US Health Care Systems

The development that contributed most significantly to the decline of the social mission of voluntary hospitals was the
Enactment of private and public insurance reimbursement for hospital care
The Medicaid program has a history of very low reimbursement as compared with Medicare reimbursement; critics site low Medicaid reimbursement as a major reason that primary care doctors have rejected serving the Medicaid population. An ACA provision addresses this issue by:
Reimbursing states for primary care physician fees for Medicaid patients at no less than100% of Medicare payment rates
Integrated health systems or ____________ have been a key provision in the ACA; these systems better coordinate care and improve quality
Accountable Care Organizations
Which of the following is synonymous with an EHR?
None of the above
U.S. annual health care expenditures far outstrip those of 7 other developed nations. In relationship with expenditures, U.S. health population status ranking on critical indicators in comparison with those other developed nations is:
Dismally lower
The U.S. healthcare delivery system has numerous stakeholders. In terms of financial power, control of delivery system parameters for the majority of Americans, and influence on consumers and providers of health care, which of the following pairs of stakeholders is the most influential:
Government and private health insurers
Of the levels of prevention associated with the natural history of disease, primary prevention refers to:
health education and specific protection
The service priorities of the U.S. health care system reflect America's fascination with dramatic high-tech medicine. As a result:
all of the above
Americans spend $9 billion + each year on alternative and complementary therapies. This trend has caused:
many private insurers and Medicare and Medicaid to provide benefit coverage for certain treatments
In the past, patient behaviors within the health care delivery system were formed from the authoritarian positions of better-educated providers who expected patients to be compliant and grateful. Today, health care providers and consumers:
encourage more proactive roles for patients' participation in health care decisions with "shared decision-making"
Potential conflicts of interest occur when physicians own or invest in businesses (e.g. diagnostic, medical supply companies) to which they can refer patients to generate profits. In response to these physician conflict of interest issues:
The ACA includes "Sunshine provisions" require reporting of all financial transactions and transfers of value between pharmaceutical/biologic product manufacturers and physicians, hospitals and other entities reimbursed by the federal government
In the natural history of a disease, the pre-pathogenesis period refers to:
Behavioral, genetic, environmental and other factors that may contribute to an individual's likelihood of contracting a disease
Long term care needs of older, chronically ill Americans pose a particular delivery system challenge because:
Neither Medicare nor private insurance support ongoing, non-acute services
As early as the 19th century some Americans carried "health insurance" through employers, fraternal orders, guilds, trade associations, unions or commercial insurance companies. However unlike health insurance of today, these insurance policies only provided for:
Fixed payments to compensate for lost wages due to injury, sickness or disability
The Oregon Death with Dignity Act was a response to which of the following?
public and professional concerns about painful and demeaning terminal medical care
The explosion of science and technology in the 1970s resulted in which of the following?
All of the above
In its early origins in colonial America, the patient/physician relationship can be best characterized as:
Personal, confidential and simple with payments based on patients' financial capacity
Blue Cross Hospital Insurance, the predominant form of health insurance for decades, was modeled after:
Baylor University Hospital's school teachers plan
A central provision of the ACA to assure health care coverage for most Americans is:
the individual mandate
The major health care advances of the second half of the 20th century were in the area of:
vaccines and antibiotics to prevent and control infectious diseases, tranquilizers, the birth control pill
The American Medical Association's initial reaction to Blue Cross hospital insurance plans suggested that the plans:
Were unsound and unethical
Two primary issues that concerned many regarding the ACA:
individual mandate & Medicaid expansion
The goals of health information technology:
Both A (improve health care quality) and B (reduce health care costs)
Policies that call on the government to prescribe and control behavior of a group of individuals in which sanctions are imposed for noncompliance:
A health information exchange architecture that is designed for all institutions to periodically send copies of their clinical data to one central repository.
Monolithic Model
This level of prevention consists of rehabilitation and maximizing remaining functional capacity when disease has occurred and left residual damage; the most costly, labor-intensive aspect of medical care:
Tertiary prevention
This important Act in 1973 attempted to hold down costs by moving from fee-for-service to promoting health and preventing illness:
HMO Act of 1973
This key Act provided financial incentive programs for physicians to buy, install and adopt EHR systems.
