Exam (elaborations)
HSA 201 EXAM 1 QUESTIONS AND ANSWERS 2023
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Exam of 12 pages for the course HSA at HSA (HSA 201 EXAM 1)
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HSA 201 EXAM 1Health care delivery system - answer major components of the system and
processes that enable people to receive health care.
Two primary objectives of health care delivery system - answer :enable all citizens to
receive health care
:deliver services that are cost effective and meet established standards of quality
Access - answer Refers to the ability of an individual to receive health care services
when needed, which is not the same as having health insurance.
Universal coverage - answer Means that all (or nearly all) citizens have access to
health insurance that provides at least a basic package of health care services.
Primary Care - answer Basic and routine care delivered by a general practitioner. In
a managed care system, the primary care physician also makes the determination of
the need for higher-level services.
capitation - answer all health care services include one set fee per person, more all-
encompassing
Medicare - answer The government insurance program for the elderly and certain
disabled individuals.
Medicaid LACHIP - answer joint federal state program of health insurance for
indigent, poor (if they meet the eligibility criteria) children.
Provider - answer can be an individual health care professional, a group, or an
institution that delivers health care services and receives reimbursement directly for
those services. A registered nurse who is employed by a hospital is not a provider
because his or her services cannot be billed for reimbursement. The same registered
nurse working as a nurse practitioner in private practice could be a provider if he or she
can bill for services.
reimbursement - answer The amount paid to a provider by the insurer. The payment
may be only a portion of the actual charge.
uninsured - answer people who are without health insurance coverage. no one is
uninsured( do not have health care benefits)
Third party payer and its role in health care - answer :Patient 1st party
, :provider 2nd party
:Intermediary 3rd party
- wall of separation between financing and delivery
- quality care is secondary concern
What have the fundamental shifts in healthcare been in the last two decades - answer
growth in population, increased in key health technologies, growth of health care
professions, increased pharmaceutical cost, rising cost of individual and family health
care insurance. system has continued to undergo periodic changes, concerning cost,
access, and quality.
medical/biomedical model - answer existence of illness or disease clinical diagnoses
& medical interventions
administrative costs - answer Incidental to the delivery of health services. These
costs are not only associated with the billing and collection of claims for services
delivered, but also include numerous other costs, such as time and effort incurred by
employers for the selection of insurance carriers, costs incurred by insurance and
managed care organizations to market their products, time and effort involved in the
negotiation of rates, and resources used in the completion and maintenance of medical
records.
balance bill - answer Refers to the leftover sum that a provider bills to the patient
after insurance has only partially paid the charge that was initially billed.
defensive medicine - answer Involves the delivery of services and maintenance of
documentation undertaken primarily to guard against the risk of malpractice lawsuits.
These additional efforts do not generally add to the quality of care.
demand - answer The quantity of health care demanded by consumers based solely
on the price of those services. Enabling services, such as transportation or translation
services, facilitate access when an individual already has health insurance coverage.
enroll - answer An individual enrolled in a health plan and therefore entitled to
receive health services the plan provides.
free market - answer Characterized by the unencumbered operation of the forces of
supply and demand when numerous buyers and sellers freely interact in a competitive
market.
global budget - answer Used to control costs in centrally managed systems. System-
wide health care expenditures are budgeted. Resources are allocated within the
budgetary limits.
health care reform - answer The expansion of health insurance to cover the
uninsured—those without private or public health insurance coverage.
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