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Public health needs to help communities increase access to safe, nutritious food grown in a sustainable way so that people can make healthy food choices. Such public health efforts can contribute to the prevention and control of which of the following ailments or conditions?

a. Obesity
b. Diabetes
c. Cancer
d. Heart disease
e. All of the above

E health policy & disease prevention

Health policy is a multidimensional process. Which of the following statements is (are) correct regarding the role of Congress in US health policy?

a. Congress plays an integral role in the development, financing, and oversight of public and private sector health policies

b. Congressional health policy agendas are driven by a range of forces, including the presidential budget, political agenda, lobbying, advocacy

c. Both of the above

d. Neither of the above

C health policy & congress

More than 60% of non-elderly Americans get private health insurance at work as a benefit from their own job or as the spouse or dependent of a working family member. Data have consistently shown that having private insurance increases the risk for late diagnosis from melanoma, prostate, and breast cancer. Which of the following conditions may result in a change in insurance coverage?

a. Loss of job
b. Change in family status
c. Birthday
d. Change in health status
e. All of the above

E health insurance dynamics

Private insurance through an employer differs from individual insurance. Which of the following statements is (are) indicative of the basic distinction?

a. Eligibility is not based on health status in individual insurance
b. Eligibility is based on age and health status in employer-sponsored insurance
c. Both of the above
d. Neither of the above

D health insurance eligibility

Private health insurance coverage is not a right but a service for those who can afford it. All of the following are true regarding coverage except:

a. Private insurance is a mainstay of health coverage for most Americans, but access, affordability, and adequacy of coverage are not guaranteed

b. Despite limited access to coverage, disease prognosis is not related by any known study or body of research to insurance coverage

c. Difficulty of getting/keeping private coverage increases with health problems, especially during coverage transitions

d. Regulation to limit risk selection involves trade-offs: access versus adequacy versus affordability

e. Additional public policy responses are needed to subsidize and expand coverage

B private health insurance coverage

The Healthy People 2010 objective indicates the need to eliminate health disparities. Which of the following strategies should be considered useful in addressing racial disparities in health?

a. Expand knowledge base through data collection and reporting of data by race/ethnicity

b. Improve sources of health financing and care

c. Increase public and provider awareness

d. a and b only

e. All of the above

E racial health disparities elimination

The local health department wishes to eliminate disparities in the receipt of quality care by diabetics and hence narrow the mortality gap between Whites and Blacks in the county. As a director of the minority health office at the health department, which of the following might serve as an effective approach toward narrowing the racial disparities in mortality associated with diabetes in the county?

a. Ensuring that policies direct activities toward diabetes treatment in particular and minority health in general

b. Enhancing research to reduce the disproportionate disease burden in minority groups

c. Developing effective internal and external communication networks

d. b and c only

e. All of the above

E health disparities narrowing

The consequences of not having private insurance have been persistently evaluated. Health insurance is associated with increased access and utilization of health services. Which of the following should be considered as other consequences of not being insured?

a. Using fewer preventive and screening services

b. Advanced stage at diagnosis of disease

c. Receiving fewer therapeutic services

d. Having poorer health outcomes (higher mortality & disability rates)

e. All of the above

E health insurance coverage

Government plays a role in improving the health of the population. Which of the following is (are) considered when enforcing laws and regulations that protect the health of the public?

a. Enforcement of clean air standards
b. Enforcement of sanitary codes
c. Protecting drinking water supplies
d. Animal control
e. All of the above

E enforcing laws and regulations regarding the health of the public

There is disarray in the private health insurance coverage in this nation. Over the years, some solutions have been suggested to address lack of coverage and quality coverage. Which of the following should be considered contributory to addressing the insurance issue?

a. Expanding state programs for low-income people

b. Using taxes to finance a single, national government health plan for all Americans

c. Offering tax credits or other assistance to help businesses provide coverage for employees

d. All of the above

e. None of the above

D strategies to improve insurance coverage

Other suggestions include mandating businesses to offer coverage, offering tax credits or other assistance to help purchase private coverage, and expanding Medicare to uninsured under 65

Policy development serves as a core function of public health. The implementation of public health services requires policy development and planning or management. As a public health professional assigned to work with the community to reduce tobacco use, which of the following aspects should be incorporated into your policy development and planning for this project?