To receive incentive payments for demonstrating "meaningful use," providers must meet criteria in three stages of EHR implementation. In what stage must providers meet objectives for "capturing patient data and sharing data in a standardized format with patients and other health care professionals?"
Stage 1
A physician who sends a prescription electronically to the pharmacy is an example of which type of HIT?
The US spends approximately what percentage of its GDP on health care?
The US health care system is unlike any in the world because:
Both A (it is fragmented) & B (it is $2.7 trillion industry)
Which of the following presents a key challenge or barrier to HIT implementation?
All of the above
The explosion of scientific knowledge and technological advancement has led to a shortage of:
primary care providers
As part of the ACA, health insurance companies will be held accountable by ensuring that premium dollars are spent primarily on health care, by generally requiring that at least _____% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and quality improvement.
The use of wireless communication devices to support public health and clinical practice:
Examples of alternative therapy:
all of the above
One of the first, most influential "plans" for hospital coverage, which generated the Blue Cross hospital insurance:
Baylor University Hospital plan
A major health care concern that has spurred multiple policies in health care:
all of the above
Which of the following is NOT considered on of the main determinants of health:
HIPAA implementation introduced several new provisions beneficial to individuals. Other than the privacy provision concerning patient data, which other was an important provision?
Elimination of preexisting periods for individuals moving from job-to-job
The AMA interest group has been vocal about which issue(s) facing physicians:
all of the above
The majority of financing in the US Health Care system comes from:
private sources
A health information exchange architecture that is designed for all institutions to maintain copies of their own data at their site in the format used by the HIE and give other institutions access to their database.
Federated Model
The two objectives of any health care delivery system, according to Shi & Singh:
enable all citizens access to care AND cost effective, quality care
Policies that benefit only certain groups of people by taking money from one group and using it to benefit another (i.e. Medicaid)
Establishment of the Office of the National Coordinator for Health Information Technology in 2004 was the federal government's first step toward creating:
a nationwide health network
"Meaningful use" of electronic health records is best described as:
efficient applications of electronic health records under internal criteria established within physician practices and hospitals.
The single most important factor in accelerating health information technology adoption since 2008 has been:
financial incentive programs that reward "meaningful use"
The central provision of the HITECH Act of 2009 was:
$ 20.8 billion allocation through the Medicare and Medicaid programs to incentivize physicians and health care organizations to adopt electronic health records
A major challenge of creating health information systems using data from many different sources is the feature known as "interoperability." The solution applied to achieving interoperability has been the development of:
health information exchanges (HIEs)
In health care, which of the following terms refers to a system that includes several service components with each addressing one or more dimensions of a population's health care needs?
Vertically integrated
In colonial America, the primary functions of hospitals were to:
shelter older adults, the dying, orphans, and vagrants and protect community residents from contagiously sick and mentally ill persons
Until the mid-1980s, hospitals were reimbursed for whatever they charged on a "retrospective" basis. Now they are paid a certain amount for each patient's care on a predetermined "prospective" basis. The amount they are paid is based on:
diagnosis related groups (DRGs)
In its landmark report on hospital errors, "To Err is Human," the Institute of Medicine emphasized that errors in care most typically originate from which one of the following sources?
Deficiencies in the systems of care
Hospital value-based purchasing now required by the ACA for over 3,000 Medicare participating hospitals is a program that may be best described as using:
Incentive payments for achievements and improvements in clinical care and patient satisfaction
A major trend is hospital corporate organization over the past few years as hospitals strategically prepared for system reforms has included:
Mergers and consolidations into larger systems of care
The ultimate responsibility for a hospital's quality of care, including the medical care provided, rests with a hospital's:
board of directors
A major obligation of doctors when obtaining informed consent for a medical procedure is to:
ensure that the patient understands the risks and benefits of the procedure
In addition to providing primary and preventive care, federally qualified community health centers also:
help patients link with other supportive programs and services such as welfare, Medicaid, the Women, Infants and Children supplemental nutrition program (WIC) and the Child Health Insurance Program.
