HCD 303 Final Exam UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
System - CORRECT ANSWER a set of connected things or parts forming a complex whole
Quality - CORRECT ANSWER how good or bad something is
Access - CORRECT ANSWER a person's ability to get care or coverage
Cost - CORRECT ANSWER cost
Universal Coverage - CORRECT ANSWER all residents have coverage
Social Solidarity - CORRECT ANSWER the principle that governments have an obligation to
ensure that every citizen has access to all social services including healthcare
Subsidiarity - CORRECT ANSWER the principle belief that matter of government
responsibility should be handled at the lowest level of government that makes operational sense
General Reciprocity - CORRECT ANSWER the principle belief in giving to something
knowing that you may not get an immediate returned benefititifif
Centralized - CORRECT ANSWER Organized at the federal level
Decentralized - CORRECT ANSWER Organized at the regional or state level
Public Health Services/Insurance - CORRECT ANSWER public, government run
Private Health Services/Insurance - CORRECT ANSWER private, privately run
Only those who make over ~$70,000/year qualify
,The premium is set by your performance on an individual health assessment
Copayment - CORRECT ANSWER The set dollar amount that you must pay at the point of
service
Coinsurance - CORRECT ANSWER The set percentage of the bill that must be paid at the
point of service
Deductible - CORRECT ANSWER The amount that must be paid out-of-pocket annually,
before insurance coverage kicks in
Sickness Funds - CORRECT ANSWER ~130 sickness funds today (although this number is
continually dropping)
Covers ~ 86% of the country's population
Membership is mandatory
Must pay a legally mandated premium of 14.6% of their income (through payroll deduction)
Split between employer and employee
Percent of premium is determined by income
~11% of the population opts out of the SHI and opts for Private Health Insurance (PHI)
Percent of premium is determined by health assessment and is risk-adjusted
Safety Net - CORRECT ANSWER Children under 18 years of age exempt from all cost-
sharing
Adults:
Annual cap equal to 2% of household income
Annual cap lowered to 1% of household income for qualifying chronically ill people
Unemployed contribute to SHI in proportion to their unemployment entitlements; For long term
unemployed government contributes on their behalf
Cost Sharing - CORRECT ANSWER Cost Sharing (all USD):
Outpatient Prescriptions: $6.40 - $12.70
Inpatient Stay: $10.00/day (first 28 days/yr)
,Rehabilitation Stay: $10.00/day (first 28 days/yr)
Deductibles: vary by sickness fund plan
Preventative services do not count towards deductible
Subsidy - CORRECT ANSWER government assistance
Health Financing - CORRECT ANSWER it is the function of a system concerned with the
mobilization, accumulation, and allocation of money to cover the health needs of the people,
individually and collectively, in the health system
Health Spending as % of GDP - CORRECT ANSWER The percent of money spent on
healthcare every year, in relation to the total amount spent throughout all industries in the same year
Fee-for-service (FFS) - CORRECT ANSWER A payment model where all healthcare services,
products, and prescription medications are unbundled and paid for separately.
incentive: Overtreatment, Provide more services, testing, and treatments that are billable through an
ICD-code.
Per Diem - CORRECT ANSWER payment model that reimburses organizations and/or
providers based upon the number of days treatment was given
Pay-for-performance - CORRECT ANSWER A payment model that reimburses healthcare
organizations and physicians who achieve, improve, or exceed their performance on specified quality
and cost measures, as well as other benchmarks.
incentive: Measure of performance metrics, Incentives can be financial or non-financial, Adherence to
process
Salary - CORRECT ANSWER Physicians are paid a predetermined salary based upon their
level of expertise and experience.
, incentive: No incentive for overtreatment, Provide the best treatment, regardless of ICD-code to the
patient, There is also no direct incentive to work hard.
Bundled payments (DRG, EDGR, Reference Pricing) - CORRECT ANSWER 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 penalty
DRG Incentive - Reduce length of stay, Discharge appropriately, Keep costs to a minimum
EDRG - 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
If patient chooses higher cost medical centers, patient pays the difference between reference price and
medical center price
Capitation - CORRECT ANSWER A prospective payment model where the hospital or
provider is paid a contracted rate per-member-per-month, regardless of the number of services
provided.
