LSUS MHA 710 Exam 1 Questions And 100%
Correct Answers
Public Option
Public health insurance plan similar to Medicaid, but designed to compete with private
insurance.
Uncertainty
More than one outcome possible, but the probability of a particular outcome cannot be
determined.
Premium
The periodic payment that is made to purchase an insurance policy.
Group Insurance
A plan where the entire group is insured under a single policy. The insurance is issued
to the plan holder, usually an employer or association.
Medicare
Health insurance for elderly, provided under an amendment to the Social Security Act.
Medicaid
Health insurance for the poor, financed jointly by federal & state governments.
Flexner Report
Report published in 1910, part of a critical review of medical education in the U.S. The
response of the medical establishment led to significant changes in the accreditation
procedures of medical schools & an improvement in quality of medical care.
,Collective Bargaining
Negotiation process in which representatives of employers & employees agree to terms
of a labor contract, including wages & benefits.
Certificate of Need
Regulations that attempt to avoid the costly duplication of services in the hospital
industry. Providers must secure a __________ before undertaking major expansion of
facilities or services.
Employee Retirement Income Security Act
Federal law passed in 1974 that established minimum standards on employee benefit
plans, including pension, health insurance, & disability. Statute protects interests in
employees in re: eligibility for benefits. Law also protects employers from certain state
regulations.
Example: States cannot regulate self-insured plans & states cannot require employers
to provide health insurance to their employees.
Entitlement Programs
Gov. programs in which eligibility is determined based on specific criteria including but
not limited to age, health status and level of income. Examples of these include but are
not limited to Social Security, Medicare, Medicaid, TANF and many more.
Prospective Payment
The amount of payment is known prior to services provided. This exists for many
managed care organizations in which the payment is based on capitation.
Capitation
A payment method that pays a fixed, per capita payment to providers for a defined
medical benefits package. Providers are required to treat a well-defined population for a
fixed sum of money, paid in advance, without regard to the number or nature of services
provided to each person.
, Diagnosis-related Group
Patient classification scheme developed by Medicare and used to compensate hospitals
based on certain demographic, diagnostic, & therapeutic characteristics.
Relative-value Scale
Index assigning weights to various medical services used to derive relative fees
assigned to them.
Retrospective Payment
Payment determined after delivery of the good/service. Traditional fee-for-service
medicine determines payment retrospectively.
Managed Care
Delivery system that originally integrated financing & provision of medical care in one
organization. Today, the term encompasses different arrangements designed to
coordinate services & control costs.
Indemnity Insurance
Insurance based on the principle that someone suffering an economic loss receives a
payment approximately equal to the size of the loss.
Horizontal Integration
Merger of two or more firms that produce the same good or service.
Vertical Integration
Expansion to secure elements of the supply chain to ensure availability of resources to
produce a product or service.
Example: Acquisition of a primary care clinic by a hospital.
Correct Answers
Public Option
Public health insurance plan similar to Medicaid, but designed to compete with private
insurance.
Uncertainty
More than one outcome possible, but the probability of a particular outcome cannot be
determined.
Premium
The periodic payment that is made to purchase an insurance policy.
Group Insurance
A plan where the entire group is insured under a single policy. The insurance is issued
to the plan holder, usually an employer or association.
Medicare
Health insurance for elderly, provided under an amendment to the Social Security Act.
Medicaid
Health insurance for the poor, financed jointly by federal & state governments.
Flexner Report
Report published in 1910, part of a critical review of medical education in the U.S. The
response of the medical establishment led to significant changes in the accreditation
procedures of medical schools & an improvement in quality of medical care.
,Collective Bargaining
Negotiation process in which representatives of employers & employees agree to terms
of a labor contract, including wages & benefits.
Certificate of Need
Regulations that attempt to avoid the costly duplication of services in the hospital
industry. Providers must secure a __________ before undertaking major expansion of
facilities or services.
Employee Retirement Income Security Act
Federal law passed in 1974 that established minimum standards on employee benefit
plans, including pension, health insurance, & disability. Statute protects interests in
employees in re: eligibility for benefits. Law also protects employers from certain state
regulations.
Example: States cannot regulate self-insured plans & states cannot require employers
to provide health insurance to their employees.
Entitlement Programs
Gov. programs in which eligibility is determined based on specific criteria including but
not limited to age, health status and level of income. Examples of these include but are
not limited to Social Security, Medicare, Medicaid, TANF and many more.
Prospective Payment
The amount of payment is known prior to services provided. This exists for many
managed care organizations in which the payment is based on capitation.
Capitation
A payment method that pays a fixed, per capita payment to providers for a defined
medical benefits package. Providers are required to treat a well-defined population for a
fixed sum of money, paid in advance, without regard to the number or nature of services
provided to each person.
, Diagnosis-related Group
Patient classification scheme developed by Medicare and used to compensate hospitals
based on certain demographic, diagnostic, & therapeutic characteristics.
Relative-value Scale
Index assigning weights to various medical services used to derive relative fees
assigned to them.
Retrospective Payment
Payment determined after delivery of the good/service. Traditional fee-for-service
medicine determines payment retrospectively.
Managed Care
Delivery system that originally integrated financing & provision of medical care in one
organization. Today, the term encompasses different arrangements designed to
coordinate services & control costs.
Indemnity Insurance
Insurance based on the principle that someone suffering an economic loss receives a
payment approximately equal to the size of the loss.
Horizontal Integration
Merger of two or more firms that produce the same good or service.
Vertical Integration
Expansion to secure elements of the supply chain to ensure availability of resources to
produce a product or service.
Example: Acquisition of a primary care clinic by a hospital.