In today's hospitals, outpatient clinics frequently provide:
all of the above
"Urgent Care" is best described as care:
provided on a walk-in, extended hour basis for acute illness and injury that is either beyond the scope of or availability of a primary care practice or retail clinic
The predominant services of local public health departments today are:
child and adult immunizations
The primary owners of community-based ambulatory surgical centers are:
Medical societies were first established for the primary purpose of:
improving the quality of medical education and practice
In 1905, the American Medical Association, with support from the Carnegie Foundation, commissioned a study of U.S. medical schools in response to decades of concern about the quality of medical education and training. The resulting Flexner Report is considered a benchmark in the history of medical education because it:
B. and C.
Which of the following organizations is responsible for approving the content of post-medical school residency training?
Accreditation Council for Graduate Medical Education
Health care reforms will change the emphasis in medical practice from treating illness in individual patients to maintaining wellness in community populations. This shift poses major challenges to the medical education process because:
all of the above
The U.S. imbalance between specialty physicians and primary care physicians has its origins in many factors. Which of the following does not contribute to physicians' attraction to specialty medicine over primary care?
Higher government tuition subsidies for specialty training
Academic Health Centers may be best described as:
complexes of medical schools and other health professional schools -- such as nursing, pharmacy, dentistry, and allied health -- affiliated with each other and with teaching hospitals and other research and clinical facilities
In order to provide direct patient care, physicians are required to:
complete a 3-7 year accredited residency program and pass a medical board exam of she state in which they will practice
In colonial America, the primary mode of medical education was:
A. and C.
Unlike medicine, dentistry essentially remains a "cottage industry," primarily serving only those with dental insurance or who can afford to pay out-of-pocket. For this reason:
Many of the population groups with the greatest need have no access to services
A physician residency training program is best described as:
an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medical specialty
The widespread use and popularity of complementary and alternative medicine in the U.S. resulted in which of the following developments?
The National Institutes of Health creating the National Center for Complementary and Alternative Medicine (NCCAM)
Health care system changes, including advancing technology, will likely result in new, more highly specialized health occupations. Which of the following is not one of the expected effects of this development?:
hospitals' resistance to employing multi-skilled personnel
Each year approximately 6,000 international medical graduates (IMGs) enter the U.S. to practice. IMGs are vitally important to the health care delivery system because they:
they fill a shortfall in the number of residents required by U.S. hospitals
The category of allied health professionals, "therapeutic science practitioners" concerned with the treatment and rehabilitation of patients with all types of diseases and injuries include which of the following professions?
Physical and occupational therapists, speech language pathologists
At the outset of the nurse practitioner movement, educational requirements were often limited to relatively short certificate programs. Today, it is generally accepted that nurse practitioners should be registered nurses with:
a master's degree
The predominant practice setting in the healthcare industry:
Which of the following is considered a physician?
The first state to restrict medical licenses to graduates of medical school
Which of the following specialist is also considered a generalist?
The most restrictive form of credentialing that restricts entry into practice and prevents abuse of titles
Systematically developed protocols concerning appropriate health care:
Clinical Practice Guidelines
The Hill Burton Act:
Expanded hospitals to over 4,600 within 20 years of its passage
Outpatient care is synonymous with:
Ambulatory Care
The primary driver for the increase in ambulatory surgical procedures:
Both A and B
According to the Flexner Report, this school was the "model for medical education":
Johns Hopkins
The ACA will impact the health care industy in which way?
All of the above
The first medical school:
College of Philadelphia
The "Patient Bill of Rights" was established by the AHA in:
Retail clinics have lessened the ______ problem that is often seen in office-based care.
The healthcare workforce projects _________ new jobs will be created in the industry in the next decade:
5.6 million
Supply of specialists to generalists is:
The Donabedian Model for quality addresses:
All of the above
A system of reimbursement that changed hospitals' behavior in discharging patients because the patient's diagnosis would determine how much the hospital would be paid:
Diagnosis-Related Group
This act states that patients in emergency care settings must be evaluated and stabilized and cannot be turned away:
Emergency Medical Treatment and Active Labor Act
Most acute care hospitals in the United States:
Which source did NOT shape the hospital industry in the early-mid 1900's?
