HCD Final Exam Study Guide Questions With Complete
Solutions
_______________% of insured individuals in India have private
coverage.
A) 16
B) 26
C) 36
D) 46 Correct Answers C) 36
4 models of healthcare Correct Answers beveridge- socialized
medicine
Medical and hospital services that are provided by a government
and paid for by taxes
EX: United Kingdom, Spain, Scandinavia, Hong Kong, New
Zealand, Cuba
bismark- Medical and hospital services are provided through
both private and public services and paid for through sickness
funds
EX: Germany, Belgium, Switzerland, France, Japan, and
Primarily everywhere in Latin America except for Cuba.
national health insurance- national health insurance model
Medical and healthcare services are provided through both
public and private entities and paid for by a single government
insurance plan
EX: Canada, Taiwan, South Korea
,out of pocket- medical and healthcare services are provided
through both public and private entities and paid for by the
individual receiving services
EX: South America, Africa, China, India
In the United States: We have elements of all 4 models working
in our healthcare system
Beveridge model- Veterans Affairs/Tricare
National health insurance model- medicare
Bismarck model- Average worker
Out-of-pocket model- ~10% with no access to health insurance
62.5% of all general practitioners (GPs) working for the NHS
are on nationally negotiated general medical services contracts.
Which payment models are used within these contracts to
reimburse these GPs? (Select all that apply).
A) Per diem
B) Performance-based payments
C) Capitation
D) Diagnosis related groups (DRGs)
E) Enhanced services Correct Answers B) Performance-based
payments
C) Capitation
E) Enhanced services
Access Correct Answers a person's ability to get care or
coverage
,Ambulatory physicians are required to be members of their
Regional Association of Statutory Health Insurance Physicians
in order to be reimbursed for their services.
True or False Correct Answers True
At what level are reimbursement payment amounts set in
Germany?
A) Federal because the system in Germany is centralized
B) Federal because the system in Germany is decentralized
C) Regional because the system in Germany is centralized
D) Regional because the system in Germany is decentralized
Correct Answers D) Regional because the system in Germany is
decentralized
Beven Correct Answers Minister of Health (1945 - 1951)
Shared in Beveridge's vision
Official founder of the NHS when it was passed into law in July,
1948. Had to make many compromises, especially w/ specialists
Beveridge Correct Answers Civil servant, educator
Worked in London's lower east side - before, during & after
WWII
1942: wrote & released The Beveridge Report
Official Name: Social Insurance & Allied Health Services
Government report
Laid out the entire plan on how to develop & implement a fully
federally-run healthcare system
, Bismarck Correct Answers Otto von Bismarck: Germany's 1st
Chancellor (1871)
Hundreds of "sickness funds" already in operation throughout
Germany
Bismarck saw working class movement at that time as a threat
(labor unions were gaining strength)
In attempt to quell social unrest among workers and to control
growing strength of labor unions Bismarck proposed a national
social insurance system
1883: Sickness Insurance Act Passed 1st social insurance
program organized at a national level
Organization & operation the sickness funds remained at the
union level
Remained primary structure of the system until WWII.
Bundled payments (DRG, EDGR) Correct Answers DRG - A
prospective payment model in which hospitals are reimbursed
with a fixed fee regardless of the actual costs. Includes hospital
expenses only. ACA required 30-day readmission penaltyDRG
Incentive - Reduce length of stay, Discharge appropriately, Keep
costs to a minimumEDRG - An EDRG is another form of a
bundled payment.The bundled payment = hospital + all
physician payments + longer period of time (e.g. 6 - 12 months
after hospitalization).The EDRG acts as a forcing function -
encouraging physician and hospital collaboration on improving
both patient outcomes and cost.
Reference Pricing - Reference Price = the payment amount now
going to medical centers with high quality and low cost
Medical centers can charge more than reference price
Patients told which medical centers charge more than reference
price
Solutions
_______________% of insured individuals in India have private
coverage.
A) 16
B) 26
C) 36
D) 46 Correct Answers C) 36
4 models of healthcare Correct Answers beveridge- socialized
medicine
Medical and hospital services that are provided by a government
and paid for by taxes
EX: United Kingdom, Spain, Scandinavia, Hong Kong, New
Zealand, Cuba
bismark- Medical and hospital services are provided through
both private and public services and paid for through sickness
funds
EX: Germany, Belgium, Switzerland, France, Japan, and
Primarily everywhere in Latin America except for Cuba.
national health insurance- national health insurance model
Medical and healthcare services are provided through both
public and private entities and paid for by a single government
insurance plan
EX: Canada, Taiwan, South Korea
,out of pocket- medical and healthcare services are provided
through both public and private entities and paid for by the
individual receiving services
EX: South America, Africa, China, India
In the United States: We have elements of all 4 models working
in our healthcare system
Beveridge model- Veterans Affairs/Tricare
National health insurance model- medicare
Bismarck model- Average worker
Out-of-pocket model- ~10% with no access to health insurance
62.5% of all general practitioners (GPs) working for the NHS
are on nationally negotiated general medical services contracts.
Which payment models are used within these contracts to
reimburse these GPs? (Select all that apply).
A) Per diem
B) Performance-based payments
C) Capitation
D) Diagnosis related groups (DRGs)
E) Enhanced services Correct Answers B) Performance-based
payments
C) Capitation
E) Enhanced services
Access Correct Answers a person's ability to get care or
coverage
,Ambulatory physicians are required to be members of their
Regional Association of Statutory Health Insurance Physicians
in order to be reimbursed for their services.
True or False Correct Answers True
At what level are reimbursement payment amounts set in
Germany?
A) Federal because the system in Germany is centralized
B) Federal because the system in Germany is decentralized
C) Regional because the system in Germany is centralized
D) Regional because the system in Germany is decentralized
Correct Answers D) Regional because the system in Germany is
decentralized
Beven Correct Answers Minister of Health (1945 - 1951)
Shared in Beveridge's vision
Official founder of the NHS when it was passed into law in July,
1948. Had to make many compromises, especially w/ specialists
Beveridge Correct Answers Civil servant, educator
Worked in London's lower east side - before, during & after
WWII
1942: wrote & released The Beveridge Report
Official Name: Social Insurance & Allied Health Services
Government report
Laid out the entire plan on how to develop & implement a fully
federally-run healthcare system
, Bismarck Correct Answers Otto von Bismarck: Germany's 1st
Chancellor (1871)
Hundreds of "sickness funds" already in operation throughout
Germany
Bismarck saw working class movement at that time as a threat
(labor unions were gaining strength)
In attempt to quell social unrest among workers and to control
growing strength of labor unions Bismarck proposed a national
social insurance system
1883: Sickness Insurance Act Passed 1st social insurance
program organized at a national level
Organization & operation the sickness funds remained at the
union level
Remained primary structure of the system until WWII.
Bundled payments (DRG, EDGR) Correct Answers DRG - A
prospective payment model in which hospitals are reimbursed
with a fixed fee regardless of the actual costs. Includes hospital
expenses only. ACA required 30-day readmission penaltyDRG
Incentive - Reduce length of stay, Discharge appropriately, Keep
costs to a minimumEDRG - An EDRG is another form of a
bundled payment.The bundled payment = hospital + all
physician payments + longer period of time (e.g. 6 - 12 months
after hospitalization).The EDRG acts as a forcing function -
encouraging physician and hospital collaboration on improving
both patient outcomes and cost.
Reference Pricing - Reference Price = the payment amount now
going to medical centers with high quality and low cost
Medical centers can charge more than reference price
Patients told which medical centers charge more than reference
price
