WGUC425 Healthcare Delivery, Regulation, and Compliance Exam
Questions and Answers with Verified Solutions | Latest 2026 Update
Q: Capitation A
Answer:
covers all services an enrollee may need during an entire year
Q: Market Justice
Answer:
most equitably distributed through the market forces of supply and demand, rather
than government interventions. Distributed on the basis of willingness and ability
to pay
Q: Social Justice
Answer:
An ideal that embraces all aspects of civilized life and that is linked to fundamental
notions of fairness and to cultural beliefs about right and wrong.
Q: defensive medicine
Answer:
Ordering more tests and procedures than are necessary in order to protect
physicians from a lawsuit.
Q: medical model
Answer:
emphasizes clinical diagnosis and medical intervention in the treatment of diseases
or symptoms. Health is defined as lack of illness
Q: National Health Insurance
Answer:
course of care delivered by providers (Canada)
Q: National Health System
Answer:
Great Britain taxes support the system, but government also manages the
infrastructure for healthcare delivery
,Q: Socialized Health Insurance
Answer:
government mandated contributions by employers and employees finance health
care (Germany)
Q: Acute Care
Answer:
relatively severe, short duration, often treatable. Ex. stroke
Q: Chronic Care
Answer:
continuing for a long time
Q: Planned Rationing
Answer:
The government making deliberate attempts to limit the supply of health care
services
Q: Medicare
Answer:
Benefit period = 60 days after admitted Pt B: cover physicians bill, small
premiums for elderly Premiums are income based
Part D: Prescription Drug coverage Voluntary, w monthly premium
1973- expanded to non elderly disabled, end stage renal disease patients. Financed
by pay roll taxes
Q: American Medical Association
Answer:
protect the interests of physicians, organized medicine. Supported licensing
discouraged employment by hospitals and insurance companies
Q: Globalization
Answer:
various forms of cross border economic activities
Q: Medicaid
, Answer:
Eligible poor, financed through federal matching funds to the states
Each state has its own criteria for eligibility based on income, bank account,
property and assets
Federal law covers: low income elderly, blind, disabled, children in low income
families. Means tested program
Q: provider-induced demand
Answer:
Artificial creation of demand by providers that enables them to deliver unneeded
services to boost their incomes.
Q: Deductible
Answer:
Amount you must pay before you begin receiving any benefits from your insurance
company
Q: Centers for Medicare and Medicaid Services (CMS)
Answer:
provide clarification and interpretation of complex provisions of the law. Promotes
consistency in
interpretation between states
Q: individual private insurance
Answer:
price based on how risky your life is
Q: fee-for-service
Answer:
get paid per individual service
Q: prospective reimbursement
Answer:
pre-established criteria to determine the amount of reimbursement
Q: Group Insurance
Questions and Answers with Verified Solutions | Latest 2026 Update
Q: Capitation A
Answer:
covers all services an enrollee may need during an entire year
Q: Market Justice
Answer:
most equitably distributed through the market forces of supply and demand, rather
than government interventions. Distributed on the basis of willingness and ability
to pay
Q: Social Justice
Answer:
An ideal that embraces all aspects of civilized life and that is linked to fundamental
notions of fairness and to cultural beliefs about right and wrong.
Q: defensive medicine
Answer:
Ordering more tests and procedures than are necessary in order to protect
physicians from a lawsuit.
Q: medical model
Answer:
emphasizes clinical diagnosis and medical intervention in the treatment of diseases
or symptoms. Health is defined as lack of illness
Q: National Health Insurance
Answer:
course of care delivered by providers (Canada)
Q: National Health System
Answer:
Great Britain taxes support the system, but government also manages the
infrastructure for healthcare delivery
,Q: Socialized Health Insurance
Answer:
government mandated contributions by employers and employees finance health
care (Germany)
Q: Acute Care
Answer:
relatively severe, short duration, often treatable. Ex. stroke
Q: Chronic Care
Answer:
continuing for a long time
Q: Planned Rationing
Answer:
The government making deliberate attempts to limit the supply of health care
services
Q: Medicare
Answer:
Benefit period = 60 days after admitted Pt B: cover physicians bill, small
premiums for elderly Premiums are income based
Part D: Prescription Drug coverage Voluntary, w monthly premium
1973- expanded to non elderly disabled, end stage renal disease patients. Financed
by pay roll taxes
Q: American Medical Association
Answer:
protect the interests of physicians, organized medicine. Supported licensing
discouraged employment by hospitals and insurance companies
Q: Globalization
Answer:
various forms of cross border economic activities
Q: Medicaid
, Answer:
Eligible poor, financed through federal matching funds to the states
Each state has its own criteria for eligibility based on income, bank account,
property and assets
Federal law covers: low income elderly, blind, disabled, children in low income
families. Means tested program
Q: provider-induced demand
Answer:
Artificial creation of demand by providers that enables them to deliver unneeded
services to boost their incomes.
Q: Deductible
Answer:
Amount you must pay before you begin receiving any benefits from your insurance
company
Q: Centers for Medicare and Medicaid Services (CMS)
Answer:
provide clarification and interpretation of complex provisions of the law. Promotes
consistency in
interpretation between states
Q: individual private insurance
Answer:
price based on how risky your life is
Q: fee-for-service
Answer:
get paid per individual service
Q: prospective reimbursement
Answer:
pre-established criteria to determine the amount of reimbursement
Q: Group Insurance
