HCM 2110 EXAM 1 QUESTIONS &
ANSWERS CORRECT 100%
Characteristics of a system (system thinking) - ANSWER- organization: means the
arrangement of components operate with each other
-interaction: refers to the manner in which the components operate with each other
-integration: means that the part of the system work together within the system even
if each part performs a unique function
-central objective: means that all the components work together to achieve that
particular objective.
Capitation - ANSWERper head, MCO pays providers either through a capitation
arrangement, in which providers receive a fixed payment for each enrollee under
their care. A reimbursement mechanism under which the provider is paid a set
monthly fee per enrollee regardless of whether the enrollee actually sees the
provider and regardless of how often an enrollee sees the provider
medicare - ANSWERone of the largest sources of public health insurance in the US.
serving the elderly, the disable, and those with end-stage renal disease. offers
coverage for hospital care, postdischarge nursing care, hospice, outpatient services,
and prescription drugs.
medicaid - ANSWERthe third largest source of health insurance in the US. insuring
approximately 19% of the US population and providing coverage for low-income
adults, children, the elderly, and the disabled. Significantly expanded under the ACA
(affordable care act)
acute - ANSWERrelatively severe, episodic, and often treatable. it is subject to
recover, and treatment is generally provided in a hospital. short-term, intense
medical care for an illness or injury usually requiring hospitalization.
chronic - ANSWERa long-lasting condition that can be controlled but not cured. less
severe but of long, continuous duration. the patient may not fully recover. a chronic
condition may be kept under control through appropriate medical treatment but, if left
untreated, may lead to severe, life-threatening health problems.
medical training and practices in preindustrial america - ANSWER-did not require
rigorous course of study or clinical practice
-residency training was not essential
-no exams or licensing requirements
-with unscientific medical training and nonprofessional medical practice meant that
there was free entry into the medical field.
-intense competition existed
-physicians fees were paid out of personal funds, people relied on family, neighbors,
and publications for domestic remedies.
, social justice - ANSWERemphasizes the well-being of the community over that of the
individual. a distribution principle according to which health care is most equitably
distributed by a government-run national health care program.
market justice - ANSWERplaces the responsibility for the fair distribution of health
care on the market forces in a free economy. a distributional principle according to
which health care is most equitably distributed through the market forces of supply
and demand rather than government interventions.
government role in the US healthcare systems - ANSWERNot as involved as
countries like canada, the UK, and germany because we dont have universal health
care. But not completely uninvolved either
risk underwriting - ANSWERis the risk of uncontrollable factors or an inaccurate
assessment of risks when writing an insurance policy. if the insurer underestimates
the risks associated with extending coverage, it could pay out more than it receives
in premiums.
social justice 2 - ANSWERhealth care is a social good, the distribution of healthcare
is society's responsibility, requires active government involvement in health services
delivery, medical resource allocation is determined by central planning, access to
medical service is a basic right, collective responsibility for health.
market justice 2 - ANSWERhealth care is an economic good governed by free
market forces, individual responsibility for health.
Just: fair distribution of health care to the market forces in a free economy, medical
care distribution is based on people's ability to pay, access to medical service is an
economic reward.
Unjust: gov. involvement in the distribution of health care, medical care allocation is
determined by central planning.
Physical view/medical model - ANSWERdefine health as the absence of illness or
disease. This perspective emphasizes diagnosis and intervention to treat disease or
symptoms. Optimal health exists when a person is free of symptoms and does not
require treatment. Delivery of health care that places its primary emphasis on the
treatment of disease and relief of symptoms instead of prevention of disease and
promotion of optimal health.
Social view - ANSWERmedical sociologists define health as the state of optimal
capacity of an individual to perform expected social roles and tasks
bio-psycho-social model - ANSWERWHO defines health as a complete state of
physical, mental, and social well-being and not merely the absence of disease or
infirmity. WHO defines health care systems as all activities aimed at promoting,
restoring, or maintaining health. inter-disciplinary model that looks at the
interconnection between biology, psychology, and socio-environmental factors.
hol Discounted payments - ANSWERproviders are willing to discount services for
MCO patients to be included in the MCO network and be guaranteed a patient
population.