a. Systematic community-wide planning for tobacco health improvement

b. Developing and tracking measurable objectives

c. Developing policy and legislation related to the practice of public health in the area of tobacco cessation

d. Implementing joint evaluation with the medical care system in terms of tobacco-related diseases

e. All of the above

E policy development and planning of public health services

Developing policies and planning involves leadership development at all levels, as well as systematic community-wide planning for tobacco health improvement, developing and tracking measurable objectives, developing policy and legislation related to the practice of public health in the area of tobacco cessation, and implementing joint evaluation with the medical care system in terms of tobacco-related diseases.

Public health is charged with disease control and health promotion. This substance reflects the commitment of public health and includes all of the following except:

a. Prevention of epidemics and spread of diseases
b. Protection against environmental hazards
c. Assuring the quality and accessibility of health services
d. Responding to disasters and assisting communities in recovery
e. None of the above

E public health services

The commitment of public health also includes injury prevention and the promotion and encouragement of healthy behaviors

Public health is charged with monitoring the health status of the population. As a public health professional, what are the activities within this responsibility of public health?

a. Ongoing community health status assessment
b. Identification of threats to health
c. Determination of health service needs
d. a and c only
e. All of the above

E public health responsibility of monitoring health status

Essential public health services include the monitoring of the health status of the population. These activities include (a) attention to special high-risk populations, (b) identification of community assets and resources, (c) interpretation and communication, and (d) management of multi-sectoral information systems. Other aspects of this essential function are (a) ongoing community health status assessment, (b) identification of threats to health, and (c) determination of health service needs

The framework for examining public health system performance involves capacity, process, and outcomes. The capacity level refers to the input, which involves the interaction with workforce, information, organization and relationships, and facilities and funding. If the process results in the outcome, which of these should be considered as the outcome of public health capacity and process?

a. Improved organizational performance
b. Improved program performance
c. Both of the above
d. Neither of the above

C framework for examining public health system performance

The Tuskegee Syphilis Study, conducted from 1932 until 1972, involved 600 subjects (399 cases and 201 controls) and resulted in 28 syphilis-specific deaths, 100 deaths from syphilis-related complications, infection of 40 spouses, and 19 children born with congenital syphilis. This study is an indication of human subject violation in research. Which specific elements in human research conduct were violated by this experiment?

a. Informed consent
b. Right to receive treatment
c. Knowledge of the research
d. Risk inherent in the research
e. All of the above

E ethical consideration in research involving human subjects

Which of the following international regulations impose(s) ethical duties on researchers who conduct nontherapeutic experiments on human subjects?

a. Helsinki Declaration
b. Nuremberg Code
c. Belmont Code
d. b and c only
e. All of the above

B human subject in research-international regulation

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes a federal floor of safeguards to protect the confidentiality of health information. Which of the following statements apply(ies) to this confidentiality act?

a. Regulates uses and disclosures of individually identifiable health information

b. Provides patient rights with respect to their health information

c. Establishes requirements to ensure privacy of patient

d. All of the above

e. None of the above

D HIPAA regulation-Privacy of Individually Identifiable Health Information

The inclusion of human subjects in research requires approval from the Institutional Review Board (lRB). This approval requires, among other things, an informed consent from all participants. Which of the following is (are) considered substantial in an informed consent?

a. Disclosure of the purpose of the research

b. The benefit of the research in advancing knowledge

c. The risk or harm inherent in the research

d. A statement that participation consent is voluntary

e. All of the above

E elements of informed consent

An appropriate informed consent form is required to state the benefits of the research, the qualifications, the affiliations, and the contact information of the principal investigator as well as the IRS that approved the research and the relevant information on the approval. In addition, all informed consent forms must state the risk or harm inherent in the research if applicable, compensation or incentive to be received by participants if applicable, as well as the statement declaring that participation is voluntary; the form must be signed and dated.

