HMGT 3301 Exam #1, Questions with accurate answers, 100% accurate.

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HMGT 3301 Exam #1, Questions with accurate answers, 100% accurate. What are the 6 main issues with a multi-payer system? (1) difficult for providers to track various health plans (2) providers ha... ve to hire claim processors (3) payments can be denied which forces rebilling (4) balance billing may occur (5) providers must engage in collection efforts (6) government programs have complex regulation What 4 things make the U.S. HCS unique? (1) no automatic coverage (2) no true "system" (3) fragmented system (4) continues to undergo periodic change The HC workforce employs over _____ million people. 16.4 What are the 5 characteristics of the U.S. system? (1) multiplicity of financial arraignments (2) numerous insurance agencies/MCOs that employ various mechanisms for insuring against risk (3) multiple payers that make their own determinations about cost for each service (4) diverse settings of delivery (5) numerous consulting firms offering expertise in planning, cost containment, electronic systems, quality, restructuring resources What are the 3 missing dimensions of the U.S. HC system? (1) planning (2) direction (3) coordination from a central agency What are the 5 inefficiencies in the U.S. HC system? (1) duplication (2) overlap (3) inadequacy (4) inconsistency (5) waste What are the 2 primary objectives? (1) access to HCS (2) cost effective w/ quality standards The U.S. leads the world in what 4 things? (1) technology (2) training (3) research (4) sophisticated institutions/products/processes The Quad-Function Model is made up of what 4 things? (1) financing (2) insurance (3) payment (4) delivery Employer-based health insurance private Premium Cost Sharing w/ groups Privately purchased health insurance private Government programs public Medicare (fed), Medicaid(fed+state), CHIP List 3 special government groups VA, Military, IHS What are 2 reasons why employment-based insurance systems leave some people unemployed? (1) small businesses cannot get group insurance at affordable rates and are unable to offer insurance (2) participation in insurance program may be optional What did the ACA do? required all U.S. citizens and legal residents to be covered by public or private insurance What 4 things make up Managed Care? (1) seeks to achieve efficiency by integrating the functions (2) controls utilization of services (3) determines price (4) payer is still employer or government What is Managed Care? an attempt to control utilization and manage the pricing established/volume of insurers because traditionally the financier, insurer, provider and payer have been different entities What are the 7 external forces affecting HC delivery? (1) social values/culture (2) global influences (3) population characteristics (4) physical environment (5) technology development (6) economic conditions (7) political climate external force - Social Values & Culture (1-3) (1) ethic diversity (2) cultural diversity (3) social cohesion external force - Political Climate (1) president/congress (2) interest groups (3) laws/regulations external force - Global influences (1-4) (1) immigration (2) trade & travel (3) terrosim (4) epidemics external force - Population Characteristics (1-3) (1) demographic trends/issues (2) health needs (3) social morbidity - AIDS, drugs, homicides, injuries, auto accidents external force - Physical Environment (1-3) (1) toxic wastes, air pollutants, chemicals (2) sanitation (3) ecological balance, global warming external force - Economic Conditions (1) general economy (2) competition external force - Technology & Development (1-2) (1) biotechnology (2) information systems what are the 4 competing aspects of HC? (1) cost (2) access (3) quality (4) experience in 2008 the national health expenditure went from ____ trillion to ___ trillion with majority (____trillion) spent on health services and supplies 2.5 trillion to 3 trillion 2.2 trillion spent in health services and supplies per the medical model Health = absence of illness or disease per WHO Health = complete state of physical, mental and social well being and not merely the absence of disease What are the determinants of health? (1) environment (2) behavior and lifestyle (3) heredity (4) medical care Utilization = the quantity of HC consumred HC is viewed as a matter of values (1) Market Good (2) Social Good (1) Market Good - HC is a privilege : economic theory view - benefits those able to pay, not concerned with efficiency (2) Social Good - HC is a right : public interest view - improve efficiency, redistribution 3 Pros of the U.S. HCS (1) medical research and technology (2) medical training (3) sophisticated institutions, products, services and care processes 4 Cons of the U.S. HCS (1) duplication and overlap (2) complexity and waste (3) inefficiency and fragmentation (4) wasted resources All economic goods have what 3 dimensions? (1) cost to the consumer (2) quality (3) availability of access A System = a set of interrelated and interdependent, logically coordinated components designed to achieve common goals 10 basic characteristics of the US HC delivery system - #1 No central agency governs the system U.S. has mostly private financing/delivery financing via employees 52% and government 48% U.S. determine public-sector expenses and reimbursement rates for Medicare/Medicaid/CHIP and the government sets standards for participation and providers must comply to be certified to provide care to these patients most developed countries have a n [Show More]

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