The government program designed to provide health care to people who are 65 years of age or older is called:
Baring major system changes, health service expenditures are projected to continue to decrease. (True or False)
False (Health care costs are exploding and are out of control.)
The U.S. safety net is for the nation's most vulnerable populations. Whic of the following is not considered a vulnerable population?
A primary motivation in the development of managed care was to:
contain costs and expenditures of health care
The U.S. government plays a limited role in the health delivery system. The government's role in this arena is to:
to organize and be responsible for care delivery for Medicare and Medicaid programs
Which one of these choices is not a characteristic of managed care?
manages to take care of those only in financial need
: Why is the US health care market considered to be "imperfect"?
prices are determined by health plans rather than the interaction of the forces of supply and demand
What is the main role of the government in the US health delivery system?
To be the major financier of health care delivery through Medicare and Medicaid programs
In a socialized health insurance system, health care is financed through
government-mandated contributions by employers and employees
True or False: The national health care model for Germany, Israel and Japan is the national health system.
What is the primary reason for employers to purchase insurance plans to provide health benefits to their employees?
Due to the fact that the U.S. does not have a universal health care system, employers purchase health insurance plans as a fringe benefit for their employees.
True or False: The tax-supported national health care program in a national health insurance system is financed by private providers rather than the government.
Over the last decade, the hallmark of the US health care industry has been
organizational integration to form integrated delivery systems or networks
True or False: Capitation is a payment mechanism in which all health care services are included under one set fee per covered individual.
Vulnerable populations does not include which of the following poor, uninsured, minority status, insured employees
The United States spend more than any other developed country on health care, and costs have
continued to rise
The World Health's Organization's definition of health is
state of physical and mental well-being that facilitates the achievement of individual goals
Illness is different from a disease in that illness
is the person's own perceptions and evaluation of how he or she feels
: One of the purposes of the Healthy People Initiative is to
integrate medical care with preventive services
True or False: Under the social justice system, inability to obtain medical services because of a lack of financial resources is considered unjust.
Community health assessment is a method used for conducting
of broad assessments of populations at the local or state level
True or False: From an economic perspective, curative medicine seems to reproduce decreasing returns in health improvement while health care expenditures increase.
Which answer is not one of the four major determinants of health? (Environment, Religion, Heredity, Behavior)
True or False: Quality of life refers to the overall satisfaction with life during and following a person's encounter with the health delivery system
What type of health insurance is based on the market justice?
private, employer-based health insurance
What is the role of health risk appraisal?
To evaluate risk factors and their health consequences in individuals
True or False: Heredity is a key determinant of health because genetic factors predispose individuals to certain diseases.
Which of the following has been the primary factor that has shielded the U.S. health care system from a major overhaul?
Beliefs and values
Which of the following was not a factor that led the rapid expansion of employer-based health insurance? (The Supreme Court ruled that employee benefits were a legitimate part of union-management negotiations, Employer-provided health coverage became nontaxable, The Congress mandated that employers offer health insurance, OR Employers offered health insurance to compensate for loss of raises in salaries during World War II
The Congress mandated that employers offer health insurance
During the Preindustrial era, medical practice was extremely competitive. What caused this intense competition?
Anyone, untrained or trained, could be a physician
The American Medical Association (AMA) played a dominant role in:
Protecting the interests of physicians
What was one of the main reasons for the failure of national health insurance proposed by President Clinton in 1993?
Americans were unwilling to pay higher taxes for such a program
In 1964, health insurance for the aged and the poor became a top priority for President Johnson's administration. In 1965, Medicare was created as:
a two-part program for the elderly that provides health insurance-regardless of income
Which of the following illustrates corporatization in the American health care delivery system?
Managed Care Organizations
True or False: Because the factors that shape health care delivery are easily identifiable, it is often easy to trace a change to the factor responsible for bringing about the change.
Which of these factors has primarily shielded the U.S. health care system from a major overhaul?
Beliefs and Values
True or False: Medical practice in the U.S. emphasizes specialization while basic care is given only secondary importance.