Policy development is an essential process in fulfilling the requirements of the essential public health services. The formulation of policy often requires communities' mobilization. Which of the following should be considered as essential stages in policy development?

a. Problem identification
b. Priority setting
c. Policy formulation and design
d. All of the above
e. None of the above

D policy development stages

Other stages in policy development include (a) passage of policy instruments, (b) implementation, (c) evaluation

The Institute of Medicine integrated the core functions of public health in its identification of the essential public health services. These services are cyclical and continuous processes managed at the systems level and are enhanced through research. Which of these services are directly linked with policy development?

a. Mobilizing community partnerships to identify and solve health problems

b. Enforcing laws and regulations that protect and ensure safety

c. Health services monitoring and identification of community health needs

d. Diagnoses and investigation of health problems and health hazards in the community

e. a and b only

E link between the essential public health services and core functions of public health

The essential public health functions are (a) health services monitoring and identification of community health needs; (b) diagnoses and investigation of health problems and health hazards in the community; (c) informing, educating and empowering people about health issues; (d) mobilizing community partnerships to identify and solve health problems; (e) enforcing laws and regulations that protect and ensure safety; (f) linking people with needed personal health services and ensuring the provision of health care when otherwise unavailable; (g) ensuring a competent public health and personal healthcare workforce; (i) evaluating effectiveness, accessibility, and quality of personal and population-based health services; (j) researching new insights and innovative solutions to health problems

Which of the following had the greatest impact on average life expectancy?

(A) Vaccinations for infectious diseases
(B) Improvements in sanitation & hygiene
(C) Advances in medical care technology
(D) Health education

(B) Improvements in sanitation and hygiene

John Snow's path-breaking studies (1848--1854) of the cholera epidemic in London that identified the source as polluted drinking water from the Thames as well as Edwin Chadwick's role in leading the sanitation movement in Great Britain in the last half of the 19 th century are representative of the importance of improvements in municipal sanitation systems and the promotion of public hygiene. Thomas McKeown and other public health investigators have demonstrated that declines in mortality during the 20 th century occurred before the advent of vaccinations, antibiotics, and other modern medical treatments.

According to John Wennberg and colleagues, small area variations in Medicare expenditures across geographic areas are primarily attributable to differences in:

(A) Physician practice styles
(B) Consumer preferences for high-cost services
(C) Age of the population served
(D) Health status of the population served

(A) Physician practice styles

John Wennberg and other researchers have found wide variations in the rates of various medical care treatments, such as tonsillectomies and hysterectomies, across different areas of the United States. Additional research has shown that these variations are likely not associated with differences in health status, patient age, or consumer preferences, but rather with the practice styles noted in option (A) and with the supply of physicians in different areas. Research on small area variations has contributed to the rationale for the development of clinical practice guidelines.

Which of the following statements accurately describes the financing of health care in the United States?

(A) Public health services represent approximately half of the total expenditures for health care

(B) Health care expenditures as a percentage of GDP have remained stable within the range of 5%-8% since the 1970s

(C) Medicare funds most of the services received by the elderly living in institutional long term care facilities

(D) Medicaid is a Federal-State partnership which covers some health care and related services for low-income families with children and individuals who are elderly, blind and disabled

(D) Medicaid is a Federal-State partnership which covers some health care and related services for low-income families with children and individuals who are elderly, blind and disabled

The percentage of the Gross National Product (GNP) attributable to health care expenditures in the United States for 2008 was approximately 16%. Public health expenditures typically represent less than 3% of total health care expenditures. Medicaid not Medicare is the major source of public funding for institutional long-term care (LTC) for the elderly.

Community rating basis for health insurance:

(A) Automatically assigns lower rates to subscribers from disadvantaged communities

(B) Allows community representatives to negotiate favorable rates

(C) Spreads the risk across the pool of insured

(D) Benefits financially the healthiest insured people who use the fewest services

(C) Spreads the risk across the pool of insured

The logic of community rating of health insurance is that it spreads the risk of insuring the relatively small percentage of frequent and costly users of services across the total number of insured by setting rates that are expected to cover the total health care costs incurred. In this approach, the healthiest low-cost users subsidize the least healthy high-cost users.

According to Mintzberg, "the central purpose of structure [in an organization] is to":

(A) Produce a high-quality product

(B) Allow for the development of strategy based on the organization's mission, vision, and values

(C) Provide the content for organization charts

(D) Coordinate the work of the organization, which has been divided in a variety of ways

(D) Coordinate the work of the organization, which has been divided in a variety of ways

Organization structure allows for the logical integration of functions, processes, and activities that have been differentiated for greater efficiency.

