115 terms

Healthcare Delivery 100 Midterm Study Guide

The primary objectives of a healthcare system include all of the following except?

a. Enabling all citizens to receive healthcare services
b. Delivering healthcare services that are cost-effective
c. Delivering healthcare services using the most current technology, regardless of cost
d. Delivering healthcare services that meet established standards of quality
The U.S. healthcare system can best be described as:

a. Expensive
b. Fragmented
c. Market-oriented
d. All of the above
For most privately insured Americans, health insurance is:

a. employer based
b. financed by the government
c. privately purchased
d. none of the above
Medicare is primarily for people who meet the following eligibility requirement:

a. Elderly
b. low-income
c. children
d. disabled
Under free market conditions, the relationship between the quanity of medical services demanded and the price of medical services is:

a. unknown
b. equal
c. direct
d. inverse
Medicaid is primarily for people who meet the following eligibility requirement:

a. elderly
b. low-income
c. children
d. disabled
The role of the government in the U.S. healthcare system is:

a. Regulator
b. Major financer
c. Medicare and Medicaid reimbursment rate-settler
d. All of the above
Which of the following countries has a National Health System (NHS)?

a. Japan
b. Great Britain
c. Australia
d. Germany
Which of the following is a characteristic of a national health insurance system?

a. The government finances health care through general taxes
b. Health care is delivered by private providers
c. Both a and b
d. Neither a nor b
A free market in healthcare requires:

a. Adequate information for patients
b. Independent actions between buyers (patients) and sellers (providers)
c. Unencumbered interation of the forces of supply and demand
d. All of the above
A multiple payer system is more cumbersome than a single payer system for all of the following reasons except:

a. There are numerous health plans, which is difficult for providers to handle
b. Payments are not standardized across health plans
c. Some healthcare services are covered for people in the north, but not in the south
d. Government programs required extensive documentation proving services were provided before paying providers
Supplier-induced demand is created by:

a. patients
b. providers
c. health insurance companies
d. the government
Which country spends the most in adminstrative health care costs?

a. United States
b. Germany
c. UK
d. Australia
Developing countries account for how much of the world-wide burden of disease?

a. 25%
b. 50%
c. 75%
d. 90%
What is the meaning of the term 'Access?'

a. all citizens have health insurance coverage
b. availability of services
c. employer-based health insurance
d. ability to get health care when needed
In a free market who would pay for the delivery of health care services?

a. numerous health insurance companies
b. patients
c. government
d. multiple payers
When providers deliver unnecessary services with the objective of protection themselves against lawsuits, this practice is called

a. defensive medicine
b. supplier-induced demand
c. primary protection
d. legal risk
Reimbursement is associated with which of the quad functions?

a. financing
b. insurance
c. delivery
d. payment
Which central agency manages the health care delivery system in the United States?

a. Centers for Disease Control and Prevention
b. Department of Health and Human Services
c. Department of Commerce
In which country are employers required by law to contribute toward health insurance for their employees?

a. germany
b. united states
c. great britain
d. canada
In its historical context, which of the following has played a major role in revolutionizing health care delivery?

a. beliefs and values
b. science and technology
c. medical education
d. economic growth
Medical care in preindustrial America had a strong _______ character.

a. scientific
b. professional
c. applied
d. domestic
The delivery of medical care in preindustrial America was governed mainly by?

a. free market conditions
b. collusion among providers
c. supply of medical services
d. high barriers to entry
Hospitals in the United States evolved from

a. Almshouses
b. Sickhomes
c. Pesthouses
d. Inns
What main purpose was served by an almshouse in the preindustrial period?

a. It was used to quarantine people who had contracted a contagious disease
b. It provided free medical care and drugs to ambulatory patients
c. It specialized in performing basic surgeries
d. It performed general welfare and custodial functions
What was the function of a pesthouse in the preindustrial period?

a. To house people who had a contagious disease
b. To provide refuge to those who were threatened by pests
c. To eradicate pests
d. To treat contagious diseases
Why, in the preindustrial period, could most people not afford the services of a qualified physician?

a. Professional fees were too high
b. The economic cost of travel was too high
c. Private health insurance was too expensive
d. Most people relied on home remedies
In the preindustrial era, asylums were built by_____ to accommodate patients with severe and chronic mental illness.

a. The federal government
b. Private entrepreneurs
c. Psychiatrists
d. The state goverments
Which of the following factors was particulary important in promoting the growth of office-based medical practice in the postindustrial period?

a. Urbanization
b. Educational reform
c. Science and technology
d. Dependency
When a profession's services are generally accepted and are legitimized, they impart ____ to the profession?

