Exam 3 US Health Care Systems

Term
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States try to protect the public from receiving incompetent care by licensing certain health professions. Certification differs from licensing, in that certification:

A. only recognizes special education or training
B. does not assure continuing competency
C. may not examine the important competencies
D. allows people to engage in activities that would otherwise be illegal
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Terms in this set (47)
States try to protect the public from receiving incompetent care by licensing certain health professions. Certification differs from licensing, in that certification:

A. only recognizes special education or training
B. does not assure continuing competency
C. may not examine the important competencies
D. allows people to engage in activities that would otherwise be illegal
A. only recognizes special education or training
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. an associate's degree
B. a hospital certificate of nursing competency
C. a master's degree
D. a doctoral degree
C. a master's degree
Complementary medicine differs from alternative medicine in that complementary medicine:

A. is used together with conventional treatment while alternative medicine is used in a place of conventional medical treatment
B. is limited to treatment by certified providers
C. uses only organic substances in treatment
D. is licensed by the Food and Drug Administration
A. is used together with conventional treatment while alternative medicine is used in a place of conventional medical treatment
A physician residency training program is best described as:

A. a program enabling medical school graduates to become familiar with a population's needs in a specific geographic area
B. an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medical specialty
C. specialized training in the business operations of a medical practice
D. the first opportunity for medical students to have actual contact with patients
B. an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medical specialty
Major obstacles to ensuring an efficient and rational health workforce in the future include:

A. an inadequate number of educational institutions to accommodate qualified students
B. an influx of foreign-trained graduates that exceeds demand
C. separate and often conflicting interests of governments, educational institutes, professional organizations, insurers and providers
D. declining need for health. are professionals in several categories of practice
C. separate and often conflicting interest of governments, educational institutes, professional organizations, insurers and providers
Health care system changes, including advanced technology, will likely result in new and more highly specialized health occupations. Which of the following is NOT one of the expected effects of this development?

A. a reduction of providers' flexibility to develop more efficient staffing patterns
B. increased personnel costs
C. small and rural providers facing increased difficulty in retaining specialty-trained personnel
D. hospitals becoming more resistant to employing multi-skilled personnel
D. hospitals becoming more resistant to employing multi-skilled personnel
Each year approximately 6,000 international medical graduates (IMGs) enter the US to practice. IMGs are vitally important to the health care delivery system because they:

A. receive education superior to that of most US medical students
B. they are willing to work for less compensation than US physicians
C. they fill a shortfall in the number of residents required by US hospitals
D. are more likely to engage in primary care than their US counterparts who prefer specialty medicine
C. they fill a shortfall in the number of residents required by US hospitals
Unlike medicine, dentistry primarily serves only those with dental insurance or who can afford to pay out-of-pocket. For this reason:

A. many of the population groups with the greatest need have no access to services
B. most dentists specialize in one of eight specialty areas
C. the American Dental Association has shown little interest in increasing minority recruitment to better reflect racial and ethnic diversity of the US population
D. few dental schools offer advanced degrees in dental public health
A. many of the population groups with the greatest need have no access to services
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:

A. laboratory technologists and technicians
B. social workers and rehabilitation counselors
C. physical and occupational therapists, speech language pathologists
D. alternative therapists
C. physical and occupational therapists, speech language pathologists
The widespread use and popularity of complementary and alternative medicine in the US resulted in which of the following developments:

A. The National Institutes of Health creating the National Center for Complementary and Alternative Medicine (NCCAM)
B. most states' licensure of complementary and alternative therapists
C. schools of pharmacy developing specialty training in herbal medicine
D. new medical residency training opportunities in natural healing
A. The National Institutes of Health creating the National Center for Complementary and Alternative Medicine (NCCAM)
The ACA addressed numerous long-standing health workforce issues. Most importantly, it established the National Health Care Workforce Commission with the overall mandate to: A. ensure private, philanthropic tuition support for minority applicants to professional schools B. increase the number of International Medical Graduates for deployment in rural and inner-city underserved geographic areas C. requires states to take more regulatory control of all health professions and develop new schools of public health D. evaluate and make recommendations in areas such as training and support for workers at all levels, efficient workforce deployment, professional compensation, and coordination among different types of providersD. evaluate and make recommendations in areas such as training and support for workers at all levels, efficient workforce deployment, professional compensation, and coordination among different types of providersThe managed care concept called "capitation" refers to: A. physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid fee B. establishing a goal budget with "caps" on expenditures C. establishing minimum quality performance standards D. purchasers of health care negotiating as a groupA. physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid feeBy focusing on insured populations rather than individuals, managed care organizations can project health service use by: A. previous patient histories B. demographic factors such as age, gender, and other factors C. national averages D. ratios of specialists to primary care providersB. demographic factors such as age, gender, and other factorsAn aim of managed care is to transfer some measure of financial risk to providers and, to a lesser extent, to patients. Transferring financial risk to patients is accomplished by: A. requiring the use of clinical pathways B. using fee withholds C. monitoring provider practice patterns D. requiring co-pays for specified servicesB. using fee withholdsThe phenomenon of managed care "backlash" is best characterized by which of the following: A. a consumer protest against increasing health care insurance premiums B. protests of organized medicine, other health care providers and consumers against MCO policies viewed as unduly restrictive C. consumer concerns about high prescription drug costs D. numerous managed care company mergersB. protests of organized medicine, other health care providers and consumers against MCO policies viewed as unduly restrictiveIn retrospect, implementation of the DRG system demonstrated that: A. hospitals were not as inefficient as previously thought B. hospitals could profit from instituting more efficient patient care procedures C. longer lengths of hospital stays were necessary to ensure quality care D. length of stay did not impact health care costsB. hospitals could profit from instituting more efficient patient care proceduresAlthough the ACA will enact sweeping US health care system reforms, one fundamental element of the system that will remain unchanged is: A. health insurance regulation B. the number of uninsured Americans C. the individually based focus on reimbursement for care D. financing of health care expenditures through a combination of public and private sourcesD. financing of health care expenditures through a combination of public and private sourcesThe current highest personal care expenditure in the US is for: A. home health services B. hospital care C. hospice care D. prescription drugsB. hospital careDespite US health care spending exceeding the expenditures of 28 other developed nations, US health outcomes lag far behind. Extensive research has concluded that reasons for high US health expenditures include: A. Americans' his demands for specialty care B. overuse of expensive technology and higher per capita physician visit rates C. higher US per capita income and much higher US prices for medical care D. vastly superior health careC. higher US per capita income and much higher US prices for medical careMajor drivers of US health expenditures include: A. advancing medical technology, growth in the older population, and reimbursement system incentives B. political and consumer concerns over the costs of care relative to its quality C. adoption of European models of health care services delivery D. a combination of employer, consumer, purchaser, and provider interestsA. advancing medical technology, growth in the older population, and reimbursement system incentivesThe basic concept of health insurance is different than the premise on which personal or property insurance was historically defined because: A. health insurance is managed by third parties B. other forms of insurance were intended to cover individuals against the low risk of unlikely events while health insurance provides coverage for unlikely events in addition to routine and discretionary services C. most health insurance is provided by employers whereas other insurance is personally purchased by individuals through brokers D. unlike other personal or property insurance, health insurance bases premiums on assessments of riskB. other forms of insurance were intended to cover individuals against the low risk of unlikely events while health insurance provides coverage for un likely events in addition to routine and discretionary servicesThe establishment of Blue Cross for hospital care and Blue Shield for physicians' services signaled a new era in health care delivery and financing. Which of the following was NOT among their major impacts? A. Americans' insulation from the knowledge of the costs of care B. large increase in the use of hospitals C. discouraging efforts to enact a national, government health insurance plan D. caused for-profit insurers to use "experience" rather than "community" ratings to establish premiumsD. caused for-profit insurers to use "experience" rather than "community" ratings to establish premiumsThe 1973 HMO legislation responded to which of the following national concerns? A. insolvency of insurers providing employer-based contracts B. rising numbers of uninsured C. growing numbers of Medicaid-eligible citizens D. rapidly increasing Medicare expenditures and concerns about the quality of careD. rapidly increasing