Briar Woods High School HOSA Biomedical Debate Practice Problems.

Q001 [Rationing and fairness] Which situation is an example of rationing as Bognar and Hirose use the term? A. Only denying emergency care during war | B. Choosing which medicines a public plan subsidizes | C. Only selecting transplant recipients | D. Any medical error

B. Choosing which medicines a public plan subsidizes | Why: Rationing includes routine controlled allocation among services and interventions, not only crisis choices among individuals. | Source: R ch. 1

Q002 [Rationing and fairness] Why would eliminating waste fail to remove every rationing problem? A. Only governments face scarcity | B. Health care has no effect on well-being | C. Time, infrastructure, and alternative uses of resources still require choices | D. Every beneficial intervention becomes free

C. Time, infrastructure, and alternative uses of resources still require choices | Why: Some limits remain even in an efficient system; spending also competes with valuable nonmedical uses. | Source: R ch. 1

Q003 [Rationing and fairness] In the island example, Program B primarily protects which value? A. Maximum number vaccinated | B. Preferential access for wealthier children | C. Equal chance of access across regions | D. Reward for prior contributions

C. Equal chance of access across regions | Why: Vaccinating half of each geographic group gives equal regional chances while protecting fewer children overall. | Source: R ch. 1

Q004 [Rationing and fairness] Which statement is a normative premise? A. Patient A has a higher estimated survival rate | B. The treatment costs $50,000 | C. We should give added priority to people who are worse off | D. The hospital has one bed

C. We should give added priority to people who are worse off | Why: A claim about what ought to matter is normative; the other options describe facts or estimates. | Source: R ch. 1

Q005 [Rationing and fairness] Health-related quality of life is best understood as: A. A complete measure of all well-being | B. The moral worth of a person | C. A measure of income | D. Health's contribution to quality of life

D. Health's contribution to quality of life | Why: R distinguishes health from the full range of things that contribute to a good life. | Source: R ch. 2

Q006 [Rationing and fairness] Which is NOT one of the five EQ-5D dimensions? A. Self-care | B. Employment income | C. Anxiety/depression | D. Mobility

B. Employment income | Why: The five are mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. | Source: R ch. 2

Q007 [Rationing and fairness] How many combinations are possible in the three-level EQ-5D? A. 125 | B. 15 | C. 243 | D. 3,125

C. 243 | Why: Five dimensions with three levels each produce 3^5 = 243 combinations. | Source: R ch. 2

Q008 [Rationing and fairness] Which valuation procedure explicitly involves a risky choice between full health and death? A. A census | B. Standard gamble | C. A rating scale | D. Time trade-off

B. Standard gamble | Why: Standard gamble elicits a value through indifference between a health state and a probabilistic alternative. | Source: R ch. 2

Q009 [Rationing and fairness] A respondent equates ten years in a condition with six years in full health. The simple time-trade-off value is: A. 1.67 | B. 0.4 | C. 0.6 | D. 4

C. 0.6 | Why: Divide full-health years by years in the impaired state: 6/10 = 0.6 under the simplifying assumptions. | Source: R ch. 2

Q010 [Rationing and fairness] Three years at quality 0.5 followed by two years at 1 represent: A. 5 QALYs | B. 2.5 QALYs | C. 1.5 QALYs | D. 3.5 QALYs

D. 3.5 QALYs | Why: 3 × 0.5 + 2 × 1 = 3.5. | Source: R chs. 2-3

Q011 [Rationing and fairness] If a treatment yields five QALYs and its comparator yields three, the incremental benefit is: A. 3 QALYs | B. 5 QALYs | C. 8 QALYs | D. 2 QALYs

D. 2 QALYs | Why: Benefits gained must be measured against the comparator: 5 - 3 = 2. | Source: R ch. 3

Q012 [Rationing and fairness] In the introductory DALY disability-weight scale, full health is represented by: A. -1 | B. 100 | C. 1 | D. 0

D. 0 | Why: DALYs measure health loss; a disability weight of zero represents no health loss. | Source: R ch. 2

Q013 [Rationing and fairness] A condition causes three years at disability weight 0.2 and ten years of life lost. Its simple burden is: A. 2 DALYs | B. 13 DALYs | C. 10.6 DALYs | D. 6 DALYs

C. 10.6 DALYs | Why: YLD = 3 × 0.2 = 0.6. Add ten YLL to obtain 10.6 DALYs. | Source: R chs. 2-3

Q014 [Rationing and fairness] Why might experienced patients value a health state differently from the general public? A. Adaptation and lived experience can change evaluations | B. The public has perfect information | C. All health states are objectively identical | D. Patients never adapt

A. Adaptation and lived experience can change evaluations | Why: Patients may develop effective coping and revise expectations; outsiders may underestimate their quality of life. | Source: R ch. 2

Q015 [Rationing and fairness] A new program costs $120,000 and yields six QALYs; the comparator costs $80,000 and yields four. The ICER is: A. $40,000 per additional QALY | B. $20,000 per additional QALY | C. $30,000 per additional QALY | D. $200,000 per additional QALY

B. $20,000 per additional QALY | Why: Additional cost is $40,000 and additional benefit two QALYs: $20,000 per QALY. | Source: R ch. 3

Q016 [Rationing and fairness] Which criticism misunderstands cost-effectiveness analysis? A. Its inputs can be uncertain | B. It can overlook distribution | C. It necessarily assigns a monetary price to each person's inherent worth | D. Its thresholds require judgment

C. It necessarily assigns a monetary price to each person's inherent worth | Why: The ratio concerns the resource cost of producing health benefit, not the worth of persons. | Source: R ch. 3

Q017 [Rationing and fairness] The Oregon case most directly illustrates a distinction between: A. Public and private moral worth | B. Research and publication | C. Expanding eligibility and limiting the covered service package | D. Older and younger genetic variants

C. Expanding eligibility and limiting the covered service package | Why: The reform sought broader coverage while defining a prioritized benefits package. | Source: R ch. 3

Q018 [Rationing and fairness] The postcode lottery concerns: A. A nationwide equal lottery | B. Local differences in publicly provided care | C. A biological aging score | D. Randomly chosen postal workers

B. Local differences in publicly provided care | Why: R uses the term for geographic variation in access and coverage within the health service. | Source: R ch. 3

Q019 [Rationing and fairness] What does an equity