Chapter 1: Health Care Delivery Systems

Chapter 1: Health Care Delivery Systems

TRUE/FALSE

• In primitive times, most of the health care was handled by medicine men or shamans.

ANS: T PTS: 1 REF: knowledge

• The development of medical specialization occurred prior to WWI.

ANS: F

It occurred after WWII.

PTS: 1 REF: knowledge

• The mentally ill were at one time housed in poorhouses or prisons.

ANS: T PTS: 1 REF: knowledge

• An IPA is a prepaid, organized system for providing comprehensive health care services within a

geographic area to all persons under contract.

ANS: F

This is the definition for an HMO. An IPA consists of a network of participating hospitals, physicians, medical groups, and other providers who contract with a sponsor to provide services to those enrolled.

PTS: 1 REF: knowledge

• Mental illness can result from the inability to cope effectively with the recurrent stresses of living

in today’s world.

ANS: T PTS: 1 REF: comprehension

• Belonging to one’s professional association is an important way of finding current information and

learning about changes in one’s chosen field.

ANS: T PTS: 1 REF: comprehension

• Voluntary health agencies are governmental organizations created to perform public work in health

care through private means.

ANS: F

They are nongovernmental organizations.

PTS: 1 REF: knowledge

• A D.O. must be supervised by an M.D.

ANS: F

They pass the same licensing boards and function similarly.

• / 4

PTS: 1 REF: knowledge

• A nurse is an allied health professional.

ANS: F

An allied health professional is an individual, other than a physician, dentist, podiatrist, chiropractor, optometrist, nurse, or physician assistant, who has graduated from an educational program in a science relating to health care and who shares the responsibility for the delivery of health care services to the patient with clinicians.

PTS: 1 REF: knowledge

• Bylaws are the framework used to identify the roles and responsibilities of the board and its

members.

ANS: T PTS: 1 REF: knowledge

• The CFO (Chief Financial Officer) reports directly to the governing board for the success of the

facility.

ANS: F

The CFO assists the CEO; the CEO reports directly to the governing board.

PTS: 1

• Accreditation is directly tied to the ability of the facility to attract patients and receive

reimbursement.

ANS: T PTS: 1

• Fringe benefits are part of every employee’s hiring package.

ANS: F

Many employees receive only the hourly rate for work and receive no supplemental benefits.

PTS: 1

• The fee-for-service basis is the primary method used by managed care.

ANS: F

Although some fee-for-service is used by IPAs, it is infrequent; most managed care uses a capitation method or a predetermined amount for services.

PTS: 1 REF: knowledge

• Tracer methodology is used by JCAHO.

ANS: T PTS: 1 REF: knowledge

• Outsourcing refers to the delegation of health care operations from internal production of a

business to an external entity that specializes in an operation.

ANS: F

Only non-care operations are outsourced; health care operations are not outsourced. 2 / 4

PTS: 1 REF: comprehension

• Sigmund Freud, Alfred Adler, and Carl Jung contributed to the reform of how mentally ill patients

were treated.

ANS: T PTS: 1 REF: knowledge

• Capitation is a fixed amount per person paid to the physician for health care services.

ANS: T PTS: 1

• Managed Care allows an individual who is buying a high deductible insurance coverage to save

money for out-of-pocket costs tax-free accounts.

ANS: F PTS: 1

• Center for Medicare and Medicaid Services administers the Medicare and Medicaid programs.

ANS: T PTS: 1

• Licensing controls the number of individuals who are permitted to practice an occupation or

provide a service.

ANS: T PTS: 1

• Tertiary care is care provided by a specialist, often at the request of the primary care physician.

ANS: F PTS: 1

• Both the JC and the AOA accredit health care entities beyond the hospital setting such as

behavioral health and home health.

ANS: T PTS: 1

• Public health focuses on the social and behavioral aspects of life that affect a person’s health.

ANS: T PTS: 1

MULTIPLE CHOICE

• Which of the following statements most accurately describes the health care delivery system?
• It has changed little over the last decade.
• It is both varied and complex.
• It will need a major overhaul to be effective.

ANS: B PTS: 1 REF: knowledge

• / 4

• Which of the following has proven to be the most relevant to the development of treatments to

improve or cure disease?

• connection between cause and effect
• connection between nature and disease
• connection between supernatural and disease
• connection between diseases and punishing forces

ANS: A PTS: 1 REF: knowledge

• A coworker states he is licensed to practice in his field. What does this mean?
• He has the right, which was conferred by a governmental entity, to practice an occupation

or provide a service.

• He has purchased a certificate stating he is licensed to practice through a private agency.
• He has completed the educational requirements and a practicum in his field of study.
• None of these statements adequately defines licensing.

ANS: A PTS: 1 REF: application

• You discover that in evaluating which college to attend that some are and some are not accredited.

What does accreditation mean?

• The college has received a license to offer the specified coursework.
• The college has met certain size and population requirements.
• An external entity has reviewed the program of study to determine if the program meets

certain predetermined standards.

ANS: C PTS: 1 REF: application

• At age 65, a U.S. citizen qualifies for
• MediCal
• Medicaid
• Medicare

ANS: C PTS: 1 REF: comprehension

• Which of the following best describes a health savings account (HSA)?
• It refers to a means of tracing the delivery of the patient’s care through the health record

and interviews.

• It allows individuals to save money for health care costs in tax-free accounts.
• With an HSA, there is a delegation of non-care operations from internal production to an

external entity.

ANS: B PTS: 1 REF: comprehension

• The continuum of care refers to
• the coordination of all aspects of the patient’s health care
• the care provided by the health care professional at the initial point of contact
• matching an individuals’s ongoing needs with the appropriate level and type of care
• ensuring that the same professionals care for the patient to maintain continuity of care

ANS: C PTS: 1 REF: application

• A patient is referred to a cardiologist for further evaluation. This is what type of care?
• primary
• secondary
• tertiary
• quaternary
• / 4