Which of the following pairs of values are most likely to conflict during a response to a public health emergency?

(A) Truth-telling versus justice
(B) Beneficence versus justice
(C) Individual autonomy versus community welfare
(D) Community welfare versus justice

(C) Individual autonomy vs community welfare

Responses to crises and emergencies by public health authorities and public officials are likely to entail some restriction of individual freedom as a trade-off to ensure the health, safety, and well-being of the broader community.

Executive managers in a not-for-profit health care organization have an obligation to:

(A) Maximize return for their stockholders
(B) Increase revenues annually
(C) Be prudent stewards of the community's assets
(D) Avoid earning any net income, i.e., profits

(C) Be prudent stewards of the community's assets

Although the not-for-profit organization is not owned by individual partners or stockholders, top managers are responsible to the community at large for effective and efficient use of the resources entrusted to the not-for-profit health care organization.

Which of the following principles of medical and public health ethics requires doing no harm while promoting the welfare of others?
(A) Autonomy
(B) Beneficence
(C) Privacy
(D) Justice

(B) Beneficence
Beneficence is defined as doing good while avoiding behavior that results in harm.

The "police powers" that public officials rely on to enforce compliance with public health standards and interventions are based on:
(A) Explicit language in the U.S. Constitution
(B) Inferences about the government's obligation to protect the health, safety, and welfare of its citizens
(C) Inferences from the Racketeer Influenced and Corrupt Organization (RICO) Act legislation
(D) Presidential executive orders

(B) Inferences about the government's obligation to protect the health, safety, and welfare of its citizens
There is no explicit language in the U.S. Constitution that ensures either the public's health or the provision of individual health care services. Racketeer Influenced and Corrupt Organization (RICO) legislation is intended to control the illegal activities of corrupt organizations. Presidential executive orders are an important supplement to Congressional legislation, but are not the legal foundation for public health interventions.

Which of the following is likely to be a major obstacle to community readiness for a public health emergency such as an act of bioterrorism?
(A) People no longer feel anxiety about the risks of bioterrorism
(B) The average person has faith that public officials are competent to handle such threats
(C) The consequences of the anthrax-letter threat following 9/11 were far less serious than anticipated
(D) Individuals are unsure about the practical actions to take to protect themselves and their families

(D) Individuals are unsure about the practical actions to take to protect themselves and their families
Public uncertainty about the nature and timing of potential threats to its health and safety makes effective planning and preventive action problematic. The other options are false or less relevant.

Which of the following terms is defined as "the systematic determination of certain risks to a population incident to a disaster"?
(A) Baseline data evaluation
(B) Risk communication
(C) Vulnerability assessment
(D) Biohazard analysis

(C) Vulnerability assessment
The definition given applies precisely to option (C).

Which of the following is not a true statement about the policy-making process?
(A) A policy is a blueprint for action relevant to some area of public concern
(B) Policy-making often occurs in the absence of complete information about all relevant variables
(C) Only experts trained in public policy have a meaningful role to play in policy development
(D) Policies as enacted often reflect compromises among key players with conflicting interests

(C) Only experts trained in public policy have a meaningful role to play in policy development.
Option (C) is false because many other professionals and lay people who are not experts in public policy nonetheless have relevant roles as participants in policy-making. Examples include, but are not limited to, media correspondents, public officials, business representatives, school system officials, public safety professionals, and representatives of faith communities.

A health policy that is implemented within a representative democracy with separation of powers at all governmental levels and that is characterized by the presence of well-funded interest groups:
(A) Will reflect the preferences of the majority of citizens
(B) Must be based on the best scientific evidence available
(C) Will represent a compromise among multiple and competing interests
(D) Is doomed to failure

(C) Will represent a compromise among multiple and competing interests
Compromise to balance competing and conflicting values, interests, and goals is regarded as inevitable and salutary in policy-making within a pluralist society.

Which of the following is most likely to enhance the staff performance appraisal?
(A) Deferring performance feedback until the scheduled annual appraisal
(B) Setting performance goals in collaboration with the employee
(C) Refusing to award outstanding ratings that might lead the employee to expect a merit-based salary increase
(D) Ensuring that no negative information is included in the written appraisal to decrease legal liability

(B) Setting performance goals in collaboration with the employee
Options (A), (C), and (D) are considered poor supervisory practice and counter to the goals of effective performance appraisal. Option (B) is widely held to be a beneficial supplement to performance ratings and other objective methods of performance evaluation.