a. Specialization
b. Organized strength
c. Cohesiveness
d. Cultural authority
Cultural authority was conveyed to the medical profession mainly through

a. The development of the AMA
b. Advances in medical science
c. Patients' dependency
d. Licensing
Development of the hospital and _____ happened almost hand in hand in a symbiotic relationship between the two.

a. Dependency of patients
b. Growth of scientific knowledge
c. Professionalization of medical practice
d. Cohesiveness of the medical profession
Why did physicians remain independent of corporate settings even after the medical profession became well recognized?

a. Hospitals were unable to pay high enough salaries to physicians
b. Physicians disliked salary arrangements
c. Licensure laws had not yet been passed
d. Physicians who took up practice in a corporate setting were castigated by the meidical profession
Organized medicine

a. Concerted activities of physicans through the American Medical Association (AMA)
b. Affliation of physicians with medical schools
c. Standardized practice of medicine
d. Unionization of physicians
The Flexner Report, published in 1910, reported on

a. Disease trends
b. Standards of training in medical schools
c. Rates of deaths in U.S. hospitals
d. The state of medical specialization
The U.S. Supreme Court decision in Olmstead v. L.C. directed U.S. states to

a. Deinstitutionalize people with mental illness
b. Acheieve parity in the delivery of physical and mental health services
c. Increase funding for mental asylums
Historically, public health practices in the United States have concentrated on

a. Sanitary regulation
b. A federal agency to oversee public health functions
c. State and local health departments
d. A presidential commission
The inception of _____ was used as a trial balloon for the idea of government-sponsored universal health insurance

a. Workers' compensation
b. Trade unions
c. Public health
d. Health care for the veterans
Initially, what was the primary purpose of private health insurance in the U.S.?

a. Prevent national health insurance from taking hold
b. Provide coverage for major illnesses
c. Provide comprehensive coverage
d. Compensate for loss of income during sickness and temporary disability
The Baylor Hospital plan, started in 1929, laid the foundation for modern health insurance in the U.S. This was a _____ plan.

a. Managed care
b. Contributory
c. Comprehensive
d. Prepaid
Why did the first Blue Cross plans cover only hospital care?

a. The AMA objected to the inclusion of physican services
b. There was little demand for including other types of health care services
c. Initial hospitalization was required in order to compensate a beneficiary for loss of income
d. The Blue Cross commission determined that including other types of health care services would be unprofitable
During the World War II period, health insurance became employer-based because of

a. Endorsement from Blue Cross and Blue Shield plans
b. Wage freezes
c. Disputes between labor and management about the cost of health care
d. The Flexner Report
The beliefs and values that form American ideology represent the sentiments of

a. The U.S. government
b. The American middle class
c. The American upper class
d. American politicians
Historically, which interest group was the most powerful in opposing national health insurance?

a. Trade unions
b. Employers
c. The American Medical Association
d. The Republican party
On what grounds have middle-class Americans generally opposed proposals for a national health insurance program?

a. Higher taxes
b. Government intervention
c. Erosion of personal freedoms
d. Cost of health care
Medicare and Medicaid programs were created for population groups regarded as

a. Elderly
b. Vulnerable
c. Underinsured
d. Politically above
How has the Medicaid created a two-tier system of medical care delivery in the U.S.?

a. There is Part A and Part B medicaid
b. Only the poor are insured under the Medicaid program
c. Funding for the program is shared by both federal and state governments
d. The program is heavily regulated
The private medical sector in the U.S. has been heavily regulated by the government mainly because

a. Most healthcare services are in private hands
b. Most people served by the medical establishment are in a position of dependency
c. The government has an intent in monitoring quality for all Americans
d. The government finances Medicare and Medicaid
Physicians and hospitals in the U.S. began consolidating and integrating mainly in response to

a. Increased government regulation
b. Pressures to contain costs
c. The growth of managed care
d. The demand for higher quality
e. b and c
E-health has resulted in

a. Patient empowerment and a dilution of their dependent role
b. Loss of control by physicians over health care delivery
c. Increased government regulation
d. Increased corporatization of health care delivery
Historically, inpatient care developed ___________ outpatient care.

a. Before
b. After
c. At the same time as
d. in the absence of
Emergency departments, in most cases, are equipped to provide:

a. Primary care services
b. Secondary care services
c. Tertiary care services
d. Both b and c
Which of the following is a typical setting for ambulatory care services?

a. Sports medicine clinics
b. Physicians' offices
c. Dialysis centers
d. All of the above
Typically, tertiary care:

a. Is highly specialized
b. Does not depend on technology
c. Takes place outside of traditional healthcare facilities
d. All of the above
Which of the following is an example of a secondary care service?