ANSWERS CORRECT 100%
Characteristics of a system (system thinking) - ANSWER- organization: means the
arrangement of components operate with each other
-interaction: refers to the manner in which the components operate with each other
-integration: means that the part of the system work together within the system even
if each part performs a unique function
-central objective: means that all the components work together to achieve that
particular objective.
Capitation - ANSWERper head, MCO pays providers either through a capitation
arrangement, in which providers receive a fixed payment for each enrollee under
their care. A reimbursement mechanism under which the provider is paid a set
monthly fee per enrollee regardless of whether the enrollee actually sees the
provider and regardless of how often an enrollee sees the provider
medicare - ANSWERone of the largest sources of public health insurance in the US.
serving the elderly, the disable, and those with end-stage renal disease. offers
coverage for hospital care, postdischarge nursing care, hospice, outpatient services,
and prescription drugs.
medicaid - ANSWERthe third largest source of health insurance in the US. insuring
approximately 19% of the US population and providing coverage for low-income
adults, children, the elderly, and the disabled. Significantly expanded under the ACA
(affordable care act)
acute - ANSWERrelatively severe, episodic, and often treatable. it is subject to
recover, and treatment is generally provided in a hospital. short-term, intense
medical care for an illness or injury usually requiring hospitalization.
chronic - ANSWERa long-lasting condition that can be controlled but not cured. less
severe but of long, continuous duration. the patient may not fully recover. a chronic
condition may be kept under control through appropriate medical treatment but, if left
untreated, may lead to severe, life-threatening health problems.
medical training and practices in preindustrial america - ANSWER-did not require
rigorous course of study or clinical practice
-residency training was not essential
-no exams or licensing requirements
-with unscientific medical training and nonprofessional medical practice meant that
there was free entry into the medical field.
-intense competition existed
-physicians fees were paid out of personal funds, people relied on family, neighbors,
and publications for domestic remedies.
, social justice - ANSWERemphasizes the well-being of the community over that of the
individual. a distribution principle according to which health care is most equitably
distributed by a government-run national health care program.
market justice - ANSWERplaces the responsibility for the fair distribution of health
care on the market forces in a free economy. a distributional principle according to
which health care is most equitably distributed through the market forces of supply
and demand rather than government interventions.
government role in the US healthcare systems - ANSWERNot as involved as
countries like canada, the UK, and germany because we dont have universal health
care. But not completely uninvolved either
risk underwriting - ANSWERis the risk of uncontrollable factors or an inaccurate
assessment of risks when writing an insurance policy. if the insurer underestimates
the risks associated with extending coverage, it could pay out more than it receives
in premiums.
social justice 2 - ANSWERhealth care is a social good, the distribution of healthcare
is society's responsibility, requires active government involvement in health services
delivery, medical resource allocation is determined by central planning, access to
medical service is a basic right, collective responsibility for health.
market justice 2 - ANSWERhealth care is an economic good governed by free
market forces, individual responsibility for health.
Just: fair distribution of health care to the market forces in a free economy, medical
care distribution is based on people's ability to pay, access to medical service is an
economic reward.
Unjust: gov. involvement in the distribution of health care, medical care allocation is
determined by central planning.
Physical view/medical model - ANSWERdefine health as the absence of illness or
disease. This perspective emphasizes diagnosis and intervention to treat disease or
symptoms. Optimal health exists when a person is free of symptoms and does not
require treatment. Delivery of health care that places its primary emphasis on the
treatment of disease and relief of symptoms instead of prevention of disease and
promotion of optimal health.
Social view - ANSWERmedical sociologists define health as the state of optimal
capacity of an individual to perform expected social roles and tasks
bio-psycho-social model - ANSWERWHO defines health as a complete state of
physical, mental, and social well-being and not merely the absence of disease or
infirmity. WHO defines health care systems as all activities aimed at promoting,
restoring, or maintaining health. inter-disciplinary model that looks at the
interconnection between biology, psychology, and socio-environmental factors.
hol Discounted payments - ANSWERproviders are willing to discount services for
MCO patients to be included in the MCO network and be guaranteed a patient
population.
