HSC 317 TEST PAPER ANSWERS AND QUESTIONS
SET A+
✔✔Packaged pricing - ✔✔several related health services are included in one price.
✔✔Resource based relative value scale - ✔✔reimbursement to physicians according to
the relative value of the service provided.
✔✔Prepaid Health care - ✔✔a method of paying for covered health care services on a
per-person premium basis for a specific time period prior to the service being rendered
(capitation)
✔✔prospective reimbursement - ✔✔uses preestablished criteria to determine in
advance the amount of reimbursement.
✔✔Fixed indemnity - ✔✔the maximum amount an insurer will pay for a certain service.
✔✔Exlusion - ✔✔a health condition written into the health insurance policy indicating
what is not covered by the policy.
✔✔Self-funded insurance programs - ✔✔one that pays the health care costs of its
employees with the premiums collected from the employees and the contributions made
by the employer.
✔✔CHIP (Children's Health Insurance Program) - ✔✔a title insurance program under
the social security act that providers health insurance to uninsured children.
✔✔Medigap - ✔✔private health insurance that supplements Medicare benefits.
✔✔quality management and utilization review - ✔✔the analysis of provided health care
for its appropriateness by someone other than the patient and provider.
✔✔PPO (Preferred provider organization) - ✔✔an organization that buys fixed-rate
health services from providers and sells them to consumers.
, ✔✔EPO (Exclusive provider organization) - ✔✔like a PPO but with fewer providers and
stronger financial incentives.
✔✔HMO's (health maintenance organizations) - ✔✔groups that supply prepaid
comprehensive care with an emphasis on prevention
✔✔Mixed HMO - ✔✔a hybrid form of health maintenance organization.
✔✔Staff model HMO - ✔✔a health maintenance organization that hires its own staff of
health care providers.
✔✔IPA's (independent practice association) - ✔✔legal entities separate from the HMO
that are physician organizations composed of community-based independent physicians
in solo or group practices who provide services to HMO members.
✔✔Group model HMO - ✔✔one that contracts with a multispeciality group practice.
✔✔Network model HMO - ✔✔One that contracts with more than one medical group
practice
✔✔Direct contract HMO - ✔✔one that contracts with individual physicans as opposed to
group practices.
✔✔POS (point of service) - ✔✔an option of an HMO plan that enables enrollees to be at
least partially reimbursed for selecting a health care provider outside the plan.
✔✔CDHP's (consumer-directed health plans) - ✔✔health plan options that combine
more consumer responsibility for decisions with a tax sheltered account to pay for out of
pocket costs for health care and a high-deductible health insurance policy.
✔✔Communicable disease - ✔✔an illness caused by some specific biological agent or
its toxic products that can be transmitted from an infected person, animal, or inanimate
reservoir to a susceptible host.
✔✔Noncommunicable disease - ✔✔a disease that cannot be transmitted from infected
host to susceptible host.
✔✔Infectivity - ✔✔the ability of a biological agent to enter and grow in the host.
✔✔Pathogenicity - ✔✔The capability of a communicable disease agent to cause
disease in a susceptible host.
SET A+
✔✔Packaged pricing - ✔✔several related health services are included in one price.
✔✔Resource based relative value scale - ✔✔reimbursement to physicians according to
the relative value of the service provided.
✔✔Prepaid Health care - ✔✔a method of paying for covered health care services on a
per-person premium basis for a specific time period prior to the service being rendered
(capitation)
✔✔prospective reimbursement - ✔✔uses preestablished criteria to determine in
advance the amount of reimbursement.
✔✔Fixed indemnity - ✔✔the maximum amount an insurer will pay for a certain service.
✔✔Exlusion - ✔✔a health condition written into the health insurance policy indicating
what is not covered by the policy.
✔✔Self-funded insurance programs - ✔✔one that pays the health care costs of its
employees with the premiums collected from the employees and the contributions made
by the employer.
✔✔CHIP (Children's Health Insurance Program) - ✔✔a title insurance program under
the social security act that providers health insurance to uninsured children.
✔✔Medigap - ✔✔private health insurance that supplements Medicare benefits.
✔✔quality management and utilization review - ✔✔the analysis of provided health care
for its appropriateness by someone other than the patient and provider.
✔✔PPO (Preferred provider organization) - ✔✔an organization that buys fixed-rate
health services from providers and sells them to consumers.
, ✔✔EPO (Exclusive provider organization) - ✔✔like a PPO but with fewer providers and
stronger financial incentives.
✔✔HMO's (health maintenance organizations) - ✔✔groups that supply prepaid
comprehensive care with an emphasis on prevention
✔✔Mixed HMO - ✔✔a hybrid form of health maintenance organization.
✔✔Staff model HMO - ✔✔a health maintenance organization that hires its own staff of
health care providers.
✔✔IPA's (independent practice association) - ✔✔legal entities separate from the HMO
that are physician organizations composed of community-based independent physicians
in solo or group practices who provide services to HMO members.
✔✔Group model HMO - ✔✔one that contracts with a multispeciality group practice.
✔✔Network model HMO - ✔✔One that contracts with more than one medical group
practice
✔✔Direct contract HMO - ✔✔one that contracts with individual physicans as opposed to
group practices.
✔✔POS (point of service) - ✔✔an option of an HMO plan that enables enrollees to be at
least partially reimbursed for selecting a health care provider outside the plan.
✔✔CDHP's (consumer-directed health plans) - ✔✔health plan options that combine
more consumer responsibility for decisions with a tax sheltered account to pay for out of
pocket costs for health care and a high-deductible health insurance policy.
✔✔Communicable disease - ✔✔an illness caused by some specific biological agent or
its toxic products that can be transmitted from an infected person, animal, or inanimate
reservoir to a susceptible host.
✔✔Noncommunicable disease - ✔✔a disease that cannot be transmitted from infected
host to susceptible host.
✔✔Infectivity - ✔✔the ability of a biological agent to enter and grow in the host.
✔✔Pathogenicity - ✔✔The capability of a communicable disease agent to cause
disease in a susceptible host.