a. Rehabilitation
b. Surgery
c. Consulation
d. All of the above
What is gatekeeping?

a. The process by which patients are denied needed care
b. The process by which PCP refer patients to specialists
c. The concept that specialists use more diagnostic tests than PCP
d. The idea that patients should be allowed to choose their own doctors
Which country's health care system is founded on the principles of gatekeeping?

a. UK
b. US
c. Australia
d. China
Countries whose health systems are oriented more toward primary care acheive:

a. Higher satisfaction with health services among their populations
b. Higher expenditures in the overall delivery of care
c. Worse health outcomes
d. None of the above
The most prominent reason for the decline in the number of procedures performed in hospitals is:

a. Most of these procedures were shifted to outpatient settings
b. Most of these procedures were deemed outdated
c. Most of these procedures were unsafe
d. Most of these procedures used technology that was too expensive
What does the acronym "PPS" stand for?

a. Preferred Provider System
b. Primary Physician System
c. Private Practice System
d. Prospective Payment System
Which of the following is a reason for the growth in outpatient services?

a. Managed care
b. New technology
c. Patient preference
d. All of the above
One reason women's health centers were created is:

a. Women have more money than men
b. Women seek care more often than men
c. Women have shorter lifepsans than men
d. None of the above
Hospice services are primarily for people with:

a. Chronic illnesses
b. Rehabilitation needs
c. Terminal illnesses
d. None of the above
What is palliation?

a. Pain and symptom management
b. Psychosocial suppport
c. A surgical intervention
d. Bed rest
Inpatient care consists of

a. Services delievered by a hospital
b. Treatment of acute conditions
c. Health care delivered in conjuntion with an overnight stay in a facility
d. Care delivered in a licensed facility
To be called a hospital, a facility must have at least ___ beds.

a. 3
b. 6
c. 12
d. 18
The biggest share of national health spending is used by

a. Hospitals
b. Physicians
c. Prescription drugs
d. Nursing home care
Which primary factor was the trigger that made hospitals limit care to the more acute periods of illness rather than the full course of the disease?

a. Technology
b. Physician training
c. Shortage of beds
d. Pressure to contain costs
Who pioneered the transformation of nursing into a recognized profession?

a. Madame Curie
b. Florence Nightingale
c. Cicely Saunders
d. Sylvia Lack
The Hill-Burton Act was passed to

a. Make it mandatory for private insurers to cover hospital services
b. Relieve a shortage of hospitals
c. Curtail the utilization of hospital beds
d. Have federal control over community hospitals
Which factor was the most instrumental in the growth of nonprofit community hospitals in the United States?

a. Hill-Burton Act
b. Growth of private health insurance
c. Medical technology
d. Tax Equity and Fiscal Responsibility Act
What did the swing bed program allow rural hospitals to do?

a. Provide emergency services or psychiatric care
b. Use the same beds for acute care or long-term care
c. Receive partial payment from Medicare for unused beds
d. Obtain high reimbursement for outpatient servcies
How did the PPS based on DRGs lead to hospital downsizing in the United States?

a. It mandated closure of beds based on occupancy rates
b. It led to greater competition among hospitals
c. It created financial incentives to perform surgeries in outpatient settings
d. It created financial incentives to minimize the patient's length of stay
Why are discharge statistics more accurate than admission statistics as a count of inpatients served by a hospital?

a. Deaths are not counted as discharges
b. Deaths are counted as discharges
c. Babies are born in hospitals
d. Some newborn infants need critical care
ALOS is an indicator of

a. Use of hospital capacity
b. Frequency of use
c. Severity of illness
d. Access
How is average length of stay calculated?

a. Days of care/discharges
b. By cumulating patient days
c. Inpatient days/capacity
d. Discharges x inpatient days
Average daily census is a measure of a hospitals

a. Daily capacity
b. Average admissions per day
c. Days of care
d. Number of patients served daily
For whose financial benefit are proprietary hospitals operated?

a. Stockholders
b. The American Public
c. The local community
d. The governing body
To be classified as a Critical Access Hospital, the number of acute care beds should not exceed

a. 20
b. 25
c. 35
What financial benefit does a small rural hospital reap by qualifying for the designation Critical Access Hospital?

a. It can receive specific federal grants for serving vulnerable populations
b. It can use its beds for either acute care or long-term care as needed
c. It can increase its profitability by receiving special payments for emergency services
d. It can receive cost-plus reimbursement under Medicare Part A
According to the U.S. law, nonprofit organizations

a. Can make only a limited amount of profit
b. Are tax exempt
c. Cannot have a governing body
d. Must pay taxes only if they are profitable
Which entity in hospital governance is legally responsible for the hospital's operations?

