NURS 151 EXAM 2 || QUESTIONS AND ANSWERS.
PHO (physician-hospital organization) correct answers A legal entity formed between a hospital
and a physician group to achieve shared market objectives and other mutual interests.
Levels of prevention correct answers Primary (Prevention, through education, regular check
ups), Secondary (Identify through preventative screenings, might have a cold so you run tests for
it). Tertiary (Heal. chemotherapy etc).
Three key individuals in the development of public health; what were their contributions, what
did they have in common? correct answers 1. Dr. John Snow investigated cholera epidemic.
(made connection between contaminated water and disease).
2. Chadwick found that the poor had higher levels of disease. (unsanitary working conditions and
disease)
3. Lemuel Shattuck helped clarify definitions of sanitation. (public health infrastructure)
THEY ALL FOCUS ON SANITATION
Principles of insurance cost-sharing correct answers Co-insurance (percentage consumer pays),
co-payment (fixed fee), deductibles (what you have to pay before your insurance kicks in).
Premiums = monthly health insurance payment.
Types of Insurance (PPO, EPO, MCO, Indemnity, government provided, etc.) correct answers
group, private, self-funded, managed care
PPO (Preferred Provider Organization) correct answers A type of health plan that contracts with
medical providers, such as hospitals and doctors, to create a network of participating providers.
You pay less if you use providers that belong to the plan's network.
HMO (Health Maintenance Organization) correct answers oldest type of managed care. Member
must see their primary care provider first in order to see a specialist.
, EPO (Exclusive Provider Organization) correct answers similar to PPO's but they restrict
members to a list of preferred or exclusive providers.
POS (Point of Service) correct answers a plan for members who want to choose their providers
but also encourage gate keepers
PSO (provider-sponsored organization) correct answers organizations owned or controlled by
health care providers
Medicare correct answers 1965. Provides health care services for the elderly (65 and older),
disabled, and renal care patients. Part A: in patient care. Part B: out patient care. Part C:
improving A and B. Part D: prescription drugs & Modernization Act.
Medicare Part A correct answers In patient care. CAN be bought if you haven't paid taxes on
medicare
Medical Loss Ratio correct answers the percentage of premium revenue spent on medical
expenses. needs to be at least 80%
Premium correct answers a monthly amount to be paid to an insurance policy by the consumer.
utilization review correct answers process of evaluating the appropriateness of services provided
Accreditation correct answers a private standard developed by accepted organizations as a way to
meet standards. The Joint Commission. NOT necessary to run a facility.
Joint Commission correct answers a not-for-profit organization that evaluates and accredits
different types of healthcare facilities
PHO (physician-hospital organization) correct answers A legal entity formed between a hospital
and a physician group to achieve shared market objectives and other mutual interests.
Levels of prevention correct answers Primary (Prevention, through education, regular check
ups), Secondary (Identify through preventative screenings, might have a cold so you run tests for
it). Tertiary (Heal. chemotherapy etc).
Three key individuals in the development of public health; what were their contributions, what
did they have in common? correct answers 1. Dr. John Snow investigated cholera epidemic.
(made connection between contaminated water and disease).
2. Chadwick found that the poor had higher levels of disease. (unsanitary working conditions and
disease)
3. Lemuel Shattuck helped clarify definitions of sanitation. (public health infrastructure)
THEY ALL FOCUS ON SANITATION
Principles of insurance cost-sharing correct answers Co-insurance (percentage consumer pays),
co-payment (fixed fee), deductibles (what you have to pay before your insurance kicks in).
Premiums = monthly health insurance payment.
Types of Insurance (PPO, EPO, MCO, Indemnity, government provided, etc.) correct answers
group, private, self-funded, managed care
PPO (Preferred Provider Organization) correct answers A type of health plan that contracts with
medical providers, such as hospitals and doctors, to create a network of participating providers.
You pay less if you use providers that belong to the plan's network.
HMO (Health Maintenance Organization) correct answers oldest type of managed care. Member
must see their primary care provider first in order to see a specialist.
, EPO (Exclusive Provider Organization) correct answers similar to PPO's but they restrict
members to a list of preferred or exclusive providers.
POS (Point of Service) correct answers a plan for members who want to choose their providers
but also encourage gate keepers
PSO (provider-sponsored organization) correct answers organizations owned or controlled by
health care providers
Medicare correct answers 1965. Provides health care services for the elderly (65 and older),
disabled, and renal care patients. Part A: in patient care. Part B: out patient care. Part C:
improving A and B. Part D: prescription drugs & Modernization Act.
Medicare Part A correct answers In patient care. CAN be bought if you haven't paid taxes on
medicare
Medical Loss Ratio correct answers the percentage of premium revenue spent on medical
expenses. needs to be at least 80%
Premium correct answers a monthly amount to be paid to an insurance policy by the consumer.
utilization review correct answers process of evaluating the appropriateness of services provided
Accreditation correct answers a private standard developed by accepted organizations as a way to
meet standards. The Joint Commission. NOT necessary to run a facility.
Joint Commission correct answers a not-for-profit organization that evaluates and accredits
different types of healthcare facilities
