WGU C425 - Healthcare Delivery Systems, Regulations, and Compliance Questions and Answers Already Passed

WGU C425 - Healthcare Delivery Systems, Regulations, and Compliance Questions and Answers Already Passed

This kind of medicine treats the whole person. (Physical, Mental, Spiritual) ✔✔Holistic

Relatively severe, episodic (short duration) and often treatable ✔✔Acute

Less severe, but long and continuous. Can be controlled but can lead to serious complications ✔✔Chronic

The market tells us what type of healthcare we need. If a service is not being used, there will not be a lot of that particular service. ✔✔Market Justice

Individual responsibility for health.Benefits are based on individual purchasing power.Rationing based on ability to pay.Limited obligation to the collective good. ✔✔Market Justice

Healthcare viewed as a social resource.Requires active government involvement.Single payer system.Highly controlled by government. ✔✔Social Justice

Ability to pay is inconsequential to receiving medical care.Right to free medical care.Everyone entitled to basic package of benefits. ✔✔Social Justic

Three distinct time periods of health care's evolution ✔✔-Preindustrial Era -Postindustrial Era -Corporate Era

Quality care and Access to care is very low in - ✔✔Rural Areas

Quality of care is lower than typical but access to care is pretty standard in - ✔✔Urban Areas

Covers only the very poor. ✔✔Medicaid

Covers all elderly persons, nonelderly disabled persons, and nonelderly persons with end-stage renal disease. ✔✔Medicare

For hospitalization and short-term nursing home stay. Financed through social security taxes.✔✔Part A Medicare

For physician and other outpatient services. Subsidized through general taxes, but participants pay part of the premium costs. ✔✔Part B Medicare

Nationally uniform program ✔✔Medicare

Program varies from state to state. Income criteria established by states. ✔✔Medicaid

Both ___ and ___ provide financial support to private and public institutions for biomedical research. ✔✔AHRQ NIH

A mechanism of providing health care services where a single organization takes on the management of: Financing, Insurance, Delivery, Payment. (Supply side rationing) ✔✔Managed Care

The provider is paid a fixed monthly sum per enrollee, often called a per member, per month (PMPM) payment. ✔✔Capitation

Care rendered to patients who come to the physicians office, clinics, or outpatient surgery ✔✔Ambulatory Care

A hospital that has achieved specialization and offers a wide scope of services. These centers often engage in teaching and research. ✔✔Medical Centers

Creation of medicare and medicaid ✔✔1965

Curtailed inpatient utilization. Emphasizes early discharge and outpatient services. ✔✔Managed Care

50% of all U.S. hospitals are ✔✔private nonprofit

____ Garned enormous buying power by enrolling a large segment of the insured population ✔✔MCOs (Managed Care Organizations)

Who are stakeholders? ✔✔Anyone who is impacted by the organization. Physicians, healthcare professionals, managers, insurers and more

The 4 Ps (Major Stakeholders) ✔✔Patient (Most important) Provider Payer Policymaker

Difference in wants and needs between the 4 P's ✔✔Conflict of Interests

Allows the market to determine when services are rendered. ✔✔Market Justice

Quality can be improved while reducing costs. Cookie cutter diagnoses. Eliminate ambiguity in treatment. ✔✔Evidence Based Care