WGU C425 OA EXAM 2023-2024 ACTUAL EXAM TEST BANK 350 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIED ANSWERS) |ALREADY GRADED A+|BRAND NEW!!

WGU C425 OA EXAM 2023-2024 ACTUAL EXAM TEST BANK 350

QUESTIONS AND CORRECT DETAILED ANSWERS WITH

RATIONALES (100% VERIFIED ANSWERS) |ALREADY GRADED

A+|BRAND NEW!!

What is one benefit that different interests in the US HC system provide? -

ANSWER- It prevents any single entity from dominating the system (big business,

labor, insurance companies, physicians, and hospitals, administrators of health care

institutions).

The ACA is an example of what type of reform? - ANSWER- incremental not

comprehensive

What makes for an ideal organizing hub for continuous, coordinated health care

services? - ANSWER- Primary Care (but is still undeveloped)

primary care integrates health care in comprehensive, coordinated, and continuous

health care services through a seamless delivery referred to as - ANSWERMedical home or health home for patients

The key to the patient-provider relationship is? - ANSWER- Accountability

The uninsured have limited options for medical care. They can - ANSWER- (1)

pay physicians out of pocket at rates typically higher than those under insurance

plans, (2) seek care from safety net providers, or (3) obtain treatment for acute

illnesses at a hospital emergency department, for which hospitals do not receive

direct payments unless patients can afford them.

This act requires screening and evaluation of all patients, provision of necessary

stabilizing treatment, and hospital admission when necessary, regardless of ability

to pay. - ANSWER- Emergency Medical Treatment Act of 1986

the misuse of emergency departments results in cost-shifting, in which the costs of

emergency room care to the uninsured are covered by? - ANSWER- patients with

the ability to pay for services, privately insured individuals, employers, and the

government (i.e., taxpayers).

Excessive medical tests and procedures performed as a protection against

malpractice lawsuits, otherwise regarded as unnecessary. - ANSWER- defensive

medicine

Characteristics of a National Health Insurance system - ANSWER- Core of care is

delivered by private providers

There is tighter consolidation of financing, insurance, and payment, which are

coordinated by the gov't.

Delivery is characterized by detached private arrangements

Ownership: Private/public

Financing: Single-payer (taxes)

Reimbursement (hospital): Global budgets

Reimbursement (physicians): Negotiated fee-for-service

Consumer Co-Pay: Negligible

Ex: Canada

Characteristics of Socialized Health Insurance system - ANSWER- HC is financed

through gov't mandated contributions by employers/employees

HC is delivered by private providers

Sickness funds collect and pay for services

Insurance/payment is closely integrated

Delivery is characterized by independent, private arrangements

Gov't exercise overall control

Ownership: Private

Financing: Employer-employee(mandated payroll contributions/taxes)

Reimbursement (hospital): Per diem payments

Reimbursement (physicians): Negotiated fee-for-service

Consumer Co-Pay: Negligible

Ex: Germany

Characteristics of National Health system - ANSWER- Gov't manages the

infrastructure for the delivery of medical care

Most medical institutions are operated by gov't

Most providers are gov't employees

Financing through tax-supported national health insurance program

Ownership: Public

Financing: Single-payer (taxes)

Reimbursement (hospital): Global budgets

Reimbursement (physicians): Salaries and capitation payments

Consumer Co-Pay: Negligible

Ex: UK

Characteristics of Pluralistic HC system - ANSWER- Ownership: Private

Financing: Voluntary, multiplayer system (premiums or general taxes)

Reimbursement (hospital): Varies (negotiated fee for service, etc)

Reimbursement (physicians): RBRVs, fee-for service

Consumer Co-Pay: small to significant

Ex: US

Consist of a set of interrelated and interdependent components designed to achieve

some common goals. - ANSWER- Systems

3 components of systems framework - ANSWER- -Explains the structure of health

care services in the United States based on the foundations

-Provides a logical arrangement of various components

-Demonstrates a progression from inputs to outputs

Systems Frame outlines include: - ANSWER- -System foundations

-System resources

-System processes

-System outcomes

-System outlook

System foundations are explained by historical, cultural, social, and economic

factors. - ANSWER- historical, cultural, social, and economic factors

Human Resources include - ANSWER- direct, ancillary workers, and HC

managers

What type of health plan includes a list of covered health services and uses

selected providers, usually primary care general practitioners (the "gatekeepers") -

ANSWER- Managed Care

The military medical care system is what? - ANSWER- Well organized, highly

integrated and offers comprehensive services, both preventative and treatment

oriented

What does the Bureau of Primary Health Care (BPHC) do? - ANSWER- -Provides

federal support for community health centers

-Programs for migrant farm workers, the homeless and public housing residents,

and children

ACOs are touted as a way to help fix an inefficient payment system that? -

ANSWER- Rewards more, not better care

Is a network of doctors and hospitals that shares financial and medical

responsibility for providing coordinated care to patients in hopes of limiting

unnecessary spending. At the heart of each patient's care is a primary care

physician. - ANSWER- Accountable Care Organization (ACO)

For ACOs to work they have to what? - ANSWER- Seamlessly share information

How do ACOs make money? - ANSWER- ACOs don't do away with fee for

service, but they create an incentive to be more efficient by offering bonuses when

providers keep costs down. Doctors and hospitals have to meet specific quality

benchmarks, focusing on prevention and carefully managing patients with chronic

diseases. In other words, providers get paid more for keeping their patients healthy

and out of the hospital.

While ACOs can include hospitals, specialists, post-acute providers and even

private companies like Walgreens, who serves as the linchpin of the program? -

ANSWER- primary care physicians

Difference between ACOs and HMOs - ANSWER- ACO patients are not required

to stay in the network

ACOs must meet a long list of quality measures to ensure they are not saving

money by stinting on necessary care

10 Public Health Objectives: - ANSWER- 1.Monitor health status to identify and

solve community health problems

2.Diagnose and investigate health problems and hazards

3.Inform, educate, and empower people about health problems and hazards

4.Mobilize the community to identify and solve health problems

5.Develop policies to support individual and community health efforts

6.Enforce laws and regulations to protect health and safety

7.Provide people with access to necessary care

8.Assure a competent and professional health workforce