HK 418 Exam 1

Which of the following are linked to access to care?

• Ability to pay for care

• Geographic distance to care

• Population characteristics

• All of the above

All of the above

Which statement best describes how the cost of healthcare can be measured?

• Healthcare cost is determined only by the prices listed on a hospital’s chargemaster.

• Healthcare cost can be measured in several ways, including national health expenditures, insurance premiums and deductibles, and household healthcare spending.

• Healthcare cost is the same as the amount a hospital receives in reimbursement from an insurer.

• Healthcare cost is measured only by the amount a patient pays out of pocket.

Healthcare cost can be measured in several ways, including national health expenditures, insurance premiums and deductibles, and household healthcare spending.

Employers, Medicare, Medicaid, and individuals are examples of which component of the value chain of the U.S. healthcare system?

• Insurers

• Payers

• Producers

• Providers

Payers

There is always the same trade-off between the quality and cost of healthcare – in order to improve quality, you have to increase costs.

True/False

False

Which of the following is a component of the Quintuple Aim?

• Improving population health

• Lowering per capita costs

• Improving workforce well-being

• All of the above

All of the above

A patient is referred by their family doctor to a dermatologist. The patient’s visit with the dermatologist is an example of:

• Secondary care

• Quaternary Care

• Tertiary Care

• Primary care

Secondary care

Sally has diabetes. When she boards a plane, she is allowed to board early because she needs extra time to organize her medical supplies and medications. What concept describes the social norms,  recognition, or treatment of a person because of their health condition?

• Disease

• Illness

• Sickness

• None of the above

Sickness

Which of the following is one reason healthcare is not considered a normal consumer good?

• Healthcare is always paid for directly by the patient.

• Patients can easily compare prices for healthcare services before making a decision.

• Patients usually have complete information about the healthcare services they need.

• Doctors have more knowledge of what healthcare services a patient will require. 

Doctors have more knowledge of what healthcare services a patient will require. 

A doctor examines a patient exhibiting shortness of breath and headaches. They diagnose the patient with high blood pressure and prescribe medication. Which of the following models of health and healthcare does this approach align with?

• Biomedical model

• Biopsychosocial model

• Social/structural model

• All of the above

Biomedical model

Sally has diabetes. She feels frustrated because managing her diabetes requires her to check her blood sugar throughout the day and change what she eats. Her personal experience of living with this health condition is an example of which of the following: 

• Disease

• Illness

• Sickness

• None of the above

Illness

Individual behaviors are the sole determinant of a person's health status and outcomes. 

True/False

False

“the health outcomes [life expectancy, functional status, health status] of a group of individuals, including the distribution of such outcomes within the group” refers to which of the following?

• Population Health

• Healthcare Delivery

• Social Drivers of Health

• Public Health

Population health

A patient has several chronic health conditions and sees multiple specialists. What is one potential disadvantage of having many specialists involved in the patient's care?

• Specialists generally provide lower-quality care than generalists.

• The patient may have difficulty coordinating care across multiple providers.

• Specialists are unable to treat complex conditions.

• The patient will have fewer healthcare services available.

The patient may have difficulty coordinating care across multiple providers.

A physician knows a patient needs more time and attention, but because of staffing shortages, she is forced to leave the patient without the care she believes they deserve. She later feels guilt and distress about the situation. What does this best illustrate?

• Burnout

• Job dissatisfaction

• Moral injury

• Care silos

Moral injury

Which of the following best describes the role of a registered nurse (RN)?

• Primarily dispensing medications

• Providing and coordinating patient care

• Diagnosing all medical conditions

• All of the above

Providing and coordinating patient care

Healthcare workforce shortages affect all parts of the U.S. equally.

True/False

False

A state requires nurse practitioners (NPs) to have a career-long collaborative agreement with a physician in order to provide patient care. The NP can evaluate patients, diagnose conditions, order and interpret diagnostic tests, and prescribe medications, but cannot practice independently without the collaborative agreement.

Which category of scope-of-practice regulation does this state have?

• Restricted practice

• Full practice

• Independent practice

• Reduced practice

Reduced practice

Which of the following is an example of a factor that increases the demand for healthcare workers, rather than a factor that reduces the supply of workers?

• Nurses leaving full-time hospital positions for short-term contract work

• Hospitals outsourcing some clinical services

• An aging population with increasing rates of chronic illness

• An increase in nurse strikes related to wages and patient-provider ratios

An aging population with increasing rates of chronic illness

A hospital system acquires a large physician group practice in its region, bringing those physicians on as salaried employees. This is an example of:

• Horizontal integration

• Vertical integration

• Community benefit

• None of the above

Vertical integration

Which of the following are requirements the IRS may consider when granting or maintaining tax-exempt status for a nonprofit hospital?

• Conducting a community health needs assessment every 3 years

• Maintaining financial assistance policies for low-income patients

• Ensuring billing practices are clear and transparent

• All of the above

All of the above

Which of the following best explains why retail clinics failed to function as a true "disruptive innovation"?

