1. What is the retrospective payment system that was most prevalent in long-term care reimbursement? How has the transition away from retrospective payments to influenced the delivery of care? What is managed care and how has managed care driven LTC organizations to consider new market and industry forces they've previously been disinterested in pursuing?

2. From the perspective of public (government) versus private (managed care) financing for LTC services, what has evolved regarding competition within the LTC industry? From the perspective of HCO versus HCO, how do hospitals represent a large competitor pool to the LTC-only organization? Overall, what effect has competition had on the LTC industry sector?

3. What's the distinction between cooperation and integration between HCOs, and HCOs who work with LTC organizations? What tends to drive the transition from cooperation to integration, what are some of the most dominating motivations(reasons) that an LTC organization would seek to join an integrated health system (IHS)?

4. List the key OBRA provisions provided by your text. What are overall content areas that are regulated in LTC as a result of OBRA? Summarize the problems associated with uncoordinated regulation of the LTC sector due to the fact that regulations have emerged at different times, for different reasons. Finally, explain the disjointed nature and inconsistent licensure requirements for LTC Administrators.