Medicare expenditures and concerns about the quality of careCost-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: A. disease management B. acute episode avoidance C. emergency room deferral D. hospitalization diversionD. hospitalization diversionThe most influential managed care quality assurance organization that accredits many different aspects of managed care organizations on a voluntary basis is: A. the Joint Commission (JC) B. the National Committee on Quality Assurance (NCQA) C. the Group Health Association of America (GHA) D. the Institute for Healthcare Improvement (IHI)B. the National Committee on Quality Assurance (NCQA)The Healthcare Effectiveness Data and Information Set (HEDIS) may be best described as: A. a program offering suggestions that helps employers' keep health insurance plan costs as low a possible B. a systematic process to assess the competence of employers' administration of their sponsored health plans C. a vehicle to allow health insurance policy holders to confidentially submit feedback on their satisfaction with health insurance benefits to their employers D. 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 parametersD. 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 parametersThe Medicare program enacted in 1965 as Title XVIII of the 1935 Social Security Act is characterized as the most sweeping social legislation ever enacted by the federal government because it: A. was only the second mandated US health insurance program after worker's compensation and signaled the federal government's entry into the personal healthcare financing arena B. required participation by all the practicing physicians C. passed expenses for providing coverage from low-income to high income workers through payroll taxes D. established the principal of universal coverage based on beneficiary incomeA. was only the second mandated US health insurance program after. worker's compensation and signaled the federal government's entry into the personal healthcare financing arenaEnacted in 1983, the Diagnosis-related Group methodology shifted hospital reimbursement from the retrospective to prospective basis. The major purpose of this new payment system was to: A. change physicians practice patterns to reflect more efficient use of resources for hospitalized patients B. provide financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patients C. discourage hospital expenditures for expensive new technology D. penalize physicians and hospital equally for wasteful resource us in the care of hospitalized patientsB. provide. financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patientsThe primary purpose of the Centers for Medicare & Medicaid Services "Hospital Compare" web-based program is to: A. provide comparative price data for specified hospital procedures B. expose hospitals' internal system deficiencies that result in medical errors C. foster competition for patients in the health care marketplace D. provide consumers with objective criteria that allow. comparisons of hospitals' use of evidence-based practices and patient satisfaction ratingsD. provide consumers with objective criteria that allow comparisons of hospitals' use of evidence-based practices and patient satisfaction ratingsEnacted in 1965 as Title XIX of the Social Security Act., Medicaid is: A. a joint federal-state program supporting basic health services for low income individuals in which federal and state support is shared based on a state's per capita income B. a federal program of support for individuals with long-term care needs, such as the chronically ill elderly C. the federal government's effort to cover the uninsured population D. an entitlement program for. Americans who are. unable to obtain employmentA. a joint federal-state program supporting basic health services for low income individuals in which federal and state support is shared based on a state's per capita incomeThe intent of the Medicaid Child Health Insurance Program (CHIP) was to: A. demonstrate the cost-effectiveness of early childhood preventive health education programs B. provide additional federal resources to struggling state Medicaid programs C. highlight the benefits of the Balanced Budget Act of 1997 to state legislatures D. enroll 10 million uninsured children in Medicaid whose family incomes were too high to qualify for Medicaid but too low to purchase private health insuranceD. enroll 10 million uninsured children in Medicaid whose family incomes were too high to qualify for Medicaid but too low. to purchase private health insuranceMedicaid and CHIP quality initiatives are carried out through partnerships with the respective states' programs suing five quality criteria that include which of the following? A. prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of services B. prevention and health promotion, healthy pregnancies, management of acute conditions, management of chronic conditions, child protection C. management of acute conditions, management of chronic conditions, child protection, residential quality and safety, child support D. residential quality and safety, child support, management of acute conditions, avoidance of hospitalizationsA. prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of servicesUnder the ACA, most Americans will be required to have health insurance or be penalized with an annual tax. In the ACA legislation, the requirement is popularly known as: A. play or pay incentive B. health insurance mandate C. individual mandate D. essential health benefitC. individual mandateAs defined and required by the ACA, health insurance exchanges (HIEs) intend to: A. decrease health insurance costs by exposing differences to purchasers and consumers about high performing and poorly performing health plans B. create a competitive health insurance market by providing web-based, easily understandable comparative information to consumers on plan choices with standardized rules regarding health plan offers and pricing C. empower state insurance regulators to more effectively monitor the performance of health plans' costs and quality D. give all consumers and purchasers the rights of appeal on increasing health insurance premium costsB. create a competitive health insurance market by providing web-based, easily understandable comparative information to consumers on plan choices with standardized rules regarding health plan offers and pricingThe ACA's "Bundled Payments for Care Improvement Initiative" intends to address which of the following long-standing concerns about the Medicare program's costs and quality? A. physicians responding to reduce reimbursements by ordering more medical procedures