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CHAPTER 1: THE HEALTH CARE SYSTEM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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CHAPTER 1: THE HEALTH CARE SYSTEM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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CHAPTER 1: THE HEALTH CARESYSTEM QUESTIONS AND ANSWERS
WITH SOLUTIONS 2024
What is the World Health Organization's definition of health? - ANSWER The World Health Organization
defines health as the absence of illness or disease and a state of being in which the individual feels well
and is able to carry out the daily functions of life with no difficulties and no pain.
What historical figure is considered to be the first to see illness as a result of physical and environmental
factors?
When did he live? - ANSWER The first historical figure to view illness as being a result of physical and
environmental factors was Hippocrates. He was born in Greece in approximately 460 BC.
What three trends in modern medicine have a strong influence on health care in ambulatory settings? -
ANSWER Three trends that have influenced ambulatory care are the desire to reduce health care costs,
encouraging the general public to take responsibility for their own good health, and an increased
understanding that people feel better if they do not have to be hospitalized.
What is fee-for-service health insurance? - ANSWER Fee-for-service health insurance pays for each
service provided to a patient separately based on the amount allowed by the insurance company for that
specific service.
List and give a short description of three government insurance plans that were introduced starting in
the 1960s. - ANSWER The Medicaid program began in order to provide health insurance for low-income
children and later expanded to cover all low-income people. The Medicare program provides health
insurance for the elderly, permanently disabled individuals, and individuals with end-stage renal disease.
The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS; now called TRICARE)
was established to provide health insurance for dependents of active-duty military personnel.
Briefly describe what managed care is. - ANSWER Managed care is a method of health insurance
reimbursement that attempts to keep health care costs as low as possible while still including routine
and preventive care. Managed care may be paid by capitation, in which a fixed monthly sum is provided
for each member regardless of the care received. Managed care employs utilization review to ensure
that health care is medically necessary and puts constant pressure on physicians to see more patients,
spend less time with each patient, and justify all services, including diagnostic tests and referrals.
, If a managed care insurance plan uses capitation to pay for health care, what does this mean? - ANSWER
Capitation is a method of payment that provides a fixed dollar amount each month for each subscriber.
Physicians must provide all care for that fee. It reduces the incentive to provide extra (especially
unnecessary) services because they will not be reimbursed separately.
How do managed care plans attempt to reduce the cost of prescription medications? - ANSWER Most
managed care plans create a list of covered and/or preferred prescription medications called a formulary.
The managed care plan covers more of the cost of medications on its formulary list than of other
prescription medications.
List the six steps of an ordinary patient visit to a medical office. - ANSWER The patient (1) comes to the
office; (2) is checked in and makes a copayment at the reception desk; (3) is seen by the physician or
other primary care provider; (4) undergoes any necessary diagnostic or laboratory tests; (5) receives a
diagnosis, treatment, or referral; and (6) receives instructions for follow-up and any additional diagnostic
tests before leaving the office.
Identify at least six other health professionals beside the physician and the medical assistant who may
work in the medical office. - ANSWER Health professionals who commonly work in the medical office
include nurse practitioners (NPs), physician assistants (PAs), nurses, business managers, receptionists,
medical secretaries, file clerks, and insurance specialists.
Describe briefly how physicians are educated. - ANSWER To become a physician, a student must
complete 4 years of college, then 4 years of medical or osteopathic school, and finally a hospital-based
residency, which lasts from 2 to 7 years, depending on the specialty.
What examination does a physician take to obtain a state license to practice medicine? How does a
physician become "board certified?" - ANSWER The physician must pass Steps I, II, and III of the U. S.
Medical Licensing Examination (USMLE). Step I and Step II are taken during medical school, but Step III
cannot be taken until at least 1 year of residency (often called an internship) has been completed.
To become "board certified," the physician must take an examination administered by the certification
board in a medical specialty.
Describe the education and training of a physician assistant (PA) and a nurse practitioner (NP). - ANSWER
A PA must complete 2 to 4 years of college, followed by at least 2 years of training in a PA program. Most
PA programs award a master's degree. An NP is a registered nurse (RN) who studies in a program in
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