Question 1

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

Accepted Answer

A PPO (Preferred Provider Organization) is a group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee.

Question 2

​Match the HMO model with its correct description. Options will only be used once.
-​HMO owns and operates its own facility, is equipped for laboratory, pharmacy, and X-ray services, and hires its own physicians and other health care providers.

Accepted Answer

The staff model is the only HMO model that hires its own physicians and operates its own facility equipped for laboratory, pharmacy, and X-ray services.

Question 3

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
-​Financed by taxes from federal, state, and local sources

Accepted Answer

Medicaid is a program that is financed by taxes from federal, state, and local sources. Medicare, on the other hand, is primarily funded through payroll taxes and premiums paid by beneficiaries.

Question 4

​Match the HMO model with its correct description. Options will only be used once.
-​HMO contracts with one or more multispecialty group practices that contract to provide health care services to its members.

Accepted Answer

The group model is an HMO model in which the HMO contracts with one or more multispecialty group practices that contract to provide health care services to its members.

Question 5

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

Accepted Answer

The definition given matches with the term deductible.

Question 6

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
-​Consists of Part A and Part B

Accepted Answer

Medicare consists of Part A (hospital insurance) and Part B (medical insurance), distinguishing it from Medicaid, which is a separate program assisting with medical costs for some people with limited income and resources.

Question 7

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

Accepted Answer

Managed-care system is an approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both.

Answer: F
 HMO (Health Maintenance Organization) is a type of managed-care system that provides health care services to its members through a network of providers.

Answer: I
 Prospective payment system is a method of paying for health care services based on predetermined rates. These rates are set prior to the provision of care and are generally based on the patient's diagnosis.

Answer: J
 Reimbursement refers to the payment made by an insurer for health care services received by a patient.

Answer: A
 Capitation is a method of paying for health care services in which a fixed amount is paid per patient to the health care provider, regardless of the number of services provided.

Answer: H
 PPO (Preferred Provider Organization) is a type of managed-care system that allows members to choose from a network of providers but also provides coverage for out-of-network care at a higher cost.

Answer: B
 Coinsurance is a type of cost-sharing in which the patient pays a percentage of the cost of a health care service, while the insurer pays the remaining percentage.

Answer: C
 Copayment is a fixed, upfront cost that a patient pays for a health care service, with the insurer usually covering the remaining cost.

Answer: D
 Deductible is the amount of money that a patient must pay out of pocket for health care expenses before the insurer begins to cover the costs.

Answer: E
 Group contract is an agreement between an insurer and a group of individuals or an employer to provide health care coverage for a specified group of people.

Question 8

​Match the HMO model with its correct description. Options will only be used once.
-​The HMO model is decentralized.

Accepted Answer

The Independent Practice Association (IPA) model of HMO is decentralized, allowing physicians to work in their own offices and see non-HMO patients as well.

Question 9

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​Payment made by a third party

Accepted Answer

Reimbursement refers to the payment made by a third party, such as an insurance company, to a healthcare provider for services rendered to a patient.

Question 10

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​A prepaid plan that both finances and delivers health care

Accepted Answer

An HMO is a managed-care system that both finances and delivers health care through a prepaid plan.

Answer: H
 A PPO is a group contract between employers and insurance companies that allows participants to seek medical care from a network of providers for a discounted rate.

Answer: I
 A prospective payment system is a payment model used by Medicare and Medicaid to pay hospitals a predetermined amount based on the patient's diagnoses, rather than the actual cost of care.

Answer: J
 Reimbursement refers to the payment of medical expenses by an insurance company to the provider, based on the terms of the insurance policy.

Answer: A, B, C, or D could all potentially fit this definition.
 Capitation, coinsurance, copayment, and deductible all relate to the financial responsibility of the patient in a health care plan, but do not necessarily involve the financing of care.

Question 11

​Match the HMO model with its correct description. Options will only be used once.
-​HMO contracts with multiple group practices, hospitals, and other providers to provide services to its members, but in a non-exclusive arrangement.

Accepted Answer

The definition given matches the description of the Network model where an HMO contracts with multiple providers in a non-exclusive arrangement. The Group model involves an exclusive arrangement with one large physician group, the Independent practice association contracts with independent physicians and possibly small group practices, and the Staff model employs physicians and other providers directly.

