Health Care Administration Final Exam
Study Guide
Academic Medical Centers - ANS -Hospitals and other types of providers that are affiliated with
a medical school and play active roles in training new health care providers, especially
physicians, and in clinical research in collaboration with a medical school.
Access - ANS -An individual's ability to obtain medical services on a timely and financially
acceptable basis. Factors determining ease of access also include availability of health care
facilities, transportation to them, and reasonable hours of operation.
Accountable Care Organization (ACOs) - ANS -An entity--usually a hospital or a physician
group--that accepts responsibility for the medical care of a population of people. An insurer or
government payer develops some form of financial incentives to motivate the ACO to ensure
that health care cost patterns for the covered group are better than the patterns for comparable
people not in the group. First initiated by the Medicare program, various versions of the ACO
idea are being tried by a range of payers.
Accreditation - ANS -A decision made by a recognized organization that an institution
substantially meets appropriate standards.
Activities of Daily Living (ADLs) - ANS -Tasks required for a person's normal functioning.
Acute Care - ANS -Medical care of a limited duration, provided in a hospital or outpatient
setting, to treat an injury or short-term illness.
Advanced practice nurse - ANS -Registered nurse, such as a clinical nurse specialist, nurse
practitioner, nurse anesthetist, or nurse midwife, with a master's or doctoral degree
concentrating on a specific area of practice
Adverse Selection - ANS -Occurs when a population characteristic, such as age, increases
health services utilization and costs above the capitation rate.
Advocacy - ANS -Actions taken by an individual or group aiming to influence public policy,
resource allocation, and other decisions. Activities may include media campaigns, public
speaking, funding, and publishing research, conducting polls, and lobbying.
Alliance - ANS -Organizational relationship for specific purposes.
,Ambulatory Care Sensitive Conditions - ANS -Conditions for which patients are hospitalized
that could have been handled on an outpatient basis.
Appropriate Care - ANS -Care for which expected health exceed negative consequences.
Assisted Living - ANS -Services provided to individuals who need assistance with activities of
daily living.
Attending physicians - ANS -Doctors who have "privileges" to use a particular hospital for
inpatient care of their patients.
Average Daily Census - ANS -The number of people ho stay overnight in a hospital bed on a
typical day at a specific hospital.
Avoidable Mortality - ANS -A count of unnecessary deaths from diseases for which effective
public health and medical interventions are available.
Bayes theorem - ANS -A formula fro determining conditional probability (the likelihood of an
event occurring given that another event has occurred) that allows for revising existing
predictions or theories given new evidence.
Behavioral Health Services - ANS -Clinical and supportive activities intended to treat or
manage mental illnesses and/or alcohol or substance abuse (chemical dependency).
Behavioral Risk Factors - ANS -An element of personal behavior--such as unbalanced nutrition,
use of tobacco products, leading a sedentary lifestyle, or the abuse of alcohol--that leads to an
increased risk of developing one or more diseases or negative health conditions.
Benchmark - ANS -The best known value for a specific measure,from any source.
Beneficiary - ANS -Any person, either a subscriber or a dependent, eligible for service under a
health plan contract.
Benefits - ANS -Specific areas of plan coverage , such as outpatient visits, hospitalizations, or
prescription drugs, that make up the range of medical services marketed under a health plan.
Biotechnology - ANS -The use of living organisms and biological systems to develop medical
products and medical treatments. Biotechnology also is used in fields such as agriculture, new
fuel products, and plastics.
Bundled Payment - ANS -A payment arrangement whereby a provider is paid a fixed amount of
money to address a specific medical problem, often for a specific period of time. For example, a
surgeon could receive a bundled payment that covers his or her services, the cost of any
, medical assistants used, the cost of any devices required for the surgery, and perhaps the cost
of the surgical suite itself.
Capitation - ANS -A payment method in which a physician or hospital is paid a fixed amount per
patient per year, regardless of the volume or cost of services each patient requires.
Carrier - ANS -An insurer; an underwriter of risk that is engaged in providing, paying for, or
reimbursing all or part of the cost of health services under group insurance policies or
contracts,medical, or hospital services agreements, membership or subscription contracts, or
similar arrangements in exchange for premiums or other periodic charges.
Case Management - ANS -A broadly used term that could describe a range of services directed
at coordinating the care a person receives, making sure the person gets the care needed, or
making sure the person follows medical advice. Case management is performed by different
types of caregivers, ranging from physicians and nurses to community health workers, who
often focus on a patient get social services he or she needs in addition to medical services.
Case Manager - ANS -An individual who coordinates and oversees other health care workers in
finding the most effective methods of caring for specific patients and arranges for necessary
services.
Cash (monetary) Assistance Programs - ANS -Previously referred to as welfare, provide
financial support to qualifying lo-income individuals or families. These programs include
Temporary Assistance for Needy Families (TANF), Supplementary Security Income (SSI), and
Unemployment Insurance (UI).
Catastrophic Coverage - ANS -A type of insurance that pays for high-cost health care, usually
associated with injuries and chronic conditions, such as cancer and AIDS.
Census - ANS -In the United States, refers to the count of members of the national population
and their demographic characteristics undertaken by the U.S Census Bureau every 10 years; in
the health care delivery system specifically, refers to the number of patients in a hospital or
other health care institution at any one time.
Centers for Medicare & Medicaid Services (CMS) - ANS -Administers Medicare, Medicaid, and
the Children's Health Insurance Program (CHIP). Formerly called the Health Care Financing
Administration (HCFA).
Certificates of need - ANS -Approval for major new services and construction or renovation of
hospitals or related facilities, as issued by states.
Charity Care - ANS -Care given to needy patients without expectation of payment.