The following statement is a tenet of which of these motivational models: "Individuals are motivated to satisfy lower-order physiological needs before they can respond to higher needs such as self-fulfillment."?
(A) Hierarchy of needs (Maslow)
(B) Expectancy theory (Vroom)
(C) Two-factor theory (Herzberg)
(D) Theory X/Theory Y (McGregor)

(A) Hierarchy of needs (Maslow)
Option (A) expresses the basic logic of Abraham Maslow's need-based model of human motivation.

What is the best explanation for the importance of liquidity to the not-for-profit health care organization (HCO) and its stakeholders?
(A) Liquidity is necessary to ensure that the HCO achieves its revenue projections.
(B) In the event that the HCO decides to invest heavily in plant expansion, it will have cash on hand.
(C) Liquidity will allow the HCO to cover its short-term obligations and unexpected cash demands.
(D) All HCO competitors have liquidity.

(C) Liquidity will allow the HCO to cover its short-term obligations and unexpected cash demands
Option (A) is false because revenue streams provide liquidity, not the reverse. Option (B) is misleading because capital expenditures such as plant expansion are usually funded by long-term debt. Option (D) is a silly answer. Option (C) succinctly expresses the major purposes of maintaining adequate liquidity.

Which of the following statements best characterizes a progressive employee discipline process?
(A) The discipline process is structured as a staged series of increasingly severe responses to chronic violations of accepted rules of behavior.
(B) The punishment must fit the crime.
(C) Discipline is not considered relevant in the modern health care organization.
(D) Progressive discipline allows the employee to exercise immunity for the first violation of the code of conduct.

(A) The discipline process is structured as a staged series of increasingly severe responses to chronic violations of accepted rules of behavior
Option (B) is inappropriate because current best practice in employee discipline emphasizes performance improvement rather than punishment. Options (C) and (D) are false attributions. Option (A) is an accurate representation of the current paradigm of progressive discipline.

The primary disadvantage of incremental program budgeting is:
(A) It makes comparison from one year to the next difficult
(B) It requires the justification of all dollars allocated
(C) It requires far more time and effort than zero-based budgeting (ZBB)
(D) It may not reflect the current programmatic priorities of the organization

(D) It may not reflect the current programmatic priorities of the organization
Incremental budgeting does allow for easy year-to-year comparisons (A), does not require last-dollar justification (B), and requires a considerably lower investment than fully implemented zero-based budgeting (ZBB). The major deficiency of traditional incremental budgeting approaches is that they do not necessarily reflect program-based allocation of resources or organizational priorities among programs.

Which of the following best characterizes the "iron triangle" logic of U.S. health care policy goals?
(A) Making necessary tradeoffs to achieve acceptable levels of quality of and access to health services while insuring profitability for health care providers
(B) Making necessary tradeoffs to achieve acceptable quality of and access to health services while controlling cost
(C) Maintaining highest quality of and full access to services regardless of cost
(D) Providing highest quality of services to all who can afford to pay and rationing services for those who cannot

(B) Making necessary tradeoffs to achieve acceptable quality of and access to health services while controlling cost
Cost (efficiency or control) is the 3rd health policy goal of the triangle, not profitability. Although optimizing quality of and access to care are desirable goals, scarcity of resources requires that the cost of health care also be considered. Eliminating rather than achieving disparities in quality of and access to health care is a goal of national health policy made explicit in Health People 2010.

The four P's of marketing health services include:
(A) Product, promotion, prestige, and planning
(B) Product, place, promotion, and pragmatism
(C) Product, price, place, and promotion
(D) Product, price, precision, and promotion
(E) Personnel, promotion, price, and place

(C) Product, price, place, and promotion
The design and characteristics of the product, the purchase price set, the place (or channels of distribution) where the good or service is offered, and the means of promotion to increase awareness of the product are the essential factors in determining the marketing mix for any good or service.

