HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
1. 1. Name the four ba- The four basic components are financing, insurance, delivery, and payment.
sic functional com- Financing pays for the purchase of health insurance. Insurance protects the
ponents of the US buyers of health coverage against catastrophic risks. Delivery of health care
healthcare delivery enables people to receive services covered under their health insurance
system. What role plans. Payment mechanisms allow providers to receive payments for services
does each play in delivered to the insured.
the delivery of health
care?
(SHORT ANSWER)
2. 2. Name and de- In order of most important to least, the four components are environmental,
scribe the four lifestyle, hereditary, and medical care. Environmental is the shelter and
key determinants of geographical problems. Lifestyle is behavioral. Hereditary is if you are born
health in the Blum's with it you cannot change it. Medical care is access to primary care.
model.
(SHORT ANSWER)
3. 3. Which conditions -Congress imposed wage freezes to control high inflation which led to
during the World employers offering health insurance to their workers.
War II period lent -Congress ruled that health insurance is necessary to became a part of
support to employ- employee benefits.
er-based health in- -In 1954, Congress amended the Internal Revenue Code to make em-
surance in the Unit- ployer-paid health coverage nontaxable. In economic value, employer-paid
ed States? health insurance was equivalent to getting additional salary without having
(SHORT ANSWER) to pay taxes on it, which provided an incentive to obtain health insurance as
an employer-furnished benefit.
4. On what basis were -The elderly & poor could not afford the cost of care
the elderly and the -The elderly had higher incidences and prevalence of disease -
poor regarded as -Provision of charity care led to private payers being charged more for
vulnerable groups cost-shifting/cross subsidization
for whom special
, HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
government-spon-
sored programs
needed to be
created?
(SHORT ANSWER)
5. 5. Who Nonphysician primary care providers include nurse practitioners, physician
are non-physician assistants, and certified nurse midwives. They play a critical role in the pro-
providers? What are vision of health care, particularly primary care to underserved populations.
their roles in the de- NPs assists in pediatric, family, adult, psychiatric, and geriatric programs.
livery of health care? PAs assists in evaluating, monitoring, diagnostic, and therapeutic practices
(SHORT ANSWER) to patients needing medical care. CNMs assists in maternal and fetal pro-
cedures, maternity and child nursing, and patient assessments.
6. 6. According to the - collection and storage of health information on individual patients over
Institute of Medi- time
cine, what are the - immediate electronic access to person and population level information by
four main compo- authorized users
nents of a fully - availability of knowledge and decision support that enhances the quality,
developed electronic safety, and efficiency of patient care
health record (EHR) - support of efficient processes for health care delivery
system?
(SHORT ANSWER)
7. 7. Discuss the re- - new technology is expensive to develop
lationship between - costs incurred in research and development are included in total health
technological inno- care expenditures
vation and health - the overall diffusion and utilization of technology is greater in the U.S
care expenditures.
(SHORT ANSWER)
8. 8. Distinguish be- Information technology (IT) gathers, stores, analyze, and transfers data.
tween information Health informatics uses IT but goes a step beyond by emphasizing the im-
, HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
technology (IT) and provement of health care and focusing on efficiency, accuracy, and reliability
health informatics. of health care delivery.
(SHORT ANSWER)
9. 9. What is Medicare Medicare Part B is the Supplementary Medical Insurance. It is completely
Part B? Discuss voluntary. Premium cost sharing between the government and the benefi-
the financing and ciary. Premiums are income based and are subsidized by the government
cost-sharing fea- out of general taxes.
tures of Medicare The benefits covered under Medicare Part B are various out-patient services,
Part B. Which main ED services, transplants, preventative services and wellness exams. It does
benefits are covered not cover routine dental care, hearing aids, cosmetic procedures, or services
under Part B? Which not related to treatment or injury.
services are not cov-
ered?
(SHORT ANSWER)
10. 10. Briefly describe Medicare Advantage plans, also known as Part C, are insurance plans offered
the Medicare Advan- by private companies as an alternative to Original Medicare. If you have
tage program. Medicare Part A and Part B you can choose to assign your Medicare benefits
(SHORT ANSWER) to a private company who will coordinate your healthcare with Medicare
Advantage plan. Medicare Advantage plans must meet or exceed the ben-
efits offered under Original Medicare. There are additional benefits that
aren't covered under Original Medicare that are covered under Part C plans.
Medicare Advantage plans are overseen by CMS, the Centers for Medicare
and Medicaid Services.
11. 11. Briefly ex- - prescription drug plans (PDP): offer only drug coverage and are used
plain the prescrip- mainly by those who want to stay in original Medicare fee-for-service pro-
tion drug program gram
under Medicare Part - medicare advantage plan with drug coverage (MA-PD): available to those
D. (SHORT ANSWER) persons who are enrolled in Part C if the MCO provides prescription drug
coverage- and most do.
, HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
12. 12. Discuss the con- A payment model that holds healthcare providers accountable for both the
cept of value-based cost and quality of care they provide making reimbursement tied to quality
payments. and cost
(SHORT ANSWER)
13. 13. What are the con- -The patient is home-bound.
ditions of eligibility - The patient is under the care of a physician who will establish a home health
for receiving home plan.
health services un- - The patient needs physical therapy, occupational therapy, speech therapy,
der Medicare? or intermittent skilled nursing care.
(SHORT ANSWER)
14. 14. Briefly explain - Staffed by specially trained nurses who receive patients' calls.
how a telephone - Access a patients medical history and view the most recent radiology and
triage system func- laboratory test results
tions. - The nurses use standardized protocols to guide them in dealing with the
(SHORT ANSWER) patients problem and consult with primary care physicians when necessary.
- If necessary, the staff can direct patients to appropriate medical services
such as an ED of a physician's office
15. 16. Define the follow- - Premium: amount that is charged by insurance company to ensure you the
ing health insurance beneficiary is protected against risk (monthly payments)
terminologies: Pre- - Deductable: what the insured must pay out of pocket before the insurance
mium, Deductible, kicks in and helps pay
Co-payment, and - Copayment: fee for seeing provider, paid each time the services are used
Co-insurance - Coinsurance: ratio of cost sharing between the insured individual and the
(SHORT ANSWER) insurance
16. 15. Discuss the glob- - shortage of physicians in certain demographics so there is maldistribution
al health workforce - the shift from acute to chronic health changed the demands due to the
challenges. different resources and skill sets chronic conditions need
(SHORT ANSWER) - migration leads to an imbalance of health care workers in different regions
Study online at https://quizlet.com/_feym64
1. 1. Name the four ba- The four basic components are financing, insurance, delivery, and payment.
sic functional com- Financing pays for the purchase of health insurance. Insurance protects the
ponents of the US buyers of health coverage against catastrophic risks. Delivery of health care
healthcare delivery enables people to receive services covered under their health insurance
system. What role plans. Payment mechanisms allow providers to receive payments for services
does each play in delivered to the insured.
the delivery of health
care?
(SHORT ANSWER)
2. 2. Name and de- In order of most important to least, the four components are environmental,
scribe the four lifestyle, hereditary, and medical care. Environmental is the shelter and
key determinants of geographical problems. Lifestyle is behavioral. Hereditary is if you are born
health in the Blum's with it you cannot change it. Medical care is access to primary care.
model.
(SHORT ANSWER)
3. 3. Which conditions -Congress imposed wage freezes to control high inflation which led to
during the World employers offering health insurance to their workers.
War II period lent -Congress ruled that health insurance is necessary to became a part of
support to employ- employee benefits.
er-based health in- -In 1954, Congress amended the Internal Revenue Code to make em-
surance in the Unit- ployer-paid health coverage nontaxable. In economic value, employer-paid
ed States? health insurance was equivalent to getting additional salary without having
(SHORT ANSWER) to pay taxes on it, which provided an incentive to obtain health insurance as
an employer-furnished benefit.
4. On what basis were -The elderly & poor could not afford the cost of care
the elderly and the -The elderly had higher incidences and prevalence of disease -
poor regarded as -Provision of charity care led to private payers being charged more for
vulnerable groups cost-shifting/cross subsidization
for whom special
, HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
government-spon-
sored programs
needed to be
created?
(SHORT ANSWER)
5. 5. Who Nonphysician primary care providers include nurse practitioners, physician
are non-physician assistants, and certified nurse midwives. They play a critical role in the pro-
providers? What are vision of health care, particularly primary care to underserved populations.
their roles in the de- NPs assists in pediatric, family, adult, psychiatric, and geriatric programs.
livery of health care? PAs assists in evaluating, monitoring, diagnostic, and therapeutic practices
(SHORT ANSWER) to patients needing medical care. CNMs assists in maternal and fetal pro-
cedures, maternity and child nursing, and patient assessments.
6. 6. According to the - collection and storage of health information on individual patients over
Institute of Medi- time
cine, what are the - immediate electronic access to person and population level information by
four main compo- authorized users
nents of a fully - availability of knowledge and decision support that enhances the quality,
developed electronic safety, and efficiency of patient care
health record (EHR) - support of efficient processes for health care delivery
system?
(SHORT ANSWER)
7. 7. Discuss the re- - new technology is expensive to develop
lationship between - costs incurred in research and development are included in total health
technological inno- care expenditures
vation and health - the overall diffusion and utilization of technology is greater in the U.S
care expenditures.
(SHORT ANSWER)
8. 8. Distinguish be- Information technology (IT) gathers, stores, analyze, and transfers data.
tween information Health informatics uses IT but goes a step beyond by emphasizing the im-
, HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
technology (IT) and provement of health care and focusing on efficiency, accuracy, and reliability
health informatics. of health care delivery.
(SHORT ANSWER)
9. 9. What is Medicare Medicare Part B is the Supplementary Medical Insurance. It is completely
Part B? Discuss voluntary. Premium cost sharing between the government and the benefi-
the financing and ciary. Premiums are income based and are subsidized by the government
cost-sharing fea- out of general taxes.
tures of Medicare The benefits covered under Medicare Part B are various out-patient services,
Part B. Which main ED services, transplants, preventative services and wellness exams. It does
benefits are covered not cover routine dental care, hearing aids, cosmetic procedures, or services
under Part B? Which not related to treatment or injury.
services are not cov-
ered?
(SHORT ANSWER)
10. 10. Briefly describe Medicare Advantage plans, also known as Part C, are insurance plans offered
the Medicare Advan- by private companies as an alternative to Original Medicare. If you have
tage program. Medicare Part A and Part B you can choose to assign your Medicare benefits
(SHORT ANSWER) to a private company who will coordinate your healthcare with Medicare
Advantage plan. Medicare Advantage plans must meet or exceed the ben-
efits offered under Original Medicare. There are additional benefits that
aren't covered under Original Medicare that are covered under Part C plans.
Medicare Advantage plans are overseen by CMS, the Centers for Medicare
and Medicaid Services.
11. 11. Briefly ex- - prescription drug plans (PDP): offer only drug coverage and are used
plain the prescrip- mainly by those who want to stay in original Medicare fee-for-service pro-
tion drug program gram
under Medicare Part - medicare advantage plan with drug coverage (MA-PD): available to those
D. (SHORT ANSWER) persons who are enrolled in Part C if the MCO provides prescription drug
coverage- and most do.
, HCA Healthcare Midterm Study Guide
Study online at https://quizlet.com/_feym64
12. 12. Discuss the con- A payment model that holds healthcare providers accountable for both the
cept of value-based cost and quality of care they provide making reimbursement tied to quality
payments. and cost
(SHORT ANSWER)
13. 13. What are the con- -The patient is home-bound.
ditions of eligibility - The patient is under the care of a physician who will establish a home health
for receiving home plan.
health services un- - The patient needs physical therapy, occupational therapy, speech therapy,
der Medicare? or intermittent skilled nursing care.
(SHORT ANSWER)
14. 14. Briefly explain - Staffed by specially trained nurses who receive patients' calls.
how a telephone - Access a patients medical history and view the most recent radiology and
triage system func- laboratory test results
tions. - The nurses use standardized protocols to guide them in dealing with the
(SHORT ANSWER) patients problem and consult with primary care physicians when necessary.
- If necessary, the staff can direct patients to appropriate medical services
such as an ED of a physician's office
15. 16. Define the follow- - Premium: amount that is charged by insurance company to ensure you the
ing health insurance beneficiary is protected against risk (monthly payments)
terminologies: Pre- - Deductable: what the insured must pay out of pocket before the insurance
mium, Deductible, kicks in and helps pay
Co-payment, and - Copayment: fee for seeing provider, paid each time the services are used
Co-insurance - Coinsurance: ratio of cost sharing between the insured individual and the
(SHORT ANSWER) insurance
16. 15. Discuss the glob- - shortage of physicians in certain demographics so there is maldistribution
al health workforce - the shift from acute to chronic health changed the demands due to the
challenges. different resources and skill sets chronic conditions need
(SHORT ANSWER) - migration leads to an imbalance of health care workers in different regions