Fundamental reforms in the financing and delivery of health care will require
A change in mind set of middle-class Americans
Why was medical practice characterized by intense competition in the preindustrial era?
Anyone could practice medicine
True or False: In Europe, hospitals had developed much earlier than they did in the United States.
True or False: The early health care institutions in the U.S. served mainly a charitable purpose.
True or False: The AMA was the first organization to support salaried employment of physicians by hospitals.
Physicians began to play a dominant role in hospitals mainly because
they could decide where to hospitalize their patients
True or False: Private health insurance began in the form of hospital plans that did not include outpatient services.
Which of the following triggered employer-based health insurance as a benefit? (Union-management negotiations, The World War, Wage Freezes, Supreme Court Ruling)
The health care subdivision of the U.S. economy continues to grow because
immigration continues to rise leading to a growth in population & baby boomers hit retirement age and are receiving Medicare
Which answer does not describe a negative consequence of specialty maldistribution? (a. high volume of intensive, expensive medical services, b. specialist services have less impact in improving overall health status, c. there are access problems by the underserved, d. more predictable hours and higher prestige for specialists)
more predictable hours and higher prestige for speciaists
Studies have shown that Nurse Practitioner services
improve access to primary care & concentrate more time with patients than physicians
A health or hospital administrator does which of the following? (A. helps patients receive medical care but only if they have insurance, B. organize the operational, clinical, and financial outcomes of the entire health system, C. increase health care spending to help make a profit for their hospital, or D. attract specialists, which increases the maldistribution of physicians in rural areas)
organize the operational, clinical, and financial outcomes of the entire health system
A doctor of osteopathic medicine is different from an MD in that they have training in:
preventive and holistic medicine
The allied health professional
constitutes approximately 60% of the U.S. health care work force and complements physicians and nurses in delivering health care
The health care sector of the US economy continues to grow due to
Aging of the population & growth of the population
Do additional years of advanced residency training in their speciality and seek certification in an sara of medical specialization only
True or False: The differences between primary and specialty care are by the time, focus, and scope of services provided to the patients
Why is there an imbalance and maldistribution of physicians?
Geographic maldistribution, speciality maldistribution, and aggregate physician oversupply
Which answer is not a negative consequence of specialty maldistribution? (high volume of intensive, expensive medical services, Specialist services have less impact in improving overall health status, Access Problems by the underserved, OR More predictable hours and higher prestige for specialists)
More predictable hours and higher prestige for specialists
True or False: Physicians are more likely to concentrate in rural and inner-city areas than metropolitan,suburban areas
Which answer does not belong to the four main categories of nurses? (Clinical, NP, Technicians, Certified Nurse Midwives)
True or False: Advanced Practice Nurses have attained education and training beyond the RN level
What are the values of NPP services?
Improve access to primary care & Better communication and interviewing skills than physicians
A health service administrator job is to
organize, coordinate, and mange health care services delivery
True or False: Nonphysician Practitioners practice in many of the areas in which physicians practice and also have an MD or DO degree
Maldistribution refers to
a surplus of health providers in a given area & a shortage of health providers in a given area
To alleviate the maldistribution problem, which of the following has been done?
Financial support for family medicine programs & expansion of nurses' roles
True or False: Pharmacists do not need a state license to dispense medicines prescribed by physicians
Which type of doctor encounters the greatest proportion of ambulatory care visits?
True or False: Health Services administrators can only work if they have a Master of Business Administration
The Health Insurance Portability and Accountability Act (HIPAA) was enacted to address which of the following?
Confidentiality of patients' health information
Current legislation regarding new drugs in the U.S. requires that
the FDA review the safety and effectiveness of a new drug before it is marketed
Capitalism and lack of government intervention play a major role in the desire to have the state-of-the-art technology. What three qualities are necessary to determine effectiveness of technology regarding patient care?
does it work; is it valuable; is it safe
True or False: In addition to drugs and devices, the FDA also has the authority to review medical and surgical procedures for their safety and effectiveness.