An example of backward vertical integration by an academic medical center is:
(A) Offering a managed care health plan
(B) Establishing a skilled nursing unit within the hospital
(C) Acquiring an established home health agency
(D) Taking over a smaller, faith-based health care system

(A) Offering a managed care health plan
Backward vertical integration entails the creation or acquisition of early stages in the process of health care service delivery. Option (A), managed care plan, represents one portal or entry point for plan subscribers to access the health care system. Options (B) and (C) represent forward integration by providing alternatives to acute care services for existing or new patients. Option (D) represents a merger entailing horizontal expansion and integration.

Which of the following is an expected benefit of consolidating independent hospitals and provider groups into an integrated health care system?
(A) Economies of scale in production
(B) Lower costs of integration
(C) Ease of accommodating diverse organizational cultures
(D) Immediate gains in administrative efficiency

(A) Economies of scale in production
Growth through mergers and acquisitions are typically justified on the basis of economic efficiencies achieved through enhanced economies of scale, an increase share of the relevant market by the integrated system, and greater revenues. However, the demands of implementation and maintaining a larger integrated system increase the administrative burden (and associated overhead costs). Accommodating different organizational cultures is a challenge faced by management in most corporate mergers and often is recognized as a root cause of failed mergers and acquisitions.

As a research analyst at a large HMO, you are asked to benchmark the percentage of enrollees treated for depression who received 6-month follow-up care. Applying Donabedian's framework, the percentage of enrollees receiving follow-up care is what type of indicator?
(A) Structure
(B) Process
(C) Outcome
(D) System

(B) Process
In Donabedian's quality assurance model, process consists of all those activities—i.e., technical, clinical, interpersonal, and managerial activities—associated with the utilization of resources and technologies to produce desired outcomes. In this example, follow-up care is regarded as a clinical process, option (B), to effect the outcome of improved mental health.

A pediatric patient complaining of an inner ear infection was diagnosed by an overworked emergency room resident who then prescribed an asthma medication. This is an example of:
(A) Poor interpersonal quality
(B) Poor technical quality
(C) Inequitable access
(D) Inefficient access

(B) Poor technical quality
Option (B) is correct because this scenario clearly reflects poor technical judgment resulting in a misdiagnosis and inappropriate treatment.

What is the relevance of HEDIS for ensuring quality in health care delivery?
(A) HEDIS (Health Enforcement, Disciplinary & Investigation Staff) is the agency the Centers for Medicare and Medicaid Services that investigates and prosecutes fraud and abuse violations in Medicare-funded hospitals
(B) Health Education Deserves Industry Support (HEDIS) is a consumer advocacy group that lobbies corporations to invest in employee health and fitness
(C) The Health Plan Employer Data and Information Set (HEDIS) provides an assessment tool for measuring the quality of care provided by HMOs
(D) HEDIS (Healthcare Education Development & Improvement System) provides programmed instruction and self-assessment tools for professional development of clinical managers in health care

(C) The Health Plan Employer Data and Information Set (HEDIS) provides an assessment tool for measuring the quality of care provided by HMOs.
Option (C) provides the accurate explanation for the acronym.

What is the term for recommendations about how to treat a patient with a particular disease that are based on findings from experimental and/or observational studies?
(A) Cost analysis
(B) Physician consensus statements
(C) Clinical practice guidelines
(D) Patient preference guidelines

(C) Clinical practice guidelines
Option (C) is the currently acceptable term for evidence-based clinical protocols.

Which of the following statements is not associated with the current paradigm of quality management in health care?
(A) Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care
(B) The appropriate locus for ensuring quality is at the system level
(C) Process improvement is essential to ensuring quality of care
(D) Employee satisfaction and patient satisfaction are closely linked

(A) Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care
Option (A) is the only correct response because the current quality management paradigm considers the primary source of errors, waste, and other indicators of poor quality to be poor system design and ineffective processes rather than individual incompetence or carelessness. Deming and others regard the sanctioning of individuals for poor quality to be misplaced and likely to aggravate the problem.

Which of the following is an example of a utilization rate used to monitor health system performance?
(A) Congenital syphilis rate
(B) Late stage breast cancer incidence rate
(C) Infant mortality rate
(D) Readmission rate for depression

(D) Readmission rate for depression
Option (D) is the only response that represents a direct measure of the use of health care services.