B. patients' demands for uncreased use of unnecessary specialist services and Medicare's obligation to pay for many unnecessary procedures C. fee-for service payments allow individual services provided during a beneficiary's illness resulting in fragmented. care with minimal coordination across providers and settings that result in rewarding service quantity rather than quality D. physicians' resistance to accountability for medical care outcomes as compared with costsC. fee-for service payments for individual services provide during a beneficiary's illness resulting in fragmented care with minimal coordination across providers and settings that result in rewarding service quantity rather than qualityLong-term care is best described as: A. home-based care for physically disabled adults and children B. hospital stays lasting more than 30 days C. services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needs D. community-based services for frail older adultsC. services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needsThe US history of institutional long-term care began with: A. family-based care for the sick and infirm in their own homes B. communal care settings operated by charitable community members and government supported almsouses C. state-supported asylums D. military hospitals to care for wounded and sick soldiersB. communal care settings operated by charitable community members and government supported almshousesWhich of the following societal factors increases the need for formal long-term care services? A. women working outside the home B. high divorce rates C. smaller family size D. all of the aboveD. all of the aboveThe development of formal home care services, such as those provided by the Visiting Nursing Association originated as: A. a means to get urban children immunized against infectious diseases B. a service to the wealthy who wished to receive care in their homes, rather than institutions C. a social response intended to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseases D. local health departments' response to the needs of older adults living aloneC. a social response intended to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseasesLong-term care and nursing-home reform legislation of the 1970s occurred as a response to which of the following? A. widespread media reports and ensuing Congressional hearings on nursing home and residential care facility abuses and negligence B. inadequate reimbursement for appropriate care in institutional settings C. national recognition of. inadequate quality assurance and monitoring systems in the long-term care industry D. A and CD. A and CThe major distinction between skilled-nursing and residential care facilities is that skilled nursing facilities: A. provide care in both community and institutional settings B. provide care primarily for people requiring intensive nursing, rehabilitation, or. related services C. typically accommodate relatively self-sufficient residents D. primarily provide at-home careB. provide care primarily for people requiring intensive nursing, rehabilitation, or related servicesWhich of the following was not a driver of expanded home care services during the 1980s through the 1990s? A. assertions by increased numbers of older persons of their desire to remain in their own homes for care, whenever possible B. audits documenting significant fraud and abuse of Medicare billing C. decreased availability of informal care-givers available to assist their family members D. the Olmstead Supreme Court decision upholding the right of citizens to receive care in the communityB. audits documenting significant fraud and abuse of Medicare billingWhich of the following best describes the informal long-term care system? A. group. living facilities where residents may come and go as they please B. care and assistance provided in the home by family members and friends C. adult daycare facilities D. assistance with activities of daily living from a home care agencyB. care and assistance provided in the home by family members and friendsRespite care is best defined as: A. services that temporarily relieve informal caregivers through assistance in the home or through institutional placement on a temporary basis B. legally required "rest periods" for caregivers of dependent family members by which employers are required to give paid leaves of absence C. temporary, Medicaid-supported vacations for caregivers of a physically or mentally-dependent family member D. permanent patient placement in a residential care facilityA. services that temporarily relieve informal caregivers through assistance in the home or through institutional placement on a temporary basisThe enactment of Medicare and Medicaid in 1965 affected the long-term care industry in many ways. Which of the following was NOT an effect of the Medicare and Medicaid enactment on the long-term care industry? A. provision of more stable reimbursement sources than previously made available from private pay and charitable sources B. prohibition of for-profit providers' participation ion Medicare and Medicaid long-term reimbursement C. establishment of minimal standards of care to qualify for Medicare and Medicaid reimbursement D. provision of resources for older and disabled Americans and those lacking the ability to pay for careB. prohibition of for-profit providers' participation in Medicare and Medicaid long-term care reimbursementThe hospice movement is concerned with care for terminally ill patients. Which of the following is not a major goal of hospice care? A. decreasing costs of care for the terminally ill by avoiding use of expensive technology B. providing an alternative to the curative/intervention approach of medical care for the terminally ill C. providing state-of-the-art pain relief intervention while supporting the patient and his/her family through the life-death transition D. supporting terminally ill patients' sense of independence throughout their dying processA. decreasing costs of care for the terminally ill by avoiding use of expensive technologyThe "naturally occurring retirement community" is best defined as: A. a federally-designated geographic area with high proportion of older Americans B. groups of federally-funded senior services centers in a defined geographic area that offer congregate meals and social activities C. apartment complexes, neighborhoods, or sections of communities where residents have opted to age-in-place D. a not-for-profit organization-operated campus of facilities and services for Medicare beneficiariesC. apartment complexes, neighborhoods, or sections of communities where residents have opted to age-in-place