a. The CEO
b. The board of trustees
c. The chief of staff
d. The chief operating officer
Which entity oversees the licensure of healthcare facilities?

a. The Joint Commission
b. Federal government
c. State government
d. Local county or city government
The acronym MCO stands for

a. Managed Clinical Office
b. Managed Care Office
c. Managed Care Organization
d. Managed Clinical Organization
Nonphysician practitioners (NPPs) include

a. Osteopaths
b. Dentists
c. Physician Assistants
d. None of the above
More than half of osteopaths (DOs) are generalists.

true or false
More than half of MDs are specialists

true of false
Registered nurses undergo the same training as licensed pratical nurses

true or false
Patients requiring services from occupational therapists need help with performing task in their daily living and working enviroments

true of false
Not all states require that physicians be licensed

true of false
Capitation is best described as

a. montly lump sum payment regardless of utilization
b. monthly lump sum payment regardless of cost
c. per member per month payment
d. payments capped to a maximum cost for delivering services
Under capitation, risk is shifted

a. from the insured to the employer
b. from the provider to the MCO
c. the employer to the MCO
d. from the MCO to the provider
Under which payment method is a fee schedule used?

a. prospective payment
b. capitation
c. discounted fees
d. fee for service
Under the fee-for-service system, providers had the incentive to

a. deliver more services than what would be medically necessary because a greater volume would increase their incomes
b. use less technology because they could increase their incomes by not using costly procedures
c. indiscriminate cost increases because they could get paid whatever they would charge
d. increase the level of quality in order to attract more patients
In the beginning, why did HMOs only had limited appeal?

a. HMOs faced resistance from employers
b. The shadow pricing practices used by HMOs were declared illegal
c. The HMOs had only limited ability to control costs
d. The insured wanted to maintain the choice of providers
Gatekeeping heavily depends on the services of a:

a. primary care physician
b. case manager
c. disease consultant
d. nurse practitioner
Gatekeeping emphasizes

a. denial of specialized services
b. closed-panel utilization
c. preventive and primary care
d. secondary care
Under _____ a PCP becomes the portal of entry to the health care delivery system.

a. case management
b. utilization review
c. gatekeeping
d. closed-panel utilization
Physicians are employees of the HMO

a. Preferred providers
b. IPA models
c. Staff model
d. Independence practice association
Which HMO model is likely to provide the greatest control over practice patterns of physicians?

a. Staff model
b. Group model
c. Network model
d. IPA model
In which HMO model is the choice of physicians likely to be most restrictied?

a. Staff model
b. Group model
c. Network model
d. IPA model
Who is likely to bear the most financial risk under the IPA model?

a. The IPA
b. The providers
c. The HMO
d. The employers
Among HMOs, which model is predominant in the marketplace?

a. Staff model
b. Group model
c. Network model
d. IPA model
PPOs were created by _____ in response to HMOs growing market share.

a. physicians
b. insurance companies
c. hospitals
d. independent contractors
Which type of MCO has achieved the greatest success in member enrollment?

a. HMOs
b. PPOs
c. POS plans
d. Exclusive provider plans
Which of the following is not an example of consolidation?

a. Building of new facilites
b. Acquiring an existing facility
c. Merging with an exisiting organization
d. Alliances among existing organizations
An organization ceases to exist as a seperate entity and is absorbed into the purchasing corporation.

a. Acqusition
b. Merger
c. Joint Venture
d. Alliance
Two organizations cease to exist, and a new corporation is formed.

a. Acqusition
b. Merger
c. Joint venture
d. Alliance
Public health is concerned with threats to the overall health of

a. The individual
b. Managed care organizations
c. A community
d. Provider organizations
Public health departments are established by

a. Managed care organization
b. Federal, state, and local governments
c. Integrated delivery systems
d. The private sector
Public health is the science of

a. Preventing disease
b. Prolonging life
c. Promoting health
d. All of the above
HIM professionals participate in a variety of public health roles by acting as

a. Data collectors
b. Data analysis
c. Data reporters
d. All of the above
The top section of the Public Health Pyramid, direct health care services, provides direct health services, such as medical care, psychlogical counseling, and hospital care to

a. Aggregates
b. States
c. Individuals
d. None of the above
The enabling services level of the Public Health Pyramid provides health and social services that support of supplement the health of

a. Aggregates
b. States
c. Individuals
d. None of the above
At which level of the Public Health Pyramid are services delivered to an entire population?

a. Direct Health care services
b. enabling services
c. population-based services
d. infrastructure services