None of the above
The basic concept of health insurance is antithetical to the premise on which personal or property insurance was historically defined because:
other forms of insurance were intended to cover individuals against the low risk of unlikely events such as premature deaths or accidents while health insurance provides coverage for unlikely events in addition to routine and discretionary services
The "Managed care backlash" beginning in the 1990s, refers to:
health care providers and consumers protesting managed care's restrictive policies on provider choice, referrals to specialty care and other practices
Although the ACA will enact sweeping U.S. health care system reforms, one fundamental element of the system that will remain unchanged is:
financing of health care expenditures through a combination of public and private sources
The intent of the Medicaid Child Health Insurance Program (CHIP) was to:
enroll 10 million uninsured children in Medicaid whose family incomes were too high to qualify for Medicaid but too low to purchase private health insurance
The managed care concept called "capitation" refers to:
physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid fee
The Centers for Medicare & Medicaid Services "Hospital Compare" web-based program the primary purpose of:
providing consumers with objective criteria that allow comparisons of hospitals' use of evidence-based practices and patient satisfaction ratings
Cost-control initiatives undertaken by managed care organizations to improve communications with chronic disease patients in the hope of avoiding unnecessary, costly care are known by the term:
disease management
Medicaid and CHIP quality initiatives are carried out through partnerships with the respective states' programs using five quality criteria that include which of the following?
prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of services
Major drivers of U.S. health expenditures include:
advancing medical technology, growth in the older population, specialty medicine, labor intensity, and reimbursement system incentives
Enacted in 1965 as Title XIX of the Social Security Act, Medicaid is:
a joint federal-state program supporting basic health services for low income individuals and in which federal and state support is shared based on a state's per capita income.
Under the ACA, most Americans will be required to have health insurance or be penalized with an annual tax. In the ACA legislation, this requirement is popularly known as:
"individual mandate"
Enacted in 1983, the Diagnosis-related Group payment methodology shifted hospital reimbursement from the retrospective to prospective basis. The major purpose of this new payment system was to:
provide financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patients
The current highest personal care expenditure in the U.S. is for:
hospital care
The Healthcare Effectiveness Data and Information Set (HEDIS) may be best described as:
a standardized method for managed care organizations to collect, calculate and report information about their performance to facilitate purchasers' and consumers' comparisons of different insurance plans on a variety of parameters
Respite care is best defined as:
services that temporarily relieve informal caregivers through assistance in the home or through institutional placement on a temporary basis
Which of the following best describes the informal long-term care system?
care and assistance provided in the home by family members and friends
A long-term care innovation, "naturally occurring retirement community," is best defined as:
apartment complexes, neighborhoods, or sections of communities where residents have opted to age-in-place
The major distinction between skilled-nursing and residential care facilities is that skilled nursing facilities:
provide care primarily for people requiring intensive nursing, rehabilitation, or related services
Which of the following societal factors increases the need for formal long-term care services?
women working outside the home
Long-term care and nursing-home reform legislation of the 1970s occurred as a response to which of the following:
A and C
The development of formal home care services, such as those provided by the Visiting Nurses Association originated as:
a social response to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseases
Long-term care is best described as:
services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needs
During the 1960s, one factor that enabled mentally ill persons to move from large institutions to community settings was:
the development of effective pharmacologic treatments for many disorders
The term, "non-parity," as it applies to insurance coverage for mental health services, is best defined as:
insurers using different and unequal systems to cover mental health from those used for medical care
National awareness of the needs of the mentally ill rose sharply in the aftermath of WWI because:
thousands of soldiers returned from the war suffering from "war neurosis" or "shell shock"
"Recovery Oriented Systems of Care" (ROSC) refers to a major paradigm shift in the approach to mental health assessment and treatment planning. One essential feature of ROSCs is:
shifting treatment plan emphasis from symptom reduction to a "hope plan" for the individual's future
Psychiatric and behavioral health problems are treated by an array of providers loosely categorized into four sectors. The sector consisting of social service agencies, school-based counseling services, rehabilitation services, vocational services and criminal justice/prison-based services is known as which of the following?
