U.S. Health Care Systems UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Access - CORRECT ANSWER - The ability of persons needing health services to obtain
appropriate care in a timely manner. Can you get medical care when you need it? If yes, you
have access to medical care. Access is not the same as health insurance coverage, although
insurance coverage is a strong predictor of access for primary care services.
Capitation - CORRECT ANSWER - A reimbursement mechanism under which the
provider is paid a set monthly fee per enrollee (sometimes referred to as per member per month
or PMPM rate), regardless of whether or not an enrollee sees the provider and regardless of how
often an enrollee sees the provider.
Enrollee - CORRECT ANSWER - A person enrolled in a health plan, especially in a
managed care plan.
Integrated delivery system (IDS) - CORRECT ANSWER - A network of organizations
that provides or arranges to provide a coordinated continuum of services to a defined population
and is willing to be held clinically and fiscally accountable for the outcomes and health status of
the population serviced.
Item-based pricing - CORRECT ANSWER - Refers to the costs of ancillary services that
often accompany major procedures such as surgery. Package pricing: Bundling of fees for an
entire package of related services.
Long-term care - CORRECT ANSWER - A variety of individualized, well-coordinated
services that are designed to promote the maximum possible independence for people with
functional limitations. These services are provided over an extended period to meet the patients'
physical, mental, social, and spiritual needs, while maximizing quality of life.
,Managed care - CORRECT ANSWER - A system that integrates the functions of
financing, insurance, delivery, and payment and uses mechanisms to control costs and utilization
of services.
Market justice - CORRECT ANSWER - A distributional principle according to which
health care is most equitably distributed through the market forces of supply and demand, rather
than government interventions. See social justice.
Medicaid - CORRECT ANSWER - A joint federal-state program of health insurance for
the poor.
Medicare - CORRECT ANSWER - A federal program of health insurance for the elderly,
certain disabled individuals, and people with end-stage renal disease.
Need - CORRECT ANSWER - The amount of medical care that medical experts believe a
person should have to remain or become healthy.
Social justic - CORRECT ANSWER - A distribution principle, according to which health
care is most equitably distributed by a government-run national health care program. See market
justice.
Socialized medicine - CORRECT ANSWER - Any large-scale government-sponsored
expansion of health insurance or intrusion in the private practice of medicine.
Children's Health Insurance Program (CHIP) - CORRECT ANSWER - Provide low-
income family with children with health insurance coverage that covers access to health care
services.
TRICARE - CORRECT ANSWER - A program that is financed by the military. This
insurance plan permits the beneficiaries to receive care from both private and military medical
care facilities.
,Veterans Integrated Service Networks (VISNs) - CORRECT ANSWER - Responsible for
coordinating the activities of the hospitals, outpatient clinics, nursing homes, and other facilities
located within its jurisdiction.
Acute condition - CORRECT ANSWER - Relatively severe, episodic (of short duration),
and often treatable. It is subject to recovery, and treatment is generally provided in a hospital.
Behavioral factors - CORRECT ANSWER - Individual lifestyles are also a key
determinant of health. For example, diet, exercise, a stress-free lifestyle, risky or unhealthy
behaviors, and other individual choices have been found to play a major role in most of the
significant health problems of today.
Chronic condition - CORRECT ANSWER - Less severe but of long and continuous
duration. The patient may not fully recover. The disease may be kept under control through
appropriate medical treatment, but if left untreated, the condition may lead to severe and life-
threatening health problems. Examples include asthma, diabetes, and hypertension.
Demand-side rationing - CORRECT ANSWER - Prices and ability to pay ration the
quantity and type of health care services people consume.
Determinants of health - CORRECT ANSWER - The leading determinants of health can
be classified into four main categories: environment, behavior and Lifestyle, heredity, and
medical care.
Disease - CORRECT ANSWER - Based on a medical professional's evaluation of a
person's health state.
Environmental factors - CORRECT ANSWER - Encompass the physical, socioeconomic,
and sociopolitical factors.
Health care system - CORRECT ANSWER - All of the activities aimed at promoting,
restoring, or maintaining health.
, Health - CORRECT ANSWER - A complete state of physical, mental, and social well-
being, and not merely the absence of disease or infirmity.
Healthy People 2020 - CORRECT ANSWER - The overarching goals of Healthy People
2020 include: attaining high-quality, longer lives free of preventable disease, injury, and
premature death; achieving health equity, eliminating disparities, and improving the health of all
groups; creating social and physical environments that promote good health for all; and
promoting quality of life, healthy development and health behaviors across all life stages
Heredity - CORRECT ANSWER - the genetic makeup of an individual that could
influence one's health status.
Holistic medicine - CORRECT ANSWER - A philosophy of health care that emphasizes
the well-being of every aspect of a person, including the physical, mental, social, and spiritual
aspects of health.
Illness - CORRECT ANSWER - Recognized by means of a person's own perceptions and
evaluation of how he or she feels.
Planned rationing or supply-side rationing - CORRECT ANSWER - Refers to government
means to limit the availability of certain health care services by deciding, for instance, how
technology will be dispersed and who will be allowed access to certain types of high-tech
services.
Public health system: Reflects an organized effort to deliver public health services within a
jurisdiction with the goal of improving health and well-being of the population.
Public health - CORRECT ANSWER - A wide variety of activities undertaken by state
and local governments to ensure conditions that promote optimum health for society as a whole.
