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Q1. Many states have enacted Certificate of Need legislation as an attempt to impose rationality on the U.S health care system. This legislation requires that:
a. Medicaid and Medicare patients prove they are worthy of federal health services
b. Medical organizations receive regulatory approval before expanding major medical centers and health care facilities
c. Physicians prove that a particular drug is needed by a particular population
d. Medical equipment developers prove a product is needed before they begin developing it
Q2. Risky behavior and lack of responsibility has fueled epidemics such as AIDS and SARS.
a. true
b. false
Q3. Under managed health care, participating providers (e.g., physicians) negotiate specific a reimbursement mechanism which determines how they will be paid for the services they deliver.
a. true
b. false
Q4. Medicare coverage of which of the following is relatively limited?
a. Somatic acute care services
b. Hospital care coverage
c. Physician care coverage
d. Mental health and long-term care
Q5. With PPACA/Obamacare, firms employing 50 or more people will be able to get subsidies if they purchase insurance through an exchange.
a. true
b. false
Q6. The passing of the Hill-Burton Legislation really boosted the development of health systems planning in the 1940s. As described by your text, Hill-Burton:
a. Promoted hospital development and renovation after World War II by requiring states to produce bed-to-population ratios
b. Reduced the number of hospitals operating in the United States in order to preserve medical resources
c. Reduced taxes on medical research and development in an effort to foster innovation
d. Increased taxes on medical equipment sales in an effort to finance hospital development
Q7. Centrally controlled health care systems utilize regionalization to facilitate health planning and resource allocation. Therefore, regionalization can be defined as:
a. A process in which regional populations vote on the legitimacy and efficacy of federal health policy
b. A process through which medical resources are allocated to regional populations based on actual need
c. A method used to horde medical resources within particular geographic regions
d. A process of health maintenance which is controlled by regional governments
Q8. Health maintenance organizations (HMOs) were developed in the U.S during the 1970's. According to your text, HMO's were intended to act as:
a. Mechanisms that stimulate economic competition among physicians and other medical professionals
b. Economic barriers that directly limit consumer access to scarce medical products and services
c. Agents of government intervention within private health care markets
d. An adjutant to the wage and price controls that were being utilized at the time, thus reducing the nation's overall inflation rate
Q9. Certificate of Need legislation is the primary form of regulation within the U.S health care system.
a. true
b. false
Q10. A key feature of Medicare prospective payments is:
a. Patients need to offset 15% of the fee with copayments
b. Set reimbursement for services is based on a categorization of possible diagnoses, termed the diagnosis-related group (DRG)
c. Service provider receives payments on a fee-for-service basis
d. Payments must be supplemented with either supplemental insurance or Medicaid contributions
Q11. According to your text, independent practice associations (IPAs) are:
a. Organizations which own their own hospitals and hire service care providers on a salary basis
b. Affiliations of community based, fee-for-service physicians who serve consumers on a contractual basis
c. Organized medical professionals who fight for the removal of federal regulation within private health care markets
d. Federally employed doctors who offer medical services to economically disadvantaged populations
Q12. What portion of health care costs for enrollees is covered by Medicare?
a. About a quarter of health care costs
b. About half of health care costs
c. About two-thirds of health care costs
d. All health care costs
Q13. Point-of-service (POS) plans are similar to those offered by planned provider organizations (PPOs), yet they allow for consumers to select non-plan providers when seeking medical care. Those who choose non-plan providers, however, will be expected to:
a. Contribute a large percentage of the copayment
b. Excuse themselves from the POS plan after medical services have been received
c. Pay large deductibles on their medical bills before the insurer picks up the bill
d. Pay higher premiums after receiving services.
Q14. With service health insurance arrangements, insurers:
a. Establish contractual arrangements with both consumers and providers
b. Establish contractual arrangements only with consumers
c. Establish contractual arrangements only with providers
d. Offer health care services under the auspices of their own health care professionals
Q15. With PPACA/Obamacare, lifetime insurance coverage caps will be banned.
a. true
b. false
Q16. Quality of medical care is uniform in hospitals throughout the country.
a. true
b. false
Q17. Preferred provider organizations (PPOs) are relatively new forms of managed care. Preferred provider organizations are:
a. Physician organized groups that provide discounted medical treatment to underprivileged or disadvantaged groups of people
b. Organizations of physicians and other health care professionals who charge a standard, hourly fee for services
c. Organizations created by insurance providers which offer medical coverage with doctors inside and outside of the organization's guidelines
d. Created by insurance companies via networking with physicians and hospitals in order to provide services in exchange for contractual, discounted, pre-negotiated fees
Q18. Quality assurance is essential for the maintenance of product and service quality in the medical industry. In fact, accredited hospitals are required to maintain quality assurance programs. To implement a quality assurance program, hospitals and health service centers must:
a. Sign a pledge to maintain the highest quality standards when administering health care services
b. Allow federal auditors to evaluate the current state of a product and service's quality.
c. Collect data from ongoing and reliable sources, such as medical records and claims forms, which can be used as quality indicators
d. Register with the American Medical Association (AMA)
Q19. The quality of care is often increased when the case management method is utilized. How is quality increased through case management?