True or False: It is accurate to say that high-technology medicine equates to high-quality care.
What is the primary benchmark for satety with regard to medical technology?
Benefits must outweigh any negative consequences
Which of the following has not taken central stage in U.S. health care delivery?
incorporation of cost-effectiveness into clinical practice
True or False: Countries that have national health insurance programs end up limiting the use of medical technology.
True or False: In a general sense, medical technology can include scientific advances from any branch of science.
Privacy of patient information is regulated by the
Health Insurance Portability and Accountability Act
Information technology cannot be used to
access personal information for purposes not related to medical care
True or False: The U.S. develops most new technology, but, on a per capita basis, other advanced nations employ more technology than the United States does.
True or False: Specialists use more technology than primary care physicians but only because specialists treat more complex conditions.
Which of the following is true about the FDA's role in approving new drugs today?
The FDA recalls drugs only after harm has occurred.
True or False: Accleration of the drug approval process by the FDA has resulted in a higher number of drug recalls due to safety concerns.
Consumer behavior that leads to a higher utilization of health care services when the services are covered by insurance
WHich of the following groups of beneficiaries has the largest proportion enrolled in managed care plans? (Medicare beneficiaries, Workers in employer-sponsored plans, Medicaid beneficiaries, OR members of unions)
Workers in employer-sponsored plans
Which of the following is an example of retrospective utilization review? (a. Medical records are examined to assess whether the care was appropriate, b.A hospital discharge planner determines that a patient can safely return home and receive ongoing care through a home health agency, c. A patient's health plan determines that outpatient surgery would be appropriate and denies admission to the hospital, OR d. A nurse and a physician determine that a patient's condition requires at least one more days stay in the hospital)
Medical records are examined to assess whether the care was appropriate
under Medicare Part A or B? (vision care, outpatient rehab, limited home health, inpatient hospitalization)
Which of these is not directly associated with financing of health care?
Determines how much hospitals will spend on treating each patient
National health insurance would lead to uncontrolled health care expenditures unless
Supply-side rationing is implemented
The prospective payment system based on DRGs
pays hospitals according to the patient's principal diagnosis
Under discounted fee arrangements
providers agree to discount their regular fees in exchange for the volume of business an MCO brings
During the 1980s, employers started switching from traditional health insurance to managed care plans because
health insurance had become less and less affordable
True or False: Compared to publicly insured beneficiaries in the Medicare and Medicaid programs, a greater proportion of privately-insured individuals are enrolled in managed care plans
In concurrent utilization of review
decisions regarding appropriateness are made during the course of health care utilization
True or False: Commerical insurance companies have been forbidden by law from developing managed care plans.
True or False: Compared to other types of managed care plans, HMOs place considerable emphasis on preventive services.
Comprehensive research shows that health care quality has declined in managed care. (True or False)
In a joint venture, two or more institutions continue to conduct their main businesses independently. (True or False)
To increase the comprehensiveness and continuity of services, the appropriate strategy is
Which of the following is listed as one of the main reasons why outpatient services have increased in popularity over the past 15 years? (Increase in hospital technology budget, Private/public insurance reimbursement, Increase in staff at acute care hospitals, and Decrease in MCOs)
Private/public insurance reimbursement
True or False: Compared to general hospitals, specialty hospitals offer services that are clinically superior
Small hospitals owned and operated by physicians were known as proprietary hospitals. These hospitals were...
Which of the following is credited with having the greatest impact on the expansion of hospital beds in the US?
What triggered the downsizing phase in the U.S. hospital industry during the 1980s?
