HAP 200 FINAL EXAM VERIFIED STUDY GUIDE
2010 Patient Protection and Affordable Care Act - Answers - implemented in 2014-
promise of universal coverage, but has fallen short- expanded Medicare eligibility,
created healthcare marketplaces, prohibited pre-existing conditions exclusions
Managed Care Organizations (MCOs) - Answers - achieve efficiency by integrating
basic functions of HC delivery and put mechanisms in place to control utilization;
contracting mechanism of insurance companies to determines service prices and how
much providers are paid
Health Managed Organizations (HMOs) - Answers - type of contract in MCOs- focus on
wellness care by preventative and screening services & tight utilization control
capitation
capitation - Answers - a payment system where providers receive a fixed amount of
money per member, per month (or other period) for providing care, regardless of the
number or type of services delivered
Preferred Provider Organizations (PPOs) - Answers - type of contract in MCOs- no
gatekeeper so enrollee can see specialist on own, discounted fees with high deductible
Health Plan - Answers - The contractual agreement between the MCO and the
enrollee—including list of covered services, utilizes selected providers
TRICARE - Answers - U.S. government health insurance plan for all military personnel;
financed by military budget
Veterans Administration (VA) - Answers - available to honorably discharged veterans,
especially disabled; provide outpatient, hospital, mental health, and long term care
safety net providers - Answers - community providers that offer services to the
uninsured and underinsured; Emergency Departments, community health centers, free
clinics, public hospitals
Medicare - Answers - government insurance for elderly (over 65), disabled, and end-
stage renal disease
Medicaid - Answers - government insurance for poor; different qualifications in every
state
Children's Health Insurance Program (CHIP) - Answers - government insurance for
children of uninsured families
, Integrated Delivery System (IDS) - Answers - A network of organizations that provides
or arranges to provide a coordinated continuum of services to a defined population and
is willing to be held clinically and fiscally accountable for the outcomes and health status
of the population serviced; ex. Kaiser, Advent Health, CommonSpirit
Accountable Care Organizations (ACOs) - Answers - the group of physicians, hospitals,
and other health care providers come together voluntarily to provide coordinated high-
quality care to their Medicare patients; new payment incentives, better quality
outcomes, and less cost
Long-term care - Answers - medical & non-medical care provided to chronically ill or
disabled individuals who can't perform daily tasks; covered by Medicaid, but not
Medicare
Patient Advocacy Organizations - Answers - Nonprofit organizations representing
patients by funding and advocating for policy changes
Characteristics of US Healthcare System - Answers - no central governing agency and
little integration and coordination, technology driven with focus on acute care, high in
costs, unequal in access, average in outcome, imperfect market conditions, gov't as
subsidiary to the private sector, fusion of market justice and social justice, multiple
payers and balance of power, quest for integration and accountability, access to
healthcare services based on insurance, legal risks influence practice behavior
Medical Mode of Health - Answers - US; focus on illness & disease, diagnose and treat
symptoms, little focus on prevention
Biopsychosocial Model of Health - Answers - WHO; activities to promote, restore, or
maintain health
Holistic Model of Health - Answers - treats whole person by incorporating physical,
mental, social, and spiritual
Acute Disease - Answers - severe, episodic, often treatable; ex. heart attack,
pneumonia
Sub-acute Disease - Answers - some acute features, post-acute treatment after
discharge; ex. concussion care, nebulizer treatment
Chronic Disease - Answers - less severe, long & continuous; ex, diabetes, hypertension
Market Justice - Answers - views healthcare as an economic good and market forces in
free economy achieve fair distribution of healthcare
2010 Patient Protection and Affordable Care Act - Answers - implemented in 2014-
promise of universal coverage, but has fallen short- expanded Medicare eligibility,
created healthcare marketplaces, prohibited pre-existing conditions exclusions
Managed Care Organizations (MCOs) - Answers - achieve efficiency by integrating
basic functions of HC delivery and put mechanisms in place to control utilization;
contracting mechanism of insurance companies to determines service prices and how
much providers are paid
Health Managed Organizations (HMOs) - Answers - type of contract in MCOs- focus on
wellness care by preventative and screening services & tight utilization control
capitation
capitation - Answers - a payment system where providers receive a fixed amount of
money per member, per month (or other period) for providing care, regardless of the
number or type of services delivered
Preferred Provider Organizations (PPOs) - Answers - type of contract in MCOs- no
gatekeeper so enrollee can see specialist on own, discounted fees with high deductible
Health Plan - Answers - The contractual agreement between the MCO and the
enrollee—including list of covered services, utilizes selected providers
TRICARE - Answers - U.S. government health insurance plan for all military personnel;
financed by military budget
Veterans Administration (VA) - Answers - available to honorably discharged veterans,
especially disabled; provide outpatient, hospital, mental health, and long term care
safety net providers - Answers - community providers that offer services to the
uninsured and underinsured; Emergency Departments, community health centers, free
clinics, public hospitals
Medicare - Answers - government insurance for elderly (over 65), disabled, and end-
stage renal disease
Medicaid - Answers - government insurance for poor; different qualifications in every
state
Children's Health Insurance Program (CHIP) - Answers - government insurance for
children of uninsured families
, Integrated Delivery System (IDS) - Answers - A network of organizations that provides
or arranges to provide a coordinated continuum of services to a defined population and
is willing to be held clinically and fiscally accountable for the outcomes and health status
of the population serviced; ex. Kaiser, Advent Health, CommonSpirit
Accountable Care Organizations (ACOs) - Answers - the group of physicians, hospitals,
and other health care providers come together voluntarily to provide coordinated high-
quality care to their Medicare patients; new payment incentives, better quality
outcomes, and less cost
Long-term care - Answers - medical & non-medical care provided to chronically ill or
disabled individuals who can't perform daily tasks; covered by Medicaid, but not
Medicare
Patient Advocacy Organizations - Answers - Nonprofit organizations representing
patients by funding and advocating for policy changes
Characteristics of US Healthcare System - Answers - no central governing agency and
little integration and coordination, technology driven with focus on acute care, high in
costs, unequal in access, average in outcome, imperfect market conditions, gov't as
subsidiary to the private sector, fusion of market justice and social justice, multiple
payers and balance of power, quest for integration and accountability, access to
healthcare services based on insurance, legal risks influence practice behavior
Medical Mode of Health - Answers - US; focus on illness & disease, diagnose and treat
symptoms, little focus on prevention
Biopsychosocial Model of Health - Answers - WHO; activities to promote, restore, or
maintain health
Holistic Model of Health - Answers - treats whole person by incorporating physical,
mental, social, and spiritual
Acute Disease - Answers - severe, episodic, often treatable; ex. heart attack,
pneumonia
Sub-acute Disease - Answers - some acute features, post-acute treatment after
discharge; ex. concussion care, nebulizer treatment
Chronic Disease - Answers - less severe, long & continuous; ex, diabetes, hypertension
Market Justice - Answers - views healthcare as an economic good and market forces in
free economy achieve fair distribution of healthcare
