HEALTHCARE DELIVERY EXAM 1 UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

HEALTHCARE DELIVERY EXAM 1 UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS

Question:
1. Define a HEALTH CARE SYSTEM
Answer:
People, institutions, resources in accordance with established policies, protecting against cost of ill-health
and whose primary intent is to improve, promote, maintain, and restore health

Question:
2. Define the core component of the health care system: HEALTH
Answer:
State of complete physical, mental, and social well-being. Not merely the absence of disease or infirmity
State where individual can function routinely, daily in a normal capacity

Question:
3. Define the core component of the health care system: CARE
Answer:
Efforts to maintain/restore physical, mental, emotional well-being by trained licensed professionals

Question:
4. What are the levels of care?
Answer:
Primary, Secondary, Tertiary care

Question:
5. What is PRIMARY CARE?
Answer:
Medical care provided by clinician of first contact for the pt GP, NP, RPh, Dentist, Optician Priority:
preventive, diagnostic, health education, minor surgery

Question:
6. What is SEC- ONDARY CARE?
Answer:
Care provided to a patient who has been referred to the specialist for an identified condition Hospital
clinic, Specialist Doctor, Dietician, Physiotherapist Priority: curative, advanced interventions

Question:
7. What is TERTIARY CARE?
Answer:
Specific care for rare/uncommon conditions or diseases. Highly specialized, institution based. Receives
referrals from both 1° and 2° care Examples: National or regional specialist services

Question:
8. What is a SYS- TEM?

,Answer:
Whole composed of several interdependent parts with differentiated roles that are interconnected by 3
processes (input, throughput, outcomes) 1° purpose is to promote, restore and/or maintain health

Question:
9. Healthcare Value Chain diagram
Answer:




Question:
10. What are the KEY COMPO- NENTS of the VALUE CHAIN?
Answer:
Payers: where funding originates Insurers: finance healthcare Providers: healthcare service delivery
Distributors/Wholesalers: supply chain management Producers: product manufacturers & innovation
sources

Question:
11. Describe the PAY- ERS: The Financial Foundation
Answer:
Role: initial source healthcare funding Includes both private and public sectors

Question:
12. What are the three main categories of PAYERS?
Answer:
Employers: employees enrolled in EBHI Government: groups receiving public insurance (Medicare,
Medicaid, VA) Individuals: out-of-pocket payments

Question:
13. Describe the INSURERS: Financers of Healthcare
Answer:
Function as fiscal intermediaries between payers and providers

Question:
14. What are SER- VICES of INSUR- ERS?
Answer:
Premium collection, Provider contracting, Claims processing

Question:
15. What are TYPES of INSURERS?

, Answer:
Traditional health insurers High-deductible health plans (HDHP) Pharmacy benefit managers (PBM)

Question:
16. Describe the PROVIDERS: The Central Players
Answer:
All parties that render healthcare services and allocate resources Account for 66% of healthcare spending

Question:
17. What are examples of PROVIDERS?
Answer:
Hospitals (33% of spending) Physicians (20% of spending) Outpatient centers, Pharmacies, Nursing
homes

Question:
18. Describe DISTRIBU- TORS/WHOLE- SALERS
Answer:
Serve as logistics background to healthcare system Connect manufacturers to providers Manage supply
chain logistics Include Group Purchasing Organizations and mail-order distributors

Question:
19. Describe PRO- DUCERS
Answer:
Drive healthcare innovation Most profitable segment of healthcare system Pharmaceutical, biotech,
medical devices companies Product manufacturers

Question:
20. What is the significance of the VALUE CHAIN?
Answer:
Places providers at critical intersection point, the center Demonstrates interconnectedness of healthcare
sectors

Question:
21. What is the role of the PATIENT in the Healthcare Value Chain?
Answer:
Patient-centered care Increasing engagement across value chain, now viewed as healthcare consumer
(buyer/demander) Target of outreach by various stakeholders

Question:
22. What is the IRON TRIANGLE?
Answer:
Focused on system level issues instead of direct clinical care Support healthcare delivery behind the scenes
without interacting directly with patients

Question:
23. What is the origin, core components, and fundamental premise of the IRON TRIANGLE?