Quality of life - CORRECT ANSWER - (1) Quality of life refers to factors considered
important by patients, such as environmental comfort, security, interpersonal relations, personal
preferences, and autonomy in making decisions when institutionalized. (2) It also includes
ACTUAL Exam Questions and CORRECT
Answers
Access - CORRECT ANSWER - The ability of persons needing health services to obtain
appropriate care in a timely manner. Can you get medical care when you need it? If yes, you
have access to medical care. Access is not the same as health insurance coverage, although
insurance coverage is a strong predictor of access for primary care services.
Capitation - CORRECT ANSWER - A reimbursement mechanism under which the
provider is paid a set monthly fee per enrollee (sometimes referred to as per member per month
or PMPM rate), regardless of whether or not an enrollee sees the provider and regardless of how
often an enrollee sees the provider.
Enrollee - CORRECT ANSWER - A person enrolled in a health plan, especially in a
managed care plan.
Integrated delivery system (IDS) - CORRECT ANSWER - A network of organizations
that provides or arranges to provide a coordinated continuum of services to a defined population
and is willing to be held clinically and fiscally accountable for the outcomes and health status of
the population serviced.
Item-based pricing - CORRECT ANSWER - Refers to the costs of ancillary services that
often accompany major procedures such as surgery. Package pricing: Bundling of fees for an
entire package of related services.
Long-term care - CORRECT ANSWER - A variety of individualized, well-coordinated
services that are designed to promote the maximum possible independence for people with
functional limitations. These services are provided over an extended period to meet the patients'
physical, mental, social, and spiritual needs, while maximizing quality of life.
,Managed care - CORRECT ANSWER - A system that integrates the functions of
financing, insurance, delivery, and payment and uses mechanisms to control costs and utilization
of services.
Market justice - CORRECT ANSWER - A distributional principle according to which
health care is most equitably distributed through the market forces of supply and demand, rather
than government interventions. See social justice.
Medicaid - CORRECT ANSWER - A joint federal-state program of health insurance for
the poor.
Medicare - CORRECT ANSWER - A federal program of health insurance for the elderly,
certain disabled individuals, and people with end-stage renal disease.
Need - CORRECT ANSWER - The amount of medical care that medical experts believe a
person should have to remain or become healthy.
Social justic - CORRECT ANSWER - A distribution principle, according to which health
care is most equitably distributed by a government-run national health care program. See market
justice.
Socialized medicine - CORRECT ANSWER - Any large-scale government-sponsored
expansion of health insurance or intrusion in the private practice of medicine.
Children's Health Insurance Program (CHIP) - CORRECT ANSWER - Provide low-
income family with children with health insurance coverage that covers access to health care
services.
TRICARE - CORRECT ANSWER - A program that is financed by the military. This
insurance plan permits the beneficiaries to receive care from both private and military medical
care facilities.
,Veterans Integrated Service Networks (VISNs) - CORRECT ANSWER - Responsible for
coordinating the activities of the hospitals, outpatient clinics, nursing homes, and other facilities
located within its jurisdiction.
Acute condition - CORRECT ANSWER - Relatively severe, episodic (of short duration),
and often treatable. It is subject to recovery, and treatment is generally provided in a hospital.
Behavioral factors - CORRECT ANSWER - Individual lifestyles are also a key
determinant of health. For example, diet, exercise, a stress-free lifestyle, risky or unhealthy
behaviors, and other individual choices have been found to play a major role in most of the
significant health problems of today.
Chronic condition - CORRECT ANSWER - Less severe but of long and continuous
duration. The patient may not fully recover. The disease may be kept under control through
appropriate medical treatment, but if left untreated, the condition may lead to severe and life-
threatening health problems. Examples include asthma, diabetes, and hypertension.
Demand-side rationing - CORRECT ANSWER - Prices and ability to pay ration the
quantity and type of health care services people consume.
Determinants of health - CORRECT ANSWER - The leading determinants of health can
be classified into four main categories: environment, behavior and Lifestyle, heredity, and
medical care.
Disease - CORRECT ANSWER - Based on a medical professional's evaluation of a
person's health state.
Environmental factors - CORRECT ANSWER - Encompass the physical, socioeconomic,
and sociopolitical factors.
Health care system - CORRECT ANSWER - All of the activities aimed at promoting,
restoring, or maintaining health.
, Health - CORRECT ANSWER - A complete state of physical, mental, and social well-
being, and not merely the absence of disease or infirmity.
Healthy People 2020 - CORRECT ANSWER - The overarching goals of Healthy People
2020 include: attaining high-quality, longer lives free of preventable disease, injury, and
premature death; achieving health equity, eliminating disparities, and improving the health of all
groups; creating social and physical environments that promote good health for all; and
promoting quality of life, healthy development and health behaviors across all life stages
Heredity - CORRECT ANSWER - the genetic makeup of an individual that could
influence one's health status.
Holistic medicine - CORRECT ANSWER - A philosophy of health care that emphasizes
the well-being of every aspect of a person, including the physical, mental, social, and spiritual
aspects of health.
Illness - CORRECT ANSWER - Recognized by means of a person's own perceptions and
evaluation of how he or she feels.
Planned rationing or supply-side rationing - CORRECT ANSWER - Refers to government
means to limit the availability of certain health care services by deciding, for instance, how
technology will be dispersed and who will be allowed access to certain types of high-tech
services.
Public health system: Reflects an organized effort to deliver public health services within a
jurisdiction with the goal of improving health and well-being of the population.
Public health - CORRECT ANSWER - A wide variety of activities undertaken by state
and local governments to ensure conditions that promote optimum health for society as a whole.
Quality of life - CORRECT ANSWER - (1) Quality of life refers to factors considered
important by patients, such as environmental comfort, security, interpersonal relations, personal
preferences, and autonomy in making decisions when institutionalized. (2) It also includes