human services
Many factors are associated with lack of access to mental health care. One reason why only about one-third of those in need of mental health services actually receives them is:
fear of family and social stigmatization
In colonial American, mental health "treatment" consisted of:
confinement in homes, in jails or in almshouses where patients suffered severely
An individual's diagnosis with two or more mental illness diagnoses occurring at the same time is termed:
A significant contribution of the ACA to enhanced mental care will be:
Requiring health insurance policies to include coverage for psychiatric and behavioral health treatment and parity with coverage for medical treatment
Cost sharing techniques (i.e. deductibles, co-payments and co-insurance) are put in place to limit _______________.
The most popular HMO model:
PPO model
Approximately one in _____ individuals suffer from a chronic condition.
Which of the following is not included in the top 3 sources of health care financing?
CHIP financing
Medicaid funding is provided by _______ government(s).
Both Federal and State
Which of the following is a major concern for the long term care industry?
cost effectiveness
Medicare prescription drug coverage fall under which option:
Part D
Recent estimates place the number of family caregivers at over ________ million individuals.
According to Ruby Wax and the TED Talk on Mental illness, society needs to lose the _______ associated with mental illness:
societal stigma
Will the uninsured continue to pose a problem to our health care system, after the ACA is fully implemented?
Provides skilled nursing care and related services for people requiring medical, nursing, or rehabilitative help:
Skilled Nursing Facilities
Which of the following is NOT an institutional-based setting for long term care?
Home Health Care
In 1955, 77% of mental health services were delivered on an in-patient basis. By 1990, the number of mental health services delivered on an in-patient basis ___________.
Costs associated with assisted living facilities are borne largely from __________ resources:
In Hospice, this type of care is given to someone with a diagnosis of terminal illness with a life expectancy of 6 months of less.
palliative care
Approximately one in _____ individuals suffer from a diagnosable mental disorder every year.
Which of the following varies widely among long term care recipients?
all of the above
Reimbursement is a barrier to respite care because funding mechanisms view it as meeting a __________ need, not a medical need.
As of 2011, the United States spent $________ on health care which equates to _____% of our GDP.
2.6 trillion; 17.9
"Public Health" is most broadly defined as:
community efforts to cope with health problems arising from people living in groups
One reason why public health suffers from a poor public image is:
public health's major triumphs such as the virtual eradication of vaccine-preventable childhood diseases have resulted in those diseases' disappearance from the public's awareness and political attraction
Colonial America's public health practices in the form of almshouses and town-employed physicians were modeled upon:
England's "Poor Laws"
Ecological models as applied to public health are best described as:
Models that take into account the vast number and interdependence of factors or determinants that impact the health status of groups of people
As a professional health- oriented discipline, public health is unique in what way?
it uses an interdisciplinary approach and methods with emphasis on preventive strategies, links with government and politics and dynamic adaptations to new problems
Overall success in meeting Healthy People 2010 goals for improved health status of Americans is best described as:
a disappointment because health disparities have not changed for 80% of health objectives and have increased for an additional 13%
The primary purpose of the Prevention and Public Health Fund created by the ACA is to:
Eliminate unpredictable federal budget appropriations for public health and prevention programs
The major difference between public health ethics and medical ethics is that while medical ethics have an individual and clinical focus, public health ethics:
are concerned with institutions' interactions with communities
The federal government's principal agency concerned with health protection, promotion and provision of services to vulnerable populations is the department of :
Health and Human Services
The September 11, 2001 terrorist attacks highlighted which of the following about the U.S. public health system?
