Health Policy Exam 1 with ALL QUESTIONS AND
CORRECT ANSWERS | BRAND NEW VERSION!
Primary objective of a Health Care system 1. To enable all citizens to receive healthcare services
2. To deliver services that are cost-effective and
meet established standards of quality.
How is US health care system unique? - it's not a system
- no universal health care financed by taxes - no entitlement
- no other country operates like the U.S.
- changes due to cost, access and quality
Ten characteristics that differentiate the U.S 1. No central agency governs a system
Health Care System 2. Access is selective based on insurance
3.Health care offered under imperfect market activity
4.Third party insurers are intermediaries between finance
and delivery
5.Multiple payers are cumbersome
6.Balance of power, no domination
7. Legal risk affects practice behavior
8.New technology creates demand for its use
9.New service settings along a continuum
10. Quality is achievable
, No Central Agency - Most developed nations have a national health
care program where every citizen is entitled to
receive a set of service
- To control costs, use global budget to determine total
health care expenses
- Government usually controls frequency of health care
services, especially expensive medical technology use
- The U.S. has mostly private financing and delivery
- Private financing through employers at 55% and
government at 45%
- Private health care, hospitals, physicians are
independent of government
- No one monitors total expenses through global budgets
and utilization
- U.S. does determine public-sector expenses and
reimbursement rates for Medicare and
Medicaid
- Government sets standards of participation through policy
and regulations
- providers must comply with standards to be certified to
provide Medicaid & Medicare patients
- regarded as minimum standards of quality
Access to healthcare is selective based on In U.S., access restricted to those who:
insurance: Partial access a) have health insurance through an employer
b) are covered under a government health care plan c)
can afford to buy insurance out of pocket
d) can pay at time of service privately
- Health insurance helps ensure access
- Those unable to pay wait until a health problem
arises then receive health care at the emergency
room
• hospital does not receive payment
• a form of catastrophic health care insurance?
- Primary Care: basic and routine care
Imperfect Market - U.S. has a quasi-market where health care is
partially managed by free markets
• patients (buyers) and providers (sellers) act independently
• prices set by interaction of supply and demand
• unrestrained competition on basis of price and quality
• patients must have info of availability of different
services (technology too complicated, skills too
advanced)
• patients have info on price and quality on each provider
• patients must bear cost of services received
• patients make decisions about the purchase of
health care services
Item pricing • obtain fees charged for service (surgeon's price)
• services can't be determined prior to procedure
Package pricing bundled fee for a group of related services
CORRECT ANSWERS | BRAND NEW VERSION!
Primary objective of a Health Care system 1. To enable all citizens to receive healthcare services
2. To deliver services that are cost-effective and
meet established standards of quality.
How is US health care system unique? - it's not a system
- no universal health care financed by taxes - no entitlement
- no other country operates like the U.S.
- changes due to cost, access and quality
Ten characteristics that differentiate the U.S 1. No central agency governs a system
Health Care System 2. Access is selective based on insurance
3.Health care offered under imperfect market activity
4.Third party insurers are intermediaries between finance
and delivery
5.Multiple payers are cumbersome
6.Balance of power, no domination
7. Legal risk affects practice behavior
8.New technology creates demand for its use
9.New service settings along a continuum
10. Quality is achievable
, No Central Agency - Most developed nations have a national health
care program where every citizen is entitled to
receive a set of service
- To control costs, use global budget to determine total
health care expenses
- Government usually controls frequency of health care
services, especially expensive medical technology use
- The U.S. has mostly private financing and delivery
- Private financing through employers at 55% and
government at 45%
- Private health care, hospitals, physicians are
independent of government
- No one monitors total expenses through global budgets
and utilization
- U.S. does determine public-sector expenses and
reimbursement rates for Medicare and
Medicaid
- Government sets standards of participation through policy
and regulations
- providers must comply with standards to be certified to
provide Medicaid & Medicare patients
- regarded as minimum standards of quality
Access to healthcare is selective based on In U.S., access restricted to those who:
insurance: Partial access a) have health insurance through an employer
b) are covered under a government health care plan c)
can afford to buy insurance out of pocket
d) can pay at time of service privately
- Health insurance helps ensure access
- Those unable to pay wait until a health problem
arises then receive health care at the emergency
room
• hospital does not receive payment
• a form of catastrophic health care insurance?
- Primary Care: basic and routine care
Imperfect Market - U.S. has a quasi-market where health care is
partially managed by free markets
• patients (buyers) and providers (sellers) act independently
• prices set by interaction of supply and demand
• unrestrained competition on basis of price and quality
• patients must have info of availability of different
services (technology too complicated, skills too
advanced)
• patients have info on price and quality on each provider
• patients must bear cost of services received
• patients make decisions about the purchase of
health care services
Item pricing • obtain fees charged for service (surgeon's price)
• services can't be determined prior to procedure
Package pricing bundled fee for a group of related services