a. By assigning a specially trained professional to monitor and control a patient's medical treatment and service utilization
b. By assigning patients to high quality medical clinics
c. By applying the latest medical technology to patient care
d. Through the application of careful oversight by insurance providers
Q20. With insurance plans that have large deductibles:
a. Premiums can be reduced dramatically
b. Premiums are reduced modestly
c. Premium are increased dramatically
d. Premiums are increased modestly
Q21. Apart from analyzing objective data, quality of medical care can be interpreted by analyzing customer satisfaction surveys. Yet the interpretation of this data is often difficult because:
a. Patients are often incapacitated during the majority of their medical treatment and cannot asses the quality of care they received
b. Patients lack the technical knowledge necessary to evaluate the quality of care they received
c. Patient satisfaction is not correlated to compliance with medical regimens and treatment processes
d. Patients often lie on their satisfaction surveys
Q22. The Health Plan Employer and Data Information Set (HEDIS) is often used to evaluate care quality offered by managed health care plans.
a. true
b. false
Q23. What patient type is most suitable for case management programs?
a. Patients with minor ailments
b. Patients with acute or chronic disease
c. Patients with mental illnesses
d. Patients who lack the means to pay their deductible or copayment
Q24. Planned provider organizations (PPOs) often require a deductible on a per-person and per-family basis, while also requiring a copayment. How much is a patient expected to contribute to PPO copayments?
a. Five to ten percent
b. Ten to twenty percent
c. Fifteen five percent
d. One to five percent
Q25. Primary care physician gatekeepers serve patients in many different capacities. As such, these gatekeepers act as:
a. Arbiters of insurance company regulations and policies
b. Hospital administrators who decide which patients deserve medical attention
c. Patient advisors, service managers, and service coordinators
d. Federal officials who protect patients from abuse or exclusion by physicians and insurance providers
Q26. Assessing the quality of care at a medical facility often involves the interpretation of objective data. For example, data illustrating professional interpretations of patient health may be analyzed to determine the quality of care administered by a hospital's staff. However, using data in this way may be problematic because:
a. Physicians often object to having their professional interpretations recorded
b. The lion's share of medical records are imprecise and contain unreliable data
c. A patient's health can be affected by variables outside of a physician's control
d. Much of this data is confidential and not available for analysis
Q27. Smoking cigarettes accounts for approximately 350,000 deaths per year.
a. true
b. false
Q28. Usual, customary, and reasonable (UCR) fees are employed to:
a. Establish a fee structure for capitation systems
b. Determine how to price discrete services in fee-for-service healthcare systems
c. Price medical testing services provided to hospitals and clinics
d. To inconvenience the customer
Q29. The term managed care encompasses a number of different incentives and relationships in the health care industry. The fundamental objective of managed care however is:
a. To restructure the organization of health services in order to enhance cost containment, maintain quality, and patient care management
b. To place physicians in a position of economic power over their patients
c. To stimulate medical research and development through economic incentives
d. To maximize profits for health care administrators relative to the benefits received by physicians and patients
Q30. Which of these political developments had the greatest amount of historic influence on health care reform in the United States?
a. The New Deal
b. The Civil Rights Act of 1964
c. The 1988 Anti-Drug Abuse Act
d. The Hill Burton Act
Q31. SIX SIGMA methods are often used to assess quality of care within hospitals and medical treatment centers.
a. true
b. false
Q32. Copayments:
a. Are payments for health services that are split between young adults and their parents
b. Are payments for health services that are split between the elderly and their benefactors (usually their children)
c. Are payments jointly made by insurance companies and government to cover expenses incurred by low-income individuals and families
d. Are relatively small, out-of-pocket payments made by patients each time they make use of a physician's service
Q33. In health insurance, what does premium refer to?
a. The fee the enrollee pays for insurance coverage
b. The highest level of service a health insurance plan offers
c. The highest cost of service the insurance contract allows
d. Additional coverage through a supplemental insurance plan
Q34. Utilization reviews are often implemented in order to monitor how medical products and services are administered. As such, utilization reviews involve:
a. Preapproval for patient utilization of medical services by health plan providers
b. A subjective evaluation of hospital services through consumer focus groups
c. Monitoring of product and service utilization by physicians within hospital settings
d. Federal monitoring of product and service utilization via statistical analysis of patient outcomes
Q35. Managed care systems have emerged in many countries throughout the world. As such, the origin of managed care systems can be attributed to which historical development in the global medical industry?
a. The unionization of physicians and other medical professionals
b. The development of prepaid healthcare plans
c. Consumer lobbying efforts to establish price ceilings on health care costs in the United States
d. The need to police economic corruption among physicians and medical officials
Q36. According to your text, the generation and introduction of new health care policies are often the result of:
a. The imposition of technocratic knowledge
b. Compromises between political officials
c. The realization of optimal economic efficiency in the health care market
d. Staged protests by social movements seeking new, inclusive forms of health care policy
Q37. Physicians are required to accept Medicare patients.
a. true
b. false
Q38. Instead of opting to use the standard Medicare health care package, eligible enrollees can opt to use a Medicare HMO.
a. true
b. false
Q39. In the arena of health insurance, moral hazard refers to:
a. The possibility that applicants lie about their health condition
b. The possibility that the insured make false claims about the medical treatment they have received
c. The possibility that once insured, people change their lifestyles and assume unhealthier behavior, knowing that their illness will be covered by insurance payments
d. The possibility that insurance companies do not provide required services to the insured in order to save money
Q40. Section 1122 of the Social Security Act Amendments is directly related to Certificate of Need legislation, as it requires that:
a. Medicare patients pay a large deductible on medical services if they fail to prove sufficient need
b. Medicare fund recipients comply with state Certificate of Need laws
c. States prove that they are worthy of federal funding for medical programs
d. More stringent measures of need be applied to Medicare fund recipients
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