HAP 200 Final Exam

What type of justice is based on people's willingness and ability to pay?

Market

Which is not a subsystem of the US healthcare system?

Acute Care

Medicare is a government program designed to provide health care to the following groups of people except:

Poor

The U.S. government plays a limited role in the health delivery system. The government's role in the arena of health care delivery consists of:

To be the responsible party for reimbursement and policy through Medicare and Medicaid programs

The US safety net is for the nation's most vulnerable populations. Which of the following groups is not a vulnerable population?

Insured employees

Barring major system changes, health service expenditures are projected to continue to decrease.

False

Which of the following would NOT be considered a social determinant of health?

Specialty care

Pneumonia would be classified as a __________ condition.

Acute

Examples of the social justice aspect of healthcare includes:

Both Medicare & Medicaid

Medical determinants of health include all but:

Tobacco use

Health disparities can be decreased though interventions like public policy as well as individual life style changes

True

The US model of healthcare focuses on prevention.

False

Capitation is:

The per member per month fee used by managed healthcare organizations to finance care

Which is the insurance program for the US military?

Tricare

Which country has its' entire infrastructure, including health systems and providers, controlled by the government and funded by taxes.

Great Britain

Which of the following has not been a factor that has shielded the U.S. health care system from a major overhaul?

Patients perceptions related to their quality of life

In preindustrial America, the destitute of society were confined in a(n):

Almshouse

What is voluntary health insurance?

Private health insurance

In preindustrial America, even untrained people could practice medicine.

True

Medicaid is a state government-based program intended to cover the eligible poor, determined by income level.

True

Medicare is a government-based program intended to cover all of the following groups except:

Those who are 65 years of age and older who are poor

Private health insurance first emerged:

To covered workers when they were ill or injured

A job description for a physician would be to:

Assess a patient's health condition & Diagnose and treat disease

Which one is not an advance practice nurse (APN)?

Physician Assistant

It has been shown that NPPs (non-physician providers) can:

Improve access to care & Spend more time with patients than physicians

All of the following are doctoral level healthcare professionals but:

Dieticians

Which healthcare administrator is the only one that must be licensed?

Nursing Home Administrator

Private health insurance (the eventual model for Blue Cross) originated to cover only inpatient hospital services

True

NPP (non-physician providers) practice in many areas in which physicians practice; however, they do not have a medical degree (MD or DO).

Ture

Pharmacists always practice as generalists and do not have specialty areas of practice.

False

Medical technology does not include which of the following:

Physician Office

According to HIPAA (Health Insurance Portability and Accountability Act), if you work for the same healthcare organization in which you receive your care, it is acceptable for you to access your own Medical Record

False

Healthcare organizations across the US typically utilize new medical technologies soon after they are approved by the FDA.

True

Most American medical graduates chose to become primary care physicians instead of specialists

False

In the U.S., competition and specialization of providers results in what conclusion?

Duplication of services and equipment

Current U.S. law requires that:

The Food & Drug Administration (FDA) reviews the safety and effectiveness of a new drugs and medical devices before approval to market and sell for use

High-technology and high-cost healthcare always leads to high-quality

False

What is self-insurance?

Large employers assume the risks and budget for medical claims

Medicaid provides identical benefits to the poor in every state.

False

Medicare Part B requires beneficiaries to make premium payments.

True

A deductible is:

Amount the insured must pay for non-preventive healthcare before the plan begins to pay some of the costs

A premium is:

Dollars charged by insurance to provide insurance coverage

Coinsurance is:

Specific percentage insured pays out-of-pocket for each service after deductible is met

Copayment is:

Specific dollar amount insured pays out-of-pocket for each service

What is the purpose of a stop-loss provision in a health insurance plan?

Limit total out-of-pocket costs in one coverage year.

Which of the following is one of the reasons why services have shifted from inpatient to outpatient over the past 20 years?

Public/private insurance reimbursement changes.

Prior-authorization is a mechanism utilized by payers to discourage inpatient hospitalization and overutilization of ancillary testing.

True

What type of care is for "end of life" patients?

