HIM 200 - Exam 1Latest Guide Complete Solutions Graded A+| Pass Guaranteed.

Managed Care Organization (MCO) - correct answer What is the dominant health care system in the U.S.? Most Americans in private and public health insurance programs through contracts with a managed care organization. - correct answer Who does the MCO system cover? Enrollee - correct answer An individual covered under a managed care plan. Health plan - correct answer What is the contract between an enrollee and an MCO known as? The expected cost of health care utilization, which often can cost more than the insurance premiums collected. - correct answer What do health plans depend on? No - correct answer Are Americans entitled to routine and basic health care services? Universal access - correct answer What kind of health insurance do other countries have? Employers and the government - correct answer Who are the primary financers of MCOs? By integrating the basic functions of health care delivery and employing mechanisms that control the utilization of medical services and determine the price at which the services are purchased and how much the providers get paid. - correct answer How does this system seek to achieve efficiency? Active-duty military personnel of the United States Army, Air Force, Navy, and Coast Guard. - correct answer Who is the military medical care system mostly free of charge for? Hospitals or dispensaries covered by Tri-care. - correct answer Where are families and dependents of active-duty or retired career military personnel treated? A health care program of the United States Department of Defense Military Health System. - correct answer What is Tri Care? A health care system that is provided to retired veterans who have served in the military, with priority given to those who are disabled. - correct answer What is the Veterans Administration (VA)? Hospital care, mental health services, and long-term care. - correct answer What does the VA system focus on? The VA - correct answer What is one of the oldest and largest formally organized health care systems in the world? To provide medical care, education and training, research, contingency support, and emergency management. - correct answer What is the mission of the VA? 21 - correct answer The VA is organized into __ geographically distributed Veterans Integrated Service Networks. People with health needs but inadequate resources to address them, including individuals who are poor and uninsured, belong to a certain minority group or are of a certain immigration status, or live in geographically or economically disadvantaged communities. - correct answer Who are included in vulnerable populations? Through the nation's safety net, including public health insurance programs such as Medicare and Medicaid - correct answer How do vulnerable populations receive care? Federally qualified health centers like the Bureau of Primary Health Care. - correct answer Who have provided primary and preventative health services to rural and urban underserved populations for fifty years? Federal support for community health centers, including programs for migrant and seasonal farm workers and their families, homeless people, public housing residents, and school-age children. - correct answer What does the Bureau of Primary Health Care provide? Medicare - correct answer What is one of the largest sources of public health insurance in the United States, serving the elderly, disabled, and those with end-stage renal disease? Hospital care, post-discharge nursing care, hospice care, outpatient services, and prescription drugs. - correct answer What does medicare offer coverage for? Medicaid - correct answer What is the third largest source of health insurance in the United States. This provides coverage for low-income adults, children, the elderly, and the disabled? Children in uninsured families. - correct answer What does the Children's Health Insurance Program (CHIP) provide insurance to? Integrated Delivery Systems - correct answer A network of healthcare providers and organizations that provide coordinated health care to a population. The health outcomes and health status of the population. - correct answer What are integrated delivery systems responsible for? To have one health care organization deliver a range of services for a defined population. - correct answer What is the objective of integrated delivery systems? Due to the ACO and a focus on the triple aim of improved health, improved health care, and lower costs. - correct answer Why is health care experiencing a paradigm shift to integrated, patient-centered care? Through safety net providers - correct answer How do uninsured populations access medical care? Social Justice System - correct answer The ideology system that emphasizes the well-being of the community over an individual is called the Market - correct answer The principle of _______ justice places the responsibility for fair distribution of health care on market forces in a free economy. TRICARE - correct answer What is the health insurance for the US Military? Access - correct answer _______ is the ability of an individual to obtain health care when it is needed. False - correct answer True or False: Barring major system changes, health service expenditures are projected to continue to decrease True - correct answer True or False: Of all developed countries, the United States spends the most on healthcare services. True - correct answer True or False: Two types of financing mechanisms commonly used in managed care plans are capitation and discounted fees. Medical and nonmedical care - correct answer What does long-term care consist of? Individuals who are chronically ill or who have disabilities that prevent them from performing regular daily tasks and includes both health care and support services for daily living. - correct answer Who is long-term care provided to? Medicare - correct answer Who does not cover most LTC services? No, it's actually difficult to meet the requirements necessary to have access to it. - correct answer Can most people access LTC insurance? - Monitor health status to identify and solve community health problems - Diagnose and investigate health problems and hazards Inform, educate, and empower people about health problems and hazards - Mobilize the community to identify and solve health problems - Develop policies to support individual and community health efforts - Enforce laws and regulations to protect health and safety - Provide people with access to necessary care - Assure a competent and professional health workforce - Evaluate the effectiveness, accessibility, and quality of personal and population-based health services - Perform research to discover innovative solutions to health problems - correct answer What are the goals of public health? To expand coverage and increase access to care - correct answer What is the goal of health care reform? - Increased coverage - Improved access and financial security, and economically benefited states and providers - Offers no-cost coverage for preventative services from private insurance plans - correct answer What does the Affordable Care Act provide? - No central governing agency - Technology driven and focuses on acute care - High on cost, unequal in access, and average in outcomes - Imperfect market conditions for healthcare delivery - Government as subsidiary to the private sector - Fusion of market justice and social justice - Multiple players and balance of power - Quest for integration and accountability - Access to health care based on insurance - Legal risk influences practice behavior - correct answer What are the key characteristics of the U.S. Health Care System? No - correct answer Does the U.S. health care system have coordination or integration? - It is not centrally controlled; central systems are less complex and less costly - Has different payment, insurance, and delivery mechanisms - correct answer How is the U.S. system different from other developed countries? Both publicly and privately - correct answer How is health care financed under the U.S. system? No - correct answer Are the terms illness and disease synonymous? The Society for Academic Emergency Medicine (SAEM) - correct answer What program emphasizes both physical and mental health, defining health as "a state of physical and mental well-being that facilitates the achievement of individual and societal goals."? The World Health Organization (WHO) - correct answer Which program defines health as "a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity"? All activities aimed at promoting, restoring, or maintaining health. - correct answer What does the WHO define a health care system as? Holistic medicine - correct answer _______ seeks to treat the whole person. Incorporates the spiritual dimension in addition to the physical, mental, and social aspects of optimal health. To improve and protect community health - correct answer What is the mission of the U.S. public health system? - Patients' homes - Assisted living facilities - Nursing homes - correct answer What types of settings are LTC provided in? To expand primary coverage and to increase access to care. - correct answer What was the primary goal of health care reform efforts?