Competitive pricing and discounted fees
Which of the following is not considered a community hospital? (VA hospital (Department of Veterans Affairs), Hospitals with patient stays of less than 30 days, Private for-profit hospitals, OR local or state governmentally owned and operated hospitals)
VA hospital (Department of Veterans Affairs)
Which of the following is not considered a long-term care service? (Respite for caregivers, Dealing with death and dying issues, pain management, treatment for acute illness)
Treatment for acute illness
In a short stay hospital, the average length of stay (ALOS) is which of the following:
Less than 30 days
True or False: Areas in which primary care is stronger have much lower total health care costs than areas that exclusively focus on specialized care
True or False: Community health centers are required by law to be located in medically underserved ares
Which factor does not contribute to the growth of group practices rather than solo practices? (the simplicity of billing and collections in a multi-payer system, rapid changes in the health delivery system, contracting MCOs with consolidated rather than solo entities, high cost of establishing a new practice)
the simplicity of billing and collections in a multi-payer system
True or False: In a gatekeeping system, patients can visit specialists without a referral from their primary care physicians.
Why is outpatient care considered an important key component of overall business strategy?
Outpatient services now constitute a key source of profits for hospitals
The growth of non-hospital-based ambulatory services intensified competition for outpatient services between
hospitals and community-based providers
Which service is not one of the five main hospital-based outpatient services? (Clinical, Surgical, Emergency, OR None of the Above)
none of the above
Which of the following is not one of the key changes that have been important in shifting the balance between inpatient and outpatient services? (Reimbursement, utilization control, technological factors, none of the above)
None of the above
Both private and public payers have a clear preference for outpatient treatment because it costs less than inpatient care (Truth or False)
Home health care
is based on the philosophy of maintaining people in the least restrictive environment possible
True or False: Development of new diagnostic and treatment procedures and less invasive surgical methods has made it possible to provide services in out-patient settings that previously required inpatient stays in hospitals.
Many hospital outpatient clinics, particularly those in inner-city areas
Function as the community's safety net
True or False: Patients generally have a preference for receiving health care in home and community-based settings.
True or False: Higher primary care physician supply has been associated with lower low-birth weight percentages and lower infant mortality.
Hospitals began to attract well-to-do patients when
Hospitals began to attract well-to-do patients when
Which of the following was not a primary factor that contributed to the growth of hospitals in the United States? (population growth, technological advances, health insurance, Hill-Burton Act)
True or False: Implementation of the prospective payment system slowed down the growth of national spending on hospital care.
Truth or False: Discharges rather than admissions more accurately measure the number of people served by a hospital.
True or False: Women are admitted to hospitals more often than men, and also incur longer stays than men.
True or False: A 200-bed hospital has an average daily census of 120. Based on these figures the hospital's occupancy rate is 66%.
Which of the following is not a characteristic of a community hospital? (Short stay, Federal, private or government owned, or general or speciality care)
True or False: A general hospital is distinguished from a specialty hospital in that the former does not provide specialized medical care.
True or False: Specialty hospitals provide only a narrow range of services for specific medical conditions.
True or False: Osteopathic hospitals have been built because osteopaths can no longer practice alongside traditional physicians.
True or False: Licensure allows a hospital to participate in the Medicaid and Medicare programs.
Which of the following is not voluntary? (Accreditation, Certification, Licensure, Serving Medicare and Medicaid patients)
True or False: Generally, as a person ages, a decline in ADLs sets in later than a Decline in IADL's.
Which of the following is not a goal of community-based long-term care services (respite care, establish an administrative network of LTC, prevent of delay institutionalization, supplement informal care)
establish an administrative network of LTC
These programs may specialize in delivering medical, nursing, and rehabilitation services for patients who may be recovering from some acute episode.
Adult Day care
The main distinction between personal care homes and assisted living is that the latter provide
True or False: SNF certification allows a facility to admit both Medicare and Medicaid patients
Which facility provides special programming and care modules for patients suffering from mental retardation and associated disabilities?
True or False: To be certified, a nursing home must comply with federal rather than state standards.
True or False: Which facility provides special programming and care modules for patients suffering from mental retardation and associated disabilities?
Health vulnerability is defined as
combined factors overwhich individuals have little or no control which predispose them to illness and disease
Which of the following is characteristic of this ethnic group?- Black Americans
Higher neonatal, infant and post-natal mortality rates
Minorities generally receive poorer quality, less access and greater deficits in health status. What is a reason this occurs in Hispanic Americans?