Hospice

All of the following are examples of alternative medicine except:

Osteopathic medicine

Gene therapy is an example of what type of care?

Quaternary

Prevention is an example of what type of care?

Primary

Which of the following is a benefit of primary care?

Gatekeeping

Countries in which primary care is emphasized have higher healthcare costs.

False

When did hospitals begin to attract well-to-do patients who could afford to pay privately?

When hospitals offered superior medical services and surgical procedures that could not be offered at home

What triggered the downsizing phase in US hospitals during the 1980s?

Prospective payment system

DRG-based reimbursement necessitated hospitals to do what?

Discharge patients quicker than before

Why has the ALOS (average length of stay) declined?

Alternative services like home health and skilled care facilities were developed

Which of the following statements about hospital utilization is incorrect?

Utilization among the poor is lower than those who are not poor

Licensure is a legal requirement for hospitals which specifies standards of care and physical environment.

True

Hospitals are responsible to which of the following stakeholders?

Accreditation agencies
Government
Community

What type of reimbursement method involves a fixed monthly sum per enrollee?

Capitation

Medicare's managed care option is called Medicare Advantage or Medicare C.

True

States can make it mandatory that their Medicaid beneficiaries enroll in managed care plans.

True

In the gatekeeping method, who makes referrals to specialists?

Primary Care Provider (PCP)

Pre-certification is associated with which type of utilization review?

Prospective

Monitoring a patient's prognosis for recovery while in the hospital becomes important in which type of utilization review?

Concurrent

Which among the following employs tighter utilization controls than the other plans?

Health Maintenance Organization (HMO)

Most elderly people reside in nursing homes or other types of long-term care facilities.

False

Most LTC services are provided informally by family and friends.

True

Severe limitations of ADL (activities of daily living) often indicate the need for what service?

Institutionalization

Long-term care services are characterized as:

Individualized

In the _______ approach, a patient's physical, mental, social, and spiritual needs are addressed.

Holistic

What type of care is end-of-life care?

Hospice Care

It is illegal to operate a nursing facility without a license.

True

Standards for licensing nursing homes vary from state to state.

True

Which are descriptors of vulnerable populations?

Underserved
Medically disadvantaged
Underprivileged

Individuals and groups are _______ because of unequal social, economic, health, and geographic conditions?

Vulnerable

Health and care differences exist across the various racial/ethnic groups.

True

Women experience more mental illness than men.

True

Which of the following does not qualify as a challenge that faces rural health?

Easy access to transportation

Barriers of the homeless include all of the following except:

Working part-time

All of the following are cornerstones of healthcare delivery except:

Technology

The rate of growth in health spending in the U.S. slowed to its lowest level during what time period?

1993-2000

Why does the third-party payment system increase healthcare costs?

Patients are shielded from the true cost.

What is it called when a physician orders more tests and services that are NOT medically justified because of the threat of malpractice lawsuits?

Defensive medicine

Peer review and establishing standards for practice is a cost reducing strategy.

True

The U.S. healthcare system is centrally planned by the government.

False

Access to healthcare is best predicted by:

Race, income, and occupation

According to Donabedian, in order to help define and measure quality in healthcare organizations, you must examine three domains. Which of the following is NOT one of those domains?

Risk

Which of the following is not a predisposing factor to potential vulnerability?

Insured women & children

The US healthcare system is centrally controlled at the federal level.

False

What type of allocative tool spreads benefits throughout society?

Distributive

When it comes to funding/financing healthcare in the US, which sector plays a larger role?

Private

How does healthcare policy making operate in the US?

Incrementally

What two main concerns dominate the debate today over Medicare reform policy?

Decrease spending & comprehensive coverage

CON (Certificate of Need) programs reduce costs by mandating healthcare organizations apply for permission in order to add or modify their existing services. Especially in regards to capital.

True

What was the main reason that Americans in the past have rejected national health care?

Traditional beliefs & values

The ACA of 2010 mandates system-wide cost control measures.

False

What is the main function of the allied health professional in the Teamlet Model?

Health coach

What change in the delivery of health care is recommended to offset the persistent workforce shortages?

Integrate the talents & expertise of trained professionals