inadequate numbers of skilled public health professionals such as nurses, epidemiologists and lab workers
In evaluating the quality of health care, explicit standards differ from implicit standards in that:
explicit standards are developed and agreed upon in advance of the assessment to minimize variation and bias
Clinical research focuses primarily on:
steps in the process of medical care such as early detection, diagnosis, and treatment of disease or injury
In contrast to traditional, randomized controlled studies, outcomes research evaluates results of health care processes by:
focusing studies on the "real world" of physician offices, hospitals, clinics and homes and includes patients' functional status
In conducting experimental studies, ethical issues may arise about:
Exposing research subjects to unknown risks or withholding beneficial treatments from control groups
The Agency for Healthcare Research and Quality (AHRQ) is a federal agency charged with:
improving outcomes and quality of health care services, reducing costs, improving patient safety and fostering effective services
Empirical standards for assessing the quality of health care practices rely upon:
distributions, averages, ranges and other data of variability measures and information collected from similar health services providers to compare practices to a norm
Changes in the health care delivery system are resulting two new, emerging roles for physicians. These are:
hospitalist and physician manager/administrator
One challenge to achieving the anticipated contributions of health information technology to the quality and cost-effectiveness of health care is:
fragmented patient information produced by a disorganized treatment system
The ACA core principle that offers potential to begin closing the gap between public health and medicine is:
reimbursement incentives aligned with population health status rather than individual health outcomes
As system reforms in primary care continue, the roles of nurse practitioners and physician assistants will likely:
Reduce the need for primary care physicians in rural and inner city communities
Attempts at health care system reforms of the basic problems of cost, quality and access have consistently demonstrated that which of the following results?
changes in any one of the 3 basic problems produces unintended consequences with one or more of the other two
Nurses may be among the best prepared to respond to delivery system reforms because:
their training emphasizes behavioral and preventive aspects of health care and they are experienced with coordinating teamwork with other professionals
Which of the following poses as a "future research challenge" in the health system:
All of the above
Advances in ________ have made same-day surgery possible for procedures that formerly required hospital admissions.
All of the above
The core discipline of public health research:
The growth of home health care will be a future trend because:
the US has a growing and aging population
When considering the determinants of health, the environment and lifestyles (behaviors) significantly impact one's health status more than any other determiant. However, the US spends more money funding which health determinant:
Medical model
There is a predicted shortage of ________ primary care physicians by the year 2025.
Measuring patient satisfaction is important because:
It captures aspects of care and personal preferences that contribute significantly to perceived quality
Which of the following is NOT part of the Healthy People steps toward understanding/combatting public health issues?
_______ kill between 44,000-98,000 people a year.
Medical errors
Which of the following does not constitute a public health issue:
None of the above
Health information technology by way of electronic medical records that lacks the ability to "communicate" with other systems has an issue with:
Because f the changing composition of the health care delivery system, ___________ are no longer considered the "hub" of the health care system.
An effect of the employer mandate of the ACA:
Both A and B
This Act of 2009 included $1.1 billion over a period of 2 years to expand "comparative effectiveness research" by the AHRQ and the NIH:
American Recovery and Reinvestment Act
In 1912, the US Public Health Service changed its name. What was it known as prior to 1912?
Marine Hospital Service
One of the largest and longest running health services research projects ever undertaken that has contributed vast amounts of information on the effects of cost-sharing on the provision and outcomes of services:
RAND Health Insurance Experiment
Research related to workforce supply and employee turnover would fall under which category of health research:
Health Administration
Because of the projected health care workforce shortage, the ACA proposes to address the gap in the comprehensive workforce planning with a:
National Health Care Workforce Commission
Which of the following is NOT a demand that the aging population will place on the healthcare system?
Decreased LOS in acute care hospitals
In an effort to enforce greater clinical accountability, _________ will no longer reimburse providers for treatment required after an adverse event (i.e. a "never" event, "serious" event, or "preventable" event).
Both A and B
The systematic application of the best available evidence to the evaluation of options and decisions in clinical practice:
Evidence-based medicine
Which of the following is an "arm" of the Department of Health and Human Service?
All of the above
The Patient Centered Outcomes Research Institute (PCORI):
Both A and B
The Tuskegee Syphilis experiment is an example of a ____________ experiment wrought with ethical issues:
Public Health
An influential report by Lemuel Shattuck documented:
morbidity and mortality rates in differing locations
Which of the following is considered a quality-monitoring activity that allows providers can measure and meet quality standards:
All of the above
Which level of government is NOT responsible for ensuring public health initiatives:
None of the above
Which of the following represents a "historic landmark" for our health care system after many failed attempts at reform: