CHAPTER 2 THE HEALTH CARE
DELIVERY SYSTEM QUESTIONS &
VALID CORRECT ANSWERS
The federal government, the biggest consumer of health care, which paid for Medicare
and Medicaid, created __________________to review the quality, quantity, and cost of
hospital care - CORRECT ANSWER professional standards review organizations
(PSROs)
Medicare-qualified hospitals had physician-supervised_________________to review
the admissions and to identify and eliminate overuse of diagnostic and treatment
services ordered by physicians caring for patients on Medicare. - CORRECT ANSWER
utilization review (UR) committees
One of the most significant factors that influenced payment for health care was the
__________________. Established by Congress in 1983, the PPS eliminated cost-
based reimbursement. Hospitals serving patients who received Medicare benefits were
no longer able to charge whatever a patient's care cost. - CORRECT ANSWER
prospective payment system (PPS)
Instead, the PPS grouped inpatient hospital services for Medicare patients
into__________________. Each group has a fixed reimbursement amount with
adjustments based on case severity, rural/urban/regional costs, and teaching costs.
Hospitals receive a set dollar amount for each patient based on the assigned DRG,
regardless of the patient's length of stay or use of services.
Many use ________ in the rehabilitation setting. - CORRECT ANSWER diagnosis-
related groups (DRGs)
__________________ means that the providers receive a fixed amount per patient or
enrollee of a health care plan.
__________________ aims to build a payment plan for select diagnoses or surgical
procedures that consists of the best standards of care at the lowest cost. - CORRECT
ANSWER Capitation
use ______________ in long-term care.
When patients are hospitalized for lengthy periods, hospitals have to absorb the portion
of costs that are not reimbursed. This simply adds more pressure to ensure that patients
are managed effectively and discharged as soon as is reasonably possible. -
CORRECT ANSWER resource utilization groups (RUGs)
,*describes health care systems in which the provider or health care system receives a
predetermined capitated payment for each patient enrolled in the program.
*The focus of care of the organization shifts from individual illness care to prevention,
early intervention, and outpatient care.
*If people stay healthy, the cost of medical care declines.
*focus on containing or reducing costs, increasing patient satisfaction, and improving
the health or functional status of individuals - CORRECT ANSWER Managed care
The MCO contracts with physicians who usually are not members of groups and whose
practices include fee-for-service and capitated patients. - CORRECT ANSWER
Independent practice association (IPA)
*Larger health care systems have _____________ that include a set of providers and
services organized to deliver a continuum of care to a population of patients at a
capitated cost in a particular setting.
*Reduces duplication of services across levels or settings of care to ensure that patients
receive care in the most appropriate settings. - CORRECT ANSWER integrated
delivery networks (IDNs)
• Prenatal and well-baby care
• Nutrition counseling
• Family planning
• Exercise classes - CORRECT ANSWER Primary Care
• Adult screenings for blood pressure, cholesterol, tobacco use, and cancer
• Pediatric screenings for hearing, vision, autism, and developmental disorders
• HIV screening for adults at higher risk
• Wellness visits
• Immunizations
• Diet counseling
• Mental health counseling and crisis prevention
• Community legislation (seat belts, car seats for children, bike helmets) - CORRECT
ANSWER Preventive Care
• Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
• Patient-centered medical home - CORRECT ANSWER . Primary Care (Health
Promotion)
• Urgent care; hospital emergency care
• Acute medical-surgical care: ambulatory care, outpatient surgery, hospital
• Radiological procedures
, Emergency care
• Acute medical-surgical care
• Radiological procedures for acute problems (e.g., x-rays, CT scans) - CORRECT
ANSWER Secondary Acute Care
• Highly specialized: intensive care, inpatient psychiatric facilities
• Specialty care (such as neurology, cardiology, rheumatology, dermatology, oncology)
Intensive care
• Subacute care - CORRECT ANSWER Tertiary Care
• Rehabilitation programs (such as cardiovascular, pulmonary, orthopedic)
• Sports medicine
• Spinal cord injury programs
• Home care
• Cardiovascular and pulmonary rehabilitation
• Sports medicine
• Spinal cord injury programs
• Home care - CORRECT ANSWER Restorative Care
Continuing Care
• Long-term care: assisted living, nursing centers
• Psychiatric and older-adult day care
• Assisted living
• Psychiatric and older adult day care - CORRECT ANSWER Continuing Care
*____________________focuses on improved health outcomes for an entire
population.
* It includes primary care and health education, proper nutrition, maternal/child health
care, family planning, immunizations, and control of diseases.
*Health promotion programs lower the overall costs of health care by reducing the
incidence of disease, minimizing complications, and thus reducing the need to use more
expensive health care resources. - CORRECT ANSWER Primary health care
*In______________________the diagnosis and treatment of illnesses are traditionally
the most common services.
*The acutely and chronically ill represent about 20% of the people in the United States,
who consume about 80% of health care spending.
*Over 80% of adults 65 years of age have at least one chronic health condition that
causes multiple health problems - CORRECT ANSWER Secondary and Tertiary Care
To contain costs, many hospitals have redesigned nursing units. Because
of____________ more services are available on nursing units, thus minimizing the need
to transfer and transport patients across multiple diagnostic and treatment areas. -
CORRECT ANSWER work redesign
DELIVERY SYSTEM QUESTIONS &
VALID CORRECT ANSWERS
The federal government, the biggest consumer of health care, which paid for Medicare
and Medicaid, created __________________to review the quality, quantity, and cost of
hospital care - CORRECT ANSWER professional standards review organizations
(PSROs)
Medicare-qualified hospitals had physician-supervised_________________to review
the admissions and to identify and eliminate overuse of diagnostic and treatment
services ordered by physicians caring for patients on Medicare. - CORRECT ANSWER
utilization review (UR) committees
One of the most significant factors that influenced payment for health care was the
__________________. Established by Congress in 1983, the PPS eliminated cost-
based reimbursement. Hospitals serving patients who received Medicare benefits were
no longer able to charge whatever a patient's care cost. - CORRECT ANSWER
prospective payment system (PPS)
Instead, the PPS grouped inpatient hospital services for Medicare patients
into__________________. Each group has a fixed reimbursement amount with
adjustments based on case severity, rural/urban/regional costs, and teaching costs.
Hospitals receive a set dollar amount for each patient based on the assigned DRG,
regardless of the patient's length of stay or use of services.
Many use ________ in the rehabilitation setting. - CORRECT ANSWER diagnosis-
related groups (DRGs)
__________________ means that the providers receive a fixed amount per patient or
enrollee of a health care plan.
__________________ aims to build a payment plan for select diagnoses or surgical
procedures that consists of the best standards of care at the lowest cost. - CORRECT
ANSWER Capitation
use ______________ in long-term care.
When patients are hospitalized for lengthy periods, hospitals have to absorb the portion
of costs that are not reimbursed. This simply adds more pressure to ensure that patients
are managed effectively and discharged as soon as is reasonably possible. -
CORRECT ANSWER resource utilization groups (RUGs)
,*describes health care systems in which the provider or health care system receives a
predetermined capitated payment for each patient enrolled in the program.
*The focus of care of the organization shifts from individual illness care to prevention,
early intervention, and outpatient care.
*If people stay healthy, the cost of medical care declines.
*focus on containing or reducing costs, increasing patient satisfaction, and improving
the health or functional status of individuals - CORRECT ANSWER Managed care
The MCO contracts with physicians who usually are not members of groups and whose
practices include fee-for-service and capitated patients. - CORRECT ANSWER
Independent practice association (IPA)
*Larger health care systems have _____________ that include a set of providers and
services organized to deliver a continuum of care to a population of patients at a
capitated cost in a particular setting.
*Reduces duplication of services across levels or settings of care to ensure that patients
receive care in the most appropriate settings. - CORRECT ANSWER integrated
delivery networks (IDNs)
• Prenatal and well-baby care
• Nutrition counseling
• Family planning
• Exercise classes - CORRECT ANSWER Primary Care
• Adult screenings for blood pressure, cholesterol, tobacco use, and cancer
• Pediatric screenings for hearing, vision, autism, and developmental disorders
• HIV screening for adults at higher risk
• Wellness visits
• Immunizations
• Diet counseling
• Mental health counseling and crisis prevention
• Community legislation (seat belts, car seats for children, bike helmets) - CORRECT
ANSWER Preventive Care
• Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
• Patient-centered medical home - CORRECT ANSWER . Primary Care (Health
Promotion)
• Urgent care; hospital emergency care
• Acute medical-surgical care: ambulatory care, outpatient surgery, hospital
• Radiological procedures
, Emergency care
• Acute medical-surgical care
• Radiological procedures for acute problems (e.g., x-rays, CT scans) - CORRECT
ANSWER Secondary Acute Care
• Highly specialized: intensive care, inpatient psychiatric facilities
• Specialty care (such as neurology, cardiology, rheumatology, dermatology, oncology)
Intensive care
• Subacute care - CORRECT ANSWER Tertiary Care
• Rehabilitation programs (such as cardiovascular, pulmonary, orthopedic)
• Sports medicine
• Spinal cord injury programs
• Home care
• Cardiovascular and pulmonary rehabilitation
• Sports medicine
• Spinal cord injury programs
• Home care - CORRECT ANSWER Restorative Care
Continuing Care
• Long-term care: assisted living, nursing centers
• Psychiatric and older-adult day care
• Assisted living
• Psychiatric and older adult day care - CORRECT ANSWER Continuing Care
*____________________focuses on improved health outcomes for an entire
population.
* It includes primary care and health education, proper nutrition, maternal/child health
care, family planning, immunizations, and control of diseases.
*Health promotion programs lower the overall costs of health care by reducing the
incidence of disease, minimizing complications, and thus reducing the need to use more
expensive health care resources. - CORRECT ANSWER Primary health care
*In______________________the diagnosis and treatment of illnesses are traditionally
the most common services.
*The acutely and chronically ill represent about 20% of the people in the United States,
who consume about 80% of health care spending.
*Over 80% of adults 65 years of age have at least one chronic health condition that
causes multiple health problems - CORRECT ANSWER Secondary and Tertiary Care
To contain costs, many hospitals have redesigned nursing units. Because
of____________ more services are available on nursing units, thus minimizing the need
to transfer and transport patients across multiple diagnostic and treatment areas. -
CORRECT ANSWER work redesign