Nearly 1/3 have less than a 9th grade education
Which of the following is a major health concern for women? (higher chance of developing more acute and chronic illnesses, poorer health outcomes, greater morbidity, all of the above)
all of the above
Amy's family is typical of the state of the economy in Texas. Her parents are recently unemployed and are living with a family member until things get better. Amy has been displaced from her home and is sleeping on the floor at her aunt's apartment. She receives two meals a day at school and eats little on the weekend. Amy's story is an example of:
It is estimated that over 20 million Americans live in areas with primary care shortages. What is a principle reason that rural citizens cannot access health care services? (Physicians won't set up a practice unless it can be financially viable, they lack transportation to get to services when available, rural citizens lack health care insurance, work in small businesses or part-time with no benefits, they are typically poorly educated and have few economic resources, OR all of the above)
All of the above
True or False: Significant health differences exist across the various racial and ethnic groups in the U.S.
True or False: The vulnerability model is an integrated approach to studying the susceptibility of certain populations experiencing good health
Disability refers to
impairments of bodily functions& restrictions of performing activities of daily living
The Healthy Schools, Healthy Communities Program became
the first federal program that encouraged the development of new, comprehensive full-time school-based primary care programs serving vulnerable children
True or False: The mental health system is composed of one system that provides services to individuals with only insurance coverage
the interaction of multiple factors that individuals have little or no control over.
Which of the following is not a health concern of women (greater morbidity, poorer health outcome, higher chance of developing more acute and chronic illnesses, higher chance of receiving second-rate health services)
Higher chance of receiving second rate health services
True or False: Health concerns of children include lack of insurance, vaccinations, and delayed access to medical care
Developmental vulnerability refers to
the rapid and cumulative physical and emotional changes that characterize childhood
How is mental health provided in the U.S.?
Through only private resources & Through only public services
Who is not one of the major mental health professionals (Social workers, Medical students, Therapists, psychologists)
True or False: Effective January 1, 2003, the United States Office of Management and Budget announced seven official racial categories
"New morbidities" include (drug abuse, alcohol abuse, family and neighborhood violence, or all of the above)
all of the above
True or False: There are no significant differences across the various racial/ethnic groups on health
True or False: Women in the U.S. enjoy a life expectancy almost eight years longer than that of men, but they suffer greater morbidity and poorer health outcomes.
The Community Health Center Program was established in
1969 to improve access to health care services for low-income families
If a physician orders more tests and services that are NOT medically justified because of the threat of malpractice lawsuits, this is called
Central health planning is a characteristic of what type of national healthcare system?
Diagnostic related groups (DRGs) were put in place to decrease costs by
Creating certain procedure/service codes to streamline payment to hospitals
True or False: Growth of technology is a reason for increased health care costs in the U.S. but not in other countries
According to Donabedain, in order to help define and measure quality in health care organizations, there are 3 domains that are equal in importance that must be evaluated collectively. Which of the following is NOT one of the 3 domains? (Risk, Structure, Process, or Outcomes)
Which process improvement area deals with reviewing unusual occurrences in the health care organization and then focuses on implementing strategies to decrease those events? (Cost Efficiency procedures, patient care plans, Risk Management, Continuous quality improvement programs)
Macroperspective of costs
is a widely used measure for national health expenditure of the proportion of the gross domestic product a country spends on the delivery of health care services
Trends in national health expenditures are evaluated by
direct transactions between provider and patient & comparing changes in national health spending to changes in the GDP
True or False: The health care sector will remain one of the fastest growing components of the US economy
is when a doctor orders additional tests and services as a protection against lawsuits
"Health Planning" refers to
an undertaking by the government to align and distribute health care resources that would achieve desired health for all people
In 1971, Nixon imposed what program that placed limits on the amount hospitals could raise their prices annually?
Economic Stabilization Program
What is peer review?