Question 12

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​A predetermined fee paid per enrollee per month to the participating health care provider

Accepted Answer

Capitation is a predetermined fee paid per enrollee per month to the participating health care provider.

Question 13

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

Accepted Answer

Coinsurance is the cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses. The other options are:
A) Capitation: a payment arrangement in which a group or provider is paid a fixed amount per capita to cover a set of services.
C) Copayment: a fixed dollar amount that the insured must pay for each covered service or medication.
D) Deductible: the amount the insured must pay out of pocket before the insurance company begins paying for covered expenses.
E) Group contract: a contract between an insurance company and a group of individuals, such as employees of a company.
F) HMO: health maintenance organization, a type of managed-care system that provides comprehensive care to members for a set fee.
G) Managed-care system: a healthcare delivery system that manages costs and utilization by controlling access to care.
H) PPO: preferred provider organization, a type of managed-care system that allows members to choose from a network of providers at varying levels of cost-sharing.
I) Prospective payment system: a payment system in which providers are paid a fixed rate for a particular service or episode of care, regardless of the actual cost or resources used.
J) Reimbursement: the process of paying for healthcare services rendered.

Question 14

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
-​Social Security Administration handles enrollment

Accepted Answer

The Social Security Administration handles enrollment for Medicare, not Medicaid.

Question 15

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​Portion of the charge for medical services that the patient must pay

Accepted Answer

A copayment is a specific amount that a patient pays out of pocket for a medical service or prescription drug, typically at the time of the visit or purchase.

Answer: B 
 Coinsurance refers to the percentage of healthcare costs that a patient is responsible for paying after meeting their deductible.

Answer: D 
 A deductible is the amount that a patient must pay out of pocket before their insurance coverage begins.

Answer: F 
 An HMO, or Health Maintenance Organization, is a type of managed-care system that provides healthcare services through a network of healthcare providers.

Answer: G 
 A managed-care system is an approach to healthcare in which providers coordinate patient care and costs are controlled through various mechanisms such as utilization management and provider networks.

Answer: H 
 A PPO, or Preferred Provider Organization, is a type of health insurance plan that allows patients to see providers both in and out of their network, but typically offers lower costs for in-network care.

Answer: I 
 A prospective payment system is a reimbursement model in which payment rates for healthcare services are established in advance, typically based on factors such as diagnosis or procedure codes.

Answer: J 
 Reimbursement refers to the payment or compensation that healthcare providers receive for services rendered to patients.

Answer: A and E 
 Capitation refers to a payment model in which providers are paid a fixed amount per patient per unit of time, regardless of the volume or type of services provided. Group contract refers to a type of insurance plan in which a single policy covers an entire group of people, such as employees of a company or members of a professional association.

Question 16

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
-​Federal-state partnership assistance program

Accepted Answer

Medicaid is a federal-state partnership assistance program that provides health coverage for low-income individuals and families, pregnant women, and people with disabilities.

Answer: B 
 Medicare is a federal health insurance program that primarily provides coverage for people over the age of 65, as well as people with certain disabilities and those with end-stage renal disease. It is not a federal-state partnership program.

Question 17

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
-​Assists individuals with end-stage renal disease

Accepted Answer

Medicare includes coverage for individuals with end-stage renal disease, while Medicaid does not specifically assist with this condition.

Question 18

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
-​Serves certain pregnant women and infants with family incomes below 133% of the poverty level

Accepted Answer

Medicaid provides healthcare coverage for certain pregnant women and infants with family incomes below 133% of the poverty level, while Medicare is generally for people 65 and older or with certain disabilities.

Question 19

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​Health insurance contract that is made with an employer and covers a group of employees

Accepted Answer

A group contract is a health insurance contract that is made with an employer and covers a group of employees. None of the other options fit this definition.

Question 20

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
-​A payment system under which hospitals are paid a fixed sum per case

Accepted Answer

prospective payment system is a payment system under which hospitals are paid a fixed sum per case.

Answer: J
 reimbursement refers to the compensation or repayment given to healthcare providers for services rendered to patients.