Study Guide
Academic Medical Centers - ANS -Hospitals and other types of providers that are affiliated with
a medical school and play active roles in training new health care providers, especially
physicians, and in clinical research in collaboration with a medical school.
Access - ANS -An individual's ability to obtain medical services on a timely and financially
acceptable basis. Factors determining ease of access also include availability of health care
facilities, transportation to them, and reasonable hours of operation.
Accountable Care Organization (ACOs) - ANS -An entity--usually a hospital or a physician
group--that accepts responsibility for the medical care of a population of people. An insurer or
government payer develops some form of financial incentives to motivate the ACO to ensure
that health care cost patterns for the covered group are better than the patterns for comparable
people not in the group. First initiated by the Medicare program, various versions of the ACO
idea are being tried by a range of payers.
Accreditation - ANS -A decision made by a recognized organization that an institution
substantially meets appropriate standards.
Activities of Daily Living (ADLs) - ANS -Tasks required for a person's normal functioning.
Acute Care - ANS -Medical care of a limited duration, provided in a hospital or outpatient
setting, to treat an injury or short-term illness.
Advanced practice nurse - ANS -Registered nurse, such as a clinical nurse specialist, nurse
practitioner, nurse anesthetist, or nurse midwife, with a master's or doctoral degree
concentrating on a specific area of practice
Adverse Selection - ANS -Occurs when a population characteristic, such as age, increases
health services utilization and costs above the capitation rate.
Advocacy - ANS -Actions taken by an individual or group aiming to influence public policy,
resource allocation, and other decisions. Activities may include media campaigns, public
speaking, funding, and publishing research, conducting polls, and lobbying.
Alliance - ANS -Organizational relationship for specific purposes.
,Ambulatory Care Sensitive Conditions - ANS -Conditions for which patients are hospitalized
that could have been handled on an outpatient basis.
Appropriate Care - ANS -Care for which expected health exceed negative consequences.
Assisted Living - ANS -Services provided to individuals who need assistance with activities of
daily living.
Attending physicians - ANS -Doctors who have "privileges" to use a particular hospital for
inpatient care of their patients.
Average Daily Census - ANS -The number of people ho stay overnight in a hospital bed on a
typical day at a specific hospital.
Avoidable Mortality - ANS -A count of unnecessary deaths from diseases for which effective
public health and medical interventions are available.
Bayes theorem - ANS -A formula fro determining conditional probability (the likelihood of an
event occurring given that another event has occurred) that allows for revising existing
predictions or theories given new evidence.
Behavioral Health Services - ANS -Clinical and supportive activities intended to treat or
manage mental illnesses and/or alcohol or substance abuse (chemical dependency).
Behavioral Risk Factors - ANS -An element of personal behavior--such as unbalanced nutrition,
use of tobacco products, leading a sedentary lifestyle, or the abuse of alcohol--that leads to an
increased risk of developing one or more diseases or negative health conditions.
Benchmark - ANS -The best known value for a specific measure,from any source.
Beneficiary - ANS -Any person, either a subscriber or a dependent, eligible for service under a
health plan contract.
Benefits - ANS -Specific areas of plan coverage , such as outpatient visits, hospitalizations, or
prescription drugs, that make up the range of medical services marketed under a health plan.
Biotechnology - ANS -The use of living organisms and biological systems to develop medical
products and medical treatments. Biotechnology also is used in fields such as agriculture, new
fuel products, and plastics.
Bundled Payment - ANS -A payment arrangement whereby a provider is paid a fixed amount of
money to address a specific medical problem, often for a specific period of time. For example, a
surgeon could receive a bundled payment that covers his or her services, the cost of any
, medical assistants used, the cost of any devices required for the surgery, and perhaps the cost
of the surgical suite itself.
Capitation - ANS -A payment method in which a physician or hospital is paid a fixed amount per
patient per year, regardless of the volume or cost of services each patient requires.
Carrier - ANS -An insurer; an underwriter of risk that is engaged in providing, paying for, or
reimbursing all or part of the cost of health services under group insurance policies or
contracts,medical, or hospital services agreements, membership or subscription contracts, or
similar arrangements in exchange for premiums or other periodic charges.
Case Management - ANS -A broadly used term that could describe a range of services directed
at coordinating the care a person receives, making sure the person gets the care needed, or
making sure the person follows medical advice. Case management is performed by different
types of caregivers, ranging from physicians and nurses to community health workers, who
often focus on a patient get social services he or she needs in addition to medical services.
Case Manager - ANS -An individual who coordinates and oversees other health care workers in
finding the most effective methods of caring for specific patients and arranges for necessary
services.
Cash (monetary) Assistance Programs - ANS -Previously referred to as welfare, provide
financial support to qualifying lo-income individuals or families. These programs include
Temporary Assistance for Needy Families (TANF), Supplementary Security Income (SSI), and
Unemployment Insurance (UI).
Catastrophic Coverage - ANS -A type of insurance that pays for high-cost health care, usually
associated with injuries and chronic conditions, such as cancer and AIDS.
Census - ANS -In the United States, refers to the count of members of the national population
and their demographic characteristics undertaken by the U.S Census Bureau every 10 years; in
the health care delivery system specifically, refers to the number of patients in a hospital or
other health care institution at any one time.
Centers for Medicare & Medicaid Services (CMS) - ANS -Administers Medicare, Medicaid, and
the Children's Health Insurance Program (CHIP). Formerly called the Health Care Financing
Administration (HCFA).
Certificates of need - ANS -Approval for major new services and construction or renovation of
hospitals or related facilities, as issued by states.
Charity Care - ANS -Care given to needy patients without expectation of payment.