A general process of medical review of utilization and quality carried out by physicians
True or False: The administrative costs in a multi-payer system are nearly double of what they would be in a single payer system
Micro Quality Indicators determine quality by focusing on
medical errors, patient satisfaction, and quality of life
are costs associated with the management of financing, insurance, delivery, and payment
True or False: Population-based surveys supported by federal statistical agencies are the major data sources for conducting analyses on access to care
refer to the cost-sharing mechanisms that place a larger cost burden on consumers
Why should the U.S. control the rising costs of health care?
Rising health care costs can erode the competitive position of American businesses in international markets
Which of the following is not one of the nine major factors contributing to high costs of health care
Lack of growth in technology
One reason why past attempts to bring universal access to health care is the
concern that such a move would be extremely costly in terms of national health care expenditures
True or False: Health care is among the few services for which a third party, not the consumer, pays the lion's share for most of the services used.
Risk management consists of
proactive efforts to prevent adverse events leading to medical malpractice
Due to a competitive employee environment, the Supreme Court ruled in the post WWII days that employers could use _____________ in the collective bargaining process.
When it comes to healthcare funding/financing in the US, which sector plays a larger role?
Which of the following is NOT an essential role that individual states play in healthcare policy making?
Providing all funding for graduate medical residents
What two main concerns dominate the debate today over Medicare reform policy?
Decrease spending; comprehensive coverage
True or False:Redistributive policies focus on taking power from one group and giving it to another
What are some of the principal features of U.S. health policy?
fragmented, piecemeal policy
decentralized role of the state
True or False: Health Policy refers to public policy that pertains to or influences the pursuit of health
What is the major concern of federal and state governments in regards to health care?
Cost Containment & Access to care
What is the most important decentralized role of the states
financial support for the care and treatment of the poor and chronically disabled
Which of these choices does not belong to the five components important for formation and implementation of health policy?
Public support financing
True or False: Special population groups such as veterans, Native Americans, and members of the armed forces have coverage provided directly by the federal government
Regulatory Tools call on the government to
call on the government to prescribe and control the behavior of a particular target group
True or False: : In 1965, the adoption of the Medicare and Medicaid legislation expanded the health sector by providing publicly subsidized health insurance to the upper and middle classes only
The recently enacted State Children's Health Insurance Program allows
States to use Medicaid expansion to extend insurance coverage to uninsured children who are not qualified for existing Medicaid Programs
True or False: Employer-provided health insurance benefits grew rapidly in the middle decades of the 19th century
American Association of Retired Persons advocates programs
To expand financing for long-term care for the elderly
The health policy concerns of American employers are shaped by
the degree to which employers are involved in the provision of health insurance benefits for their employees
True or False: The government plays a subsidiary role to the private sector in the health care field
The purpose of policy intervention is to
Identify situations in which markets fail or do not function efficiently
Healthy policy concerns regarding medical technology are driven by
The important role it plays in rising health costs
The health benefits provided to people
The utilization of medical technology to provide economic benefits aside from health benefits
True or False: Government spending for health care has been largely confined to filling the gaps in the private sector
license and regulate health care facilities and restrict marketing and price of health insurance
The greater control states have over health care policies
Means that it is more difficult to coordinate a national strategy
The making of health policy in the United States is a
complex process involving both an dprivate sectors
True or False: States are vested with limited legal authority to regulate almost every facet of the health care system
Employers are passing on the rising costs of health care to employees by:
Increasing cost sharing of health care services
Ever-Increasing health care costs will require __ at some point in the future
If a comprehensive health insurance reform is to occur in the US which of the following is the least likely to be adopted?
True or False: The US does not have universal health insurance because most Americans are opposed to expanding coverage to the uninsured.
True or False: Consumers have no incentive to be prudent purchaser of health insurance in a defined benefit plan
Which single factor will dramatically increase health care expenditures starting around 2013?
Retirement of baby boomers
As health insurance reform moves forward, at least initially who is likely to bear an increasing burden of high premiums?
Assuming that a major health care reform occurs in the U.S., which proposal is the least likely to be adopted?
In which program, prospective budgets are used to control national health expenditures?
True or False: Since most infectious diseases have now been conquered, the health care system must pay particular attention to chronic disease management.