Rates are typically (but not always) risk-adjusted
Incentive: Keep the patient healthy and living their daily lives in their own home, keep patient out of
the hospital/clinic, freedom to provide non-traditional healthcare services
Components of a healthcare system - CORRECT ANSWER people, parts, inter-relationships,
and culture
US rankings in:
1. WHO report
QUESTIONS AND CORRECT ANSWERS
System - CORRECT ANSWER a set of connected things or parts forming a complex whole
Quality - CORRECT ANSWER how good or bad something is
Access - CORRECT ANSWER a person's ability to get care or coverage
Cost - CORRECT ANSWER cost
Universal Coverage - CORRECT ANSWER all residents have coverage
Social Solidarity - CORRECT ANSWER the principle that governments have an obligation to
ensure that every citizen has access to all social services including healthcare
Subsidiarity - CORRECT ANSWER the principle belief that matter of government
responsibility should be handled at the lowest level of government that makes operational sense
General Reciprocity - CORRECT ANSWER the principle belief in giving to something
knowing that you may not get an immediate returned benefititifif
Centralized - CORRECT ANSWER Organized at the federal level
Decentralized - CORRECT ANSWER Organized at the regional or state level
Public Health Services/Insurance - CORRECT ANSWER public, government run
Private Health Services/Insurance - CORRECT ANSWER private, privately run
Only those who make over ~$70,000/year qualify
,The premium is set by your performance on an individual health assessment
Copayment - CORRECT ANSWER The set dollar amount that you must pay at the point of
service
Coinsurance - CORRECT ANSWER The set percentage of the bill that must be paid at the
point of service
Deductible - CORRECT ANSWER The amount that must be paid out-of-pocket annually,
before insurance coverage kicks in
Sickness Funds - CORRECT ANSWER ~130 sickness funds today (although this number is
continually dropping)
Covers ~ 86% of the country's population
Membership is mandatory
Must pay a legally mandated premium of 14.6% of their income (through payroll deduction)
Split between employer and employee
Percent of premium is determined by income
~11% of the population opts out of the SHI and opts for Private Health Insurance (PHI)
Percent of premium is determined by health assessment and is risk-adjusted
Safety Net - CORRECT ANSWER Children under 18 years of age exempt from all cost-
sharing
Adults:
Annual cap equal to 2% of household income
Annual cap lowered to 1% of household income for qualifying chronically ill people
Unemployed contribute to SHI in proportion to their unemployment entitlements; For long term
unemployed government contributes on their behalf
Cost Sharing - CORRECT ANSWER Cost Sharing (all USD):
Outpatient Prescriptions: $6.40 - $12.70
Inpatient Stay: $10.00/day (first 28 days/yr)
,Rehabilitation Stay: $10.00/day (first 28 days/yr)
Deductibles: vary by sickness fund plan
Preventative services do not count towards deductible
Subsidy - CORRECT ANSWER government assistance
Health Financing - CORRECT ANSWER it is the function of a system concerned with the
mobilization, accumulation, and allocation of money to cover the health needs of the people,
individually and collectively, in the health system
Health Spending as % of GDP - CORRECT ANSWER The percent of money spent on
healthcare every year, in relation to the total amount spent throughout all industries in the same year
Fee-for-service (FFS) - CORRECT ANSWER A payment model where all healthcare services,
products, and prescription medications are unbundled and paid for separately.
incentive: Overtreatment, Provide more services, testing, and treatments that are billable through an
ICD-code.
Per Diem - CORRECT ANSWER payment model that reimburses organizations and/or
providers based upon the number of days treatment was given
Pay-for-performance - CORRECT ANSWER A payment model that reimburses healthcare
organizations and physicians who achieve, improve, or exceed their performance on specified quality
and cost measures, as well as other benchmarks.
incentive: Measure of performance metrics, Incentives can be financial or non-financial, Adherence to
process
Salary - CORRECT ANSWER Physicians are paid a predetermined salary based upon their
level of expertise and experience.
, incentive: No incentive for overtreatment, Provide the best treatment, regardless of ICD-code to the
patient, There is also no direct incentive to work hard.
Bundled payments (DRG, EDGR, Reference Pricing) - CORRECT ANSWER 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 penalty
DRG Incentive - Reduce length of stay, Discharge appropriately, Keep costs to a minimum
EDRG - 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
If patient chooses higher cost medical centers, patient pays the difference between reference price and
medical center price
Capitation - CORRECT ANSWER A prospective payment model where the hospital or
provider is paid a contracted rate per-member-per-month, regardless of the number of services
provided.
Rates are typically (but not always) risk-adjusted
Incentive: Keep the patient healthy and living their daily lives in their own home, keep patient out of
the hospital/clinic, freedom to provide non-traditional healthcare services
Components of a healthcare system - CORRECT ANSWER people, parts, inter-relationships,
and culture
US rankings in:
1. WHO report