• They were banned in most states

• They disproportionately located in affluent, insured neighborhoods rather than underserved areas

• They exclusively treated patients with chronic conditions

• All of the above

They disproportionately located in affluent, insured neighborhoods rather than underserved areas

A community clinic is governed by a board where at least 51% of members are patients, offers services on a sliding fee scale, and cannot turn away patients regardless of insurance status or ability to pay. This is best classified as a:

• Federally Qualified Health Center 

• Retail clinic

• Ambulatory surgery center

• Nonprofit Hospital

Federally Qualified Health Center 

Hospitals only provide inpatient care.

True/False

False

Which of the following best describes an urgent care center (UCC)?

• A freestanding facility where outpatient surgeries are performed

• A hospital department that treats trauma and life-threatening conditions 24/7

• A walk-in clinic that treats injuries or illnesses needing prompt attention but not serious enough for an ED visit

• A federally funded primary care clinic for underserved populations

A walk-in clinic that treats injuries or illnesses needing prompt attention but not serious enough for an ED visit

Price: definition

the total amount a provider or supplier requires as payment for a healthcare item or service

Cost: definition

input costs of production (e.g.,labor, overhead, energy, capital expenses, supplies, and equipment)

Spending: definition

total amount spent on healthcare (e.g., national health expenditures).

spending = price x utilization

Illness: definition

a person experiences a loss of health

Disease: definition

a condition diagnosed by a medical expert (doctor)

Sickness: definition

social role/experience of a condition

Commoditization of healthcare

“conversion of medical care from a highly personal set of services unique to each individual patient/physician relationship into a fungible commercial product available from a variety of vendors”

unique service to commercial product from vendors

Medical care: definition

• serves individuals

• involves diagnosis, treatment, prevention

• mostly private

• collaboration across sectors

Population health: definition

• serves targeted populations

• addresses SDOH

• data driven interventions and strategies

• government and private

Public health: definition

• serves entire community

• surveillance

• identifies risk factors

• community-based prevention and promotion

• mostly government

Health equity: definition

“state in which everyone has a fair and just opportunity to achieve their highest level of health”

Key word: unfair differences

Health disparity: definition

“[preventable] differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States.”

Key word: preventable differences

Intervention levels

• SDOH (upstream): root-cause conditions that shape health for entire populations

• Social risk factors (midstream): an individual’s exposure to adverse social conditions associated with poor health (ex. food insecurity)

• Health related social need (downstream): an individual’s current unmet need

Medicalization of population health is very ____ driven.

data

Community hospitals: definition

short-term non-federal general and specialty hospitals that are open to the general public; most are nonprofit

Non-profit hospitals

tax exempt

owned by municipality or a non-for-profit organization

For-profit hospitals

not tax exempt

owned by shareholders with the goal of making a profit from the facility’s operations

IRS requirements for nonprofit hospitals

• Hospitals have to conduct a community health needs assessment (CHNA) every 3 years

• Hospitals must have clear policies on financial assistance and emergency medical care

• Hospitals must limit how much they charge low-income patients

• Billing practices must be clear and transparent, particularly for low-income patients

Safety-net hospitals

No standard definition

typically a hospital that serves low-income, specifically medicaid or uninsured patients

Critical access hospitals

rural hospitals that receive special government funding to operate in areas with insufficient healthcare resources

Horizontal Integration

consolidation between entities that offer the same or similar services

ex) hospital mergers

Vertical integration

consolidation between entities that offer different services along the same supply chain

ex) hospital-physician integration

Community Health Centers (CHCs)

• local, community-based clinics that provide healthcare to people no

matter their income, insurance, or background

• must be located in federally designated medically underserved areas/populations

• type of FQHC

Federally Qualified Health Centers (FQHCs)

outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid; funded by Health Resources and Service Administration

Ambulatory surgery centers (ASCs)

A freestanding facility, separate from a hospital, where surgical procedures not requiring an overnight stay are performed on an outpatient basis

Retail clinic

A healthcare clinic located inside a retail setting (e.g., pharmacy, supermarket), typically staffed by nurse practitioners or physician assistants, that treats simple medical conditions and provides basic preventive care

Post-acute care (PAC)

services that help patients recover, rehabilitate, or manage ongoing needs after a hospital stay.

• Includes skilled nursing, physical therapy, occupational therapy, speech-language pathology, and wound care.

Long-term care hospitals

hospitals that provide extended, hospital-level care for medically complex patients.

• Patients no longer need acute intensive care, but still require

hospital-level care (e.g., patients with chronic critical illness)

Inpatient rehabilitation facilities

specialized facility or unit within acute care hospital providing intensive, multidisciplinary rehabilitation therapy

• Designed for patients who can tolerate and benefit from intensive therapy (often 3+ hours/day)

Skilled nursing facilities

facility-based care providing short or long-term skilled nursing care and rehabilitation services; 24-hour medical support

• Serve two distinct populations: short-term rehab patients, and

long-term residents who need ongoing care

Home health agencies

skilled nursing, therapy, and other clinical services delivered in a patient’s home, rather than in a facility

• Designed for patients who are homebound and need intermittent skilled

care, but do not require 24-hour supervision

Long-term care: definition

“variety of services designed to meet a person’s health or personal care needs when they can no longer perform everyday activities on their own.”

Palliative vs hospice care

Hospice: comfort and dignity

Palliative: pain relief