Answer: F
 HMO (health maintenance organization) is a managed-care system that provides healthcare services to members for a fixed fee.

Answer: H
 PPO (preferred provider organization) is a group contract between health insurance companies and select healthcare providers who agree to provide services to members at discounted rates.

Answer: A
 capitation is a payment system in which healthcare providers are paid a fixed sum per patient regardless of the services provided.

Answer: D
 deductible refers to the amount that a patient must pay out of pocket for healthcare services before insurance coverage begins.

Answer: B
 coinsurance refers to the shared responsibility between the patient and the insurance company for healthcare costs after the deductible has been met.

Answer: C
 copayment refers to a fixed amount that a patient must pay out of pocket for healthcare services, often at the time of service.

Answer: G
 managed-care system refers to a healthcare system that emphasizes cost containment and coordination of services through a network of providers.

Quiz 9: Health Care Systems and Policy

Match the definition in the left column with its correct term in the right column. Options will only be used once. -A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

Match the HMO model with its correct description. Options will only be used once. -HMO owns and operates its own facility, is equipped for laboratory, pharmacy, and X-ray services, and hires its own physicians and other health care providers.

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -Financed by taxes from federal, state, and local sources

Match the HMO model with its correct description. Options will only be used once. -HMO contracts with one or more multispecialty group practices that contract to provide health care services to its members.

Match the definition in the left column with its correct term in the right column. Options will only be used once. -Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -Consists of Part A and Part B

Match the definition in the left column with its correct term in the right column. Options will only be used once. -Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

Match the HMO model with its correct description. Options will only be used once. -The HMO model is decentralized.

Match the definition in the left column with its correct term in the right column. Options will only be used once. -Payment made by a third party

Match the definition in the left column with its correct term in the right column. Options will only be used once. -A prepaid plan that both finances and delivers health care

Match the HMO model with its correct description. Options will only be used once. -HMO contracts with multiple group practices, hospitals, and other providers to provide services to its members, but in a non-exclusive arrangement.

Match the definition in the left column with its correct term in the right column. Options will only be used once. -A predetermined fee paid per enrollee per month to the participating health care provider

Match the definition in the left column with its correct term in the right column. Options will only be used once. -A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -Social Security Administration handles enrollment

Match the definition in the left column with its correct term in the right column. Options will only be used once. -Portion of the charge for medical services that the patient must pay

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -Federal-state partnership assistance program

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -Assists individuals with end-stage renal disease

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -Serves certain pregnant women and infants with family incomes below 133% of the poverty level

Match the definition in the left column with its correct term in the right column. Options will only be used once. -Health insurance contract that is made with an employer and covers a group of employees

Match the definition in the left column with its correct term in the right column. Options will only be used once. -A payment system under which hospitals are paid a fixed sum per case

Quiz 9: Health Care Systems and Policy

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

​Match the HMO model with its correct description. Options will only be used once. -​HMO owns and operates its own facility, is equipped for laboratory, pharmacy, and X-ray services, and hires its own physicians and other health care providers.

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -​Financed by taxes from federal, state, and local sources

​Match the HMO model with its correct description. Options will only be used once. -​HMO contracts with one or more multispecialty group practices that contract to provide health care services to its members.

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -​Consists of Part A and Part B

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

​Match the HMO model with its correct description. Options will only be used once. -​The HMO model is decentralized.

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​Payment made by a third party

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​A prepaid plan that both finances and delivers health care

​Match the HMO model with its correct description. Options will only be used once. -​HMO contracts with multiple group practices, hospitals, and other providers to provide services to its members, but in a non-exclusive arrangement.

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​A predetermined fee paid per enrollee per month to the participating health care provider

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -​Social Security Administration handles enrollment

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​Portion of the charge for medical services that the patient must pay

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -​Federal-state partnership assistance program

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -​Assists individuals with end-stage renal disease

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once. -​Serves certain pregnant women and infants with family incomes below 133% of the poverty level

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​Health insurance contract that is made with an employer and covers a group of employees

​Match the definition in the left column with its correct term in the right column. Options will only be used once. -​A payment system under which hospitals are paid a fixed sum per case