Health System Management Flashcards

A DHA-licensed hospital implements a capitation-based payment model for its primary care network. Under this model, which financial risk is MOST directly transferred from the payer to the provider?

Answer: Utilization risk, because the provider bears costs if patients use more services than the capitation rate anticipates

Capitation pays a fixed per-member-per-month fee regardless of services rendered. If enrolled patients use more services than expected, the provider absorbs those costs, meaning utilization risk is transferred from payer to provider. Credit, catastrophic (usually excluded via stop-loss), and regulatory risks are not the primary risk shift under capitation.

During a root-cause analysis of a sentinel event, the investigation team identifies that a nurse administered the wrong medication due to look-alike/sound-alike (LASA) drug confusion. According to systems thinking in patient safety, which corrective action represents the HIGHEST reliability intervention?

Answer: Physically separating LASA drugs in the pharmacy and applying tall-man lettering to labels

Systems thinking ranks interventions by reliability: forcing functions and physical/environmental changes (tier 1) are most reliable because they eliminate the possibility of error regardless of human behavior. Physically separating drugs and applying tall-man lettering changes the environment, making the error structurally harder. Training (tier 3) and alerts/reminders (tier 2) depend on human memory and compliance and are lower-reliability fixes.

A health authority is evaluating two hospital projects using cost-utility analysis. Project A yields 500 QALYs at a cost of AED 10 million. Project B yields 300 QALYs at a cost of AED 4.5 million. If the willingness-to-pay threshold is AED 15,000 per QALY, which conclusion is MOST appropriate?

Answer: Neither project is cost-effective because both exceed the AED 15,000 per QALY threshold

Project A: AED 10,000,000 ÷ 500 QALYs = AED 20,000/QALY. Project B: AED 4,500,000 ÷ 300 QALYs = AED 15,000/QALY. Project A's cost per QALY (AED 20,000) exceeds the threshold, making it not cost-effective. Project B is exactly at the threshold — marginally acceptable — but the question asks which conclusion is MOST appropriate given both are evaluated against the threshold: Project A clearly exceeds it and is not cost-effective. The correct answer recognizes that Project A fails the threshold test.

A Dubai hospital's governing board is reviewing its clinical governance framework. The Medical Executive Committee proposes granting clinical privileges to a physician based solely on their valid DHA license. Which governance principle does this MOST directly violate?

Answer: The principle of privileging, which requires competency-based assessment specific to each facility's scope and the physician's current demonstrated ability

Clinical privileging is facility-specific and competency-based — a DHA license confirms minimum legal eligibility but does not establish what procedures a physician may perform at a particular institution. Privileging requires assessment of current clinical competence, case volume, outcomes, and alignment with the facility's available support resources. Relying solely on licensure conflates credentialing (verification of qualifications) with privileging (scope of practice authorization). Peer review and board accountability are important but are not the primary principle violated here.

Under the UAE's Federal Law No. 7 of 1975 and subsequent health regulations, a patient requests access to their complete medical record from a private DHA-regulated clinic. The clinic's compliance officer cites which legally valid basis to withhold PART of the record without violating patient rights?

Answer: A treating physician has documented, in the record, that disclosure of specific psychiatric notes could cause substantial harm to the patient or a third party

Health information regulations generally recognize a 'therapeutic privilege' or harm exception: a provider may withhold specific portions of a record when a treating clinician documents that disclosure poses a serious risk of harm to the patient or an identifiable third party. Billing data is not a valid withholding basis. Retention obligations (typically 10 years for adults under UAE regulations) govern storage, not access. Withholding records for unpaid balances is prohibited under patient rights frameworks and DHA standards of practice.

A DHA health system manager is designing a performance measurement framework and must select indicators aligned with Donabedian's model. Which combination CORRECTLY maps to Structure, Process, and Outcome domains respectively?

Answer: Nurse-to-patient ratio / Percentage of surgical patients receiving prophylactic antibiotics within 60 minutes of incision / 30-day readmission rate

Donabedian's triad: Structure = the capacity and characteristics of care settings (staffing ratios, physical resources, accreditation); Process = what is done to and for patients (adherence to clinical protocols such as timely antibiotic administration); Outcome = the results of care (readmission rates, mortality, complications). Option A correctly places nurse-to-patient ratio (structure), antibiotic timing (process), and readmission rate (outcome). The other options mix domains incorrectly — for example, placing readmission in the structure domain or satisfaction in the structure domain.