified as primary care or trained as family practice, general practice, general
specialists. internal medicine, and pediatrics. Physicians
serving in primary care roles usually treat common
medical conditions or injuries, and often provide
preventive health screenings. Their role is often
viewed as: a coordinator of a patient's care,
assessing a patient's condition (and treating if
simple) or referring a patient to a specialist
physician.
Specialists: Specialists normally do not provide
primary care services, instead focusing their work
based on in-depth training in different diseases,
body systems or types of healthcare service.
Examples of specialist physicians include
anesthesiology, radiology, pathology, cardiology,
obstetrics/gynecology, ophthalmology,
orthopedics, psychiatry, general surgery, oncology,
neurology, or hospitalist medicine.
The specialties of radiology, anesthesiology,
pathology - along with emergency room
physicians and hospitalists - are commonly referred
to as hospital-based physicians, since the majority
of their work is done within a hospital facility. Other
physician specialties may also provide care within a
facility provider, such as when a surgeon operates
on a patient in an ambulatory surgery center or an
obstetrician/gynecologist delivers a baby in the
hospital.
,Healthcare Finance: Financing the The "business of healthcare" is unique in that less
Healthcare system than 11 percent of the U.S. healthcare expenditures
are paid for directly by the recipients or
beneficiaries of care (known as out-of-pocket). The
remainder of costs are paid by someone else:
employers, federal and state governments, and the
healthcare industry itself (through free care and
through taxes on providers, pharmaceutical
manufacturers and insurers). Indirectly, of course,
the cost of healthcare is borne by everyone
through higher prices, lower wages, higher taxes,
and an increase in the national debt.
All in all, 55 percent of U.S. healthcare is financed
privately, and 45 percent is financed with public
funds.
Approximately 50% of Americans receive
healthcare as a benefit through their employers.
The second largest group, low-income adults and
children, pregnant women and people with
disabilities (20%), is covered by Medicaid or CHIP
(Children's Health Insurance Program) ; 14% of
elderly Americans receive their care through
Medicare.
About 6% purchase health insurance on the
individual market or through the Affordable Care
Act's federal and state Health Insurance
Marketplaces (also known as Exchanges)
Currently, approximately 9% of individuals are
uninsured.
, Still, the cost of healthcare is a significant factor for
many people. 20 percent of workers have high-
deductible health plans (HDHPs). Medical debt
remains a significant factor in personal
bankruptcies. Premiums, deductibles, coinsurance
and copays can be steep and add up despite
annual out-of-pocket limits.
The American healthcare system is expensive.
While we have made some progress in bending the
cost curve, a significant portion of healthcare
spending is still wasteful and has no benefit to
patients. The Commonwealth Fund has calculated
that we could have saved $15.5 trillion between
1980 and 2010 if we had matched the per capita
spending on healthcare of the next highest country
(Switzerland) and several studies have concluded
that about one-third of US healthcare expenditures
are unnecessary and are due to consumer demand,
defensive medicine, and medical error. 2
Deductible The deductible is a predetermined amount that the
patient pays before the insurer begins to pay for
services.
Coinsurance Coinsurance is a percentage of the insurance
payment amount that is paid by the patient, along
with the amount paid by the insurer.
Copayment A copayment is a flat amount that the patient pays
at each time of service.
with 100% Correct Answers | Verified | Latest
Update 2026
Save
Terms in this set (329)
02.-HEALTHCARE FINANCE : iew of Health care in the U.S. is not a simple relationship
US Healthcare SOvervystem between a sick or injured person (referred to as the
patient) and a party rendering medical care such
as a physician or hospital (referred to as providers).
There are a myriad of participants in the delivery of
medical care, most of which are not directly
involved with treating an illness or injury. These
participants include insurers, regulators, and
suppliers.
Three key players in the healthcare Patient, Insurer and Provider
industry.
The broadest classification is Facility Providers: Examples of facility providers
between facility and professional include hospitals, skilled nursing facilities, assisted
providers. living facilities, home health agencies, and
ambulatory surgery centers.
Professional Providers: Professional providers
include physicians, pharmacists, nurses, and allied
health professionals (APPs) such as physical
therapists, clinical social workers, and others.
,At the most basic level, physicians Primary Care: Primary care physicians are usually
are classified as primary care or trained as family practice, general practice, general
specialists. internal medicine, and pediatrics. Physicians
serving in primary care roles usually treat common
medical conditions or injuries, and often provide
preventive health screenings. Their role is often
viewed as: a coordinator of a patient's care,
assessing a patient's condition (and treating if
simple) or referring a patient to a specialist
physician.
Specialists: Specialists normally do not provide
primary care services, instead focusing their work
based on in-depth training in different diseases,
body systems or types of healthcare service.
Examples of specialist physicians include
anesthesiology, radiology, pathology, cardiology,
obstetrics/gynecology, ophthalmology,
orthopedics, psychiatry, general surgery, oncology,
neurology, or hospitalist medicine.
The specialties of radiology, anesthesiology,
pathology - along with emergency room
physicians and hospitalists - are commonly referred
to as hospital-based physicians, since the majority
of their work is done within a hospital facility. Other
physician specialties may also provide care within a
facility provider, such as when a surgeon operates
on a patient in an ambulatory surgery center or an
obstetrician/gynecologist delivers a baby in the
hospital.
,Healthcare Finance: Financing the The "business of healthcare" is unique in that less
Healthcare system than 11 percent of the U.S. healthcare expenditures
are paid for directly by the recipients or
beneficiaries of care (known as out-of-pocket). The
remainder of costs are paid by someone else:
employers, federal and state governments, and the
healthcare industry itself (through free care and
through taxes on providers, pharmaceutical
manufacturers and insurers). Indirectly, of course,
the cost of healthcare is borne by everyone
through higher prices, lower wages, higher taxes,
and an increase in the national debt.
All in all, 55 percent of U.S. healthcare is financed
privately, and 45 percent is financed with public
funds.
Approximately 50% of Americans receive
healthcare as a benefit through their employers.
The second largest group, low-income adults and
children, pregnant women and people with
disabilities (20%), is covered by Medicaid or CHIP
(Children's Health Insurance Program) ; 14% of
elderly Americans receive their care through
Medicare.
About 6% purchase health insurance on the
individual market or through the Affordable Care
Act's federal and state Health Insurance
Marketplaces (also known as Exchanges)
Currently, approximately 9% of individuals are
uninsured.
, Still, the cost of healthcare is a significant factor for
many people. 20 percent of workers have high-
deductible health plans (HDHPs). Medical debt
remains a significant factor in personal
bankruptcies. Premiums, deductibles, coinsurance
and copays can be steep and add up despite
annual out-of-pocket limits.
The American healthcare system is expensive.
While we have made some progress in bending the
cost curve, a significant portion of healthcare
spending is still wasteful and has no benefit to
patients. The Commonwealth Fund has calculated
that we could have saved $15.5 trillion between
1980 and 2010 if we had matched the per capita
spending on healthcare of the next highest country
(Switzerland) and several studies have concluded
that about one-third of US healthcare expenditures
are unnecessary and are due to consumer demand,
defensive medicine, and medical error. 2
Deductible The deductible is a predetermined amount that the
patient pays before the insurer begins to pay for
services.
Coinsurance Coinsurance is a percentage of the insurance
payment amount that is paid by the patient, along
with the amount paid by the insurer.
Copayment A copayment is a flat amount that the patient pays
at each time of service.
