(CD) Helth Care Systems

Question 1

*Federal agency regulating healthcare for Native Americans, veterans and residents in undeserved areas.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 1

e. HHS (Health and Human Services agency)

Question 2

*Researches healthcare quality and cost issues based on the best evidence/science.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 2

d. AHRQ (Agency for Healthcare Research and Quality)

Question 3

*Third party payer establishes limit on reimbursement for a particular service.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 3

f. Prospective reimbursement

Question 4

*Financial assistance that pays for medical services for the poor, blind, disabled.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 4

g. Medicaid

Question 5

*Agency involved in prevention of disease and emergency preparedness.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 5

a. CDC (Center for Disease Control)

Question 6

*Third party payer establishes a set amount for delivery of care to a client regardless of services provided.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 6

c. Capitation

Question 7

*Provides insurance coverage to qualified beneficiaries for doctor visits and preventative screenings.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 7

h. Medicare part B

Question 8

*Federal regulatory agency for overseeing spending for Medicare and Medicaid.

a. CDC (Center for Disease Control)
b. CMS (Center for Medicare & Medicaid services)
c. Capitation
d. AHRQ (Agency for Healthcare Research and Quality)
e. HHS (Health and Human Services agency)
f. Prospective reimbursement
g. Medicaid
h. Medicare part B

Answer 8

b. CMS (Center for Medicare & Medicaid services)

Question 9

• Requires a monthly premium be paid by the beneficiary

a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare

Answer 9

c. Medicare Part B

Question 10

*Health care jointly funded by state and federal government for the poor and medically needy

a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare

Answer 10

a. Medicaid

Question 11

*Covers individuals permanently disabled & those with end-stage renal disease

a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare

Answer 11

e. Medicare

Question 12

*Covers prescription drugs

a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare

Answer 12

b. Medicare Part D

Question 13

*Covers hospital care, home care and limited nursing home care

a. Medicaid
b. Medicare Part D
c. Medicare Part B
d. Medicare Part A
e. Medicare

Answer 13

d. Medicare Part A

Question 14

Current issues/problems with american Health care systems? per class discusion

Answer 14

high cost/co-pay
not enough info on what it covers
confusing

Question 15

Current issues in health care

Answer 15

Limited resources
Emphasis on cost-people get kicked out faster
New roles (increased specialization and turf battles)
Reorganized delivery

Question 16

What is meant by reorganized delivery (current issues I health care)

Answer 16

hospital stays are shorter (have to get in and out)
Inc. dependency on technology
Patients more acute (wait before going in)

Question 17

Define Health Care organization

Answer 17

System developed for the delivery of health care services by a specialized workforce to defined communities, populations or markets

Question 18

Examples of Health care organization(S)

Answer 18

hospitals
out-patient centers
Urgent cares
PCP office
Home health agencies
County health departments
rehab facilities
assisted living

Question 19

Private health care subsystem

Answer 19

Provides direct care to individuals and families and includes nonprofit and for-profit sectors

ex/hospitals, nursing homes, clinicas

Question 20

Public health care sub-systems

Answer 20

Concerned with the health of populations and provision of a healthy environment; composed of programs at the federal, state and local levels.

ex/ military family services, jails, county health department

Question 21

Declaration of Alma Ata

Answer 21

Goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives.

Question 22

What organization was started with/bc of the Declaration of Alma Ata

Answer 22

WHO

Question 23

Healthy People 2020

Answer 23

“Road map” to improve the health of all people in USA

Question 24

Examples of policies or organizations at the federal systems

Answer 24

HIPPA

CDC, FDA, NIH, AHRQ

Question 25

Center for Medicare and Medicaid Service (CMS)

Answer 25

Overseer of medicare and medicaid spending

Federal

Question 26

Medicare

Who is eligible?

Answer 26

65yr+
Disabled
End staged renal disease (ESRD)

Question 27

Medicaid

Who is eligible?

Answer 27

poor older adults
blind
dialed
low income families with dependent children

Question 28

Proportion of/percentage of people in each category
Employer-provided health insurance
Medicaid
Medicare
Un-insured

Answer 28

Employer-provided health insurance: 60
Medicaid: 17
Medicare: 13
Un-insured: 10

Question 29

Social Security Act of 1935

Answer 29

Was supposed to supplemental income to pension and retirement savings

for/ retirees, older low-income, disabled

Question 30

Medicare Part A

Covers?

Answer 30

What all have

Covers; hospital care, home care, skilled nursing-lmiited)

Question 31

Medicare Part B

covers/adds

Answer 31

For physician services, outpatient care

Question 32

Medicare Part C

covers/adds

Answer 32

Allows access at a wider ranges of offices/services

Question 33

Medicare Part D

covers/adds

Answer 33

prescription drugs

Question 34

What is a benifit period?

Answer 34

Period in which medicare is being used.

admit-discharge at the hospital
Each new stay/admit is a new benifit period

Question 35

Medicaid

what it covers

Answer 35

Minimally: hospital care, lab and radiology, physician services, skilled nursing care at home or nursing home, screening

Additional: determined by the state

Question 36

Children’s Health Insurance Plan (CHIP)

Answer 36

Coverage for low income children not covered my medicaid

part of medicaid????

Question 37

What is prospective reimbursement?

Answer 37

When a third party (insurance) payer establishes the amount of money that will be paid for a service

Question 38

Scope of services at the state level

Answer 38

collect vital statistics
communicable disease control and prevention
participate in research projects
develop health plans
set standard for local health agencies
license health professionals/institutions/organizations
environmental safety