Which of the following represents a boundary management function in public health?
(A) Creating cubicles for the staff to maximize the efficiency of the work space
(B) Developing maps showing the incidence of diabetes within target communities
(C) Reprimanding an employee for behavior perceived to be sexual harassment
(D) Scheduling the Director of the county health department to be interviewed by a journalist about a recent outbreak of food-borne illness

(D) Scheduling the Director of the county health department to be interviewed by a journalist about a recent outbreak of food-borne illness
From a systems perspective, boundary management refers to the processes that the organization uses to attempt to control its interactions with relevant actors and forces within its environment. Among other activities, boundary management includes buffering, monitoring, communicating, and adapting to environmental stimuli. Option (D) provides an example of an organization attempting to manage the public perception of its role in response to a public health threat.

One implication of the claim that "the complex organization tends to map its environment" is that the public health agency:
(A) Uses geographic information system (GIS) technology to map the spread of a contagious disease
(B) Hires a professional to provide environmental law expertise
(C) Only serves the population within its political boundaries
(D) Identifies its various constituencies geographically

(B) Hires a professional to provide environmental law expertise
By mapping its environment, the organization replicates the relevant forces and influences its external environment by adapting its internal structures and processes to achieve stability and (temporary) equilibrium. Option (B) represents an internal staffing modification to ensure compliance with regulatory pressures.

Identify which of the following terms characterizes the throughput of the health care system?
(A) The geographical boundary that defines the system's market
(B) Measures of patient's functionality post-surgery
(C) Patient satisfaction scores
(D) The core technologies involved in providing health care services

(D) The core technologies involved in providing health care services
Throughput is the technical term for the technologies that transform inputs into outputs in a systems model.

Which of the following statements best characterizes the contingency theory of leadership?
(A) The leader's authority is unchallenged by subordinates.
(B) The leader's effectiveness depends on various factors in the leadership context.
(C) The leader's effectiveness is contingent primarily on the technical competence of followers.
(D) The leader's authority depends on formal legislation and sanctions.

(B) The leader's effectiveness depends on various factors in the leadership context.
Option (B) presents a succinct, precise definition of the contingency theory of leadership. Options (A) and (D) are not components of the contingency theory. Option (C) is too narrow an application of the contingency theory because other factors also affect the effectiveness of the leader.

SCHIP is a federal program that is important for public health because:
(A) It remedies the state differences in health insurance that characterize Medicaid
(B) It covers preventive services for children who otherwise might not have access to them
(C) It provides a comprehensive immunization program
(D) It increases funding for school health initiatives

(B) It covers preventive services for children who otherwise might not have access to them

The two largest categories of expenditures for the Medicare program (not necessarily in order of magnitude) are:
(A) Hospitals and nursing homes
(B) Physicians and hospitals
(C) Public health and physicians
(D) Hospitals and pharmaceuticals

(B) Physicians and hospitals

While the 10th amendment to the constitution gives the states primary responsibility for public health, inequities between and among the states persist because:
(A) The amendment did not specify standards of care that each state had to meet
(B) Standards of care are implied but implementation is left to the states
(C) Each state has the right to define and delegate authority and responsibility for public health services
(D) Public health services are funded through property taxes that vary from state to state

(C) Each state has the right to define and delegate authority and responsibility for public health services
The states' discretionary implementation policies are the real source of inequity.

The principal difference between those who believe in universal health care and those who believe in a free market system for allocating care is:
(A) A willingness to sustain continuing tax increases to support care a predetermined level of care for those who cannot afford to pay for their own care
(B) The belief that health care is an entitlement versus the belief that health care is a reward
(C) A moral judgment regarding the origin of disease and the corresponding belief that we all are ultimately responsible for our own health and well being
(D) A desire to not have the government involved in the health care of its citizens

(B) The belief that health care is an entitlement versus the belief that health care is a reward

When confronted with constrained community resources for emergency preparedness, a critical success factor for a community emergency response program is:
(A) Community-wide practice drills
(B) A community-wide alert system
(C) A unified command and control center
(D) A community-wide campaign promoting family preparedness
(E) All of the above

(E) All of the above

What are the non-traditional partners that could be effective collaborators in community-wide preparedness planning?
(A) Public safety agencies (e.g. Fire, Police)
(B) Public health departments
(C) Emergency management
(D) Social service and faith-based agencies

(D) Social service and faith-based agencies

Public health is concerned with the health of populations. Accordingly one of the core functions of public health as described by the Institute of Medicine (1988) is:
(A) Refining the definition of populations
(B) To create and advocate for solutions to address, at all levels, the health concerns of populations
(C) Making certain that health policy legislation always contains the phrase "population health"
(D) Developing a new model for solving all public health problems

(B) To create and advocate for solutions to address, at all levels, the health concerns of populations
The other two are assessment and assurance that the actions are taken.

It is frequently said that the most difficult component of the policy process is not implementation but getting health legislation approved because of the
(A) Politics of health care and services delivery are so value laden
(B) Need to have funds to hire well connected lobbyists
(C) Very different opinions held by the two major political parties
(D) Ability to preserve and keep a piece of legislation on the agenda and in front of those in power

(D) Ability to preserve and keep a piece of legislation on the agenda and in front of those in power

The largest single component in most public health and health care budgets, and therefore the one with which managers must be most familiar with, is:
(A) Computer software and hardware
(B) Pharmaceuticals
(C) Personnel
(D) Shortfalls

(C) Personnel

For the overarching guidance of an organization, which of the following should be measurable?
(A) Vision and values
(B) Mission and vision
(C) Goals and objectives
(D) Mission and goals

(C) Goals and objectives

The primary purpose of strategic planning is:
(A) To beat the competition
(B) To define the organization's vision
(C) To maximize financial status
(D) To determine the direction an organization will pursue within its chosen environment and guide the allocation of resources and efforts

(D) To determine the direction an organization will pursue within its chosen environment and guide the allocation of resources and efforts

The definition of healthcare marketing is:
(A) The process of publicizing services and programs
(B) Management activities that create markets for goods and services
(C) A management process that assess customer wants and needs and performs the activities associated with the development, pricing, provision, and promotion of product solutions that satisfy those wants and needs
(D) Multi-media outreach to a single or multiple target audiences

(C) A management process that assess customer wants and needs and performs the activities associated with the development, pricing, provision, and promotion of product solutions that satisfy those wants and needs

The CEO of a managed care organization praised her administrators at a national conference for exceeding their enrollment targets. She noted that long waits for care and travel distances might increase but that the members would certainly understand given the popularity of their health plan. The CEO's statements reflect:
(A) A sound knowledge of quality care
(B) The ability to integrate quality and organizational solvency
(C) A serious lack of understanding around members' perceptions of quality of care and the consequences of poor organizational performance
(D) Her perception of quality care

(D) Her perception of quality care
She does not understand that long waits for care and extended travel times are two of the reasons why people switch - the opportunity costs of time.

In order to effectively evaluate organizational performance, an administrator must also have:
(A) Measurable performance indicators
(B) Previously agreed upon performance standards
(C) Measurable performance indicators benchmarked to previously agreed upon performance standards
(D) Measurable performance indicators that can be used to identify acceptable and superior performance

(C) Measurable performance indicators benchmarked to previously agreed upon performance standards
Measurable performance indicators are useless unless they are benchmarked to previously agreed upon performance standards.

It is often said that the typical manager (and health care managers are no exception) devote up to 81% of his/her time to communication daily. This implies that:
(A) Managers have to be equipped with the most technological advancements for speedy communication
(B) Have a thorough understanding of the communication process including the role of "noise" in the communication process
(C) Know how to encode and decode a message
(D) Have a thorough understanding of the communication process including when to use the most appropriate communication venue and how to use it most effectively

(D) Have a thorough understanding of the communication process including when to use the most appropriate communication venue and how to use it most effectively
If you do not have a communications plan that includes the when and the how, you will not be effective

Information management deserves greater attention nationally from public health administrators and managers. Which of the functions below would not be a priority reason for IMs increased funding for public health departments?
(A) Pivotal, all encompassing role information plays in management's organizing function
(B) Strategic implications of storing information for operational decision making
(C) Potential information management holds for mitigating health disparities
(D) Potential for developing public health electronic medical records

(D) Potential for developing public health electronic medical records
An electronic medical record is more of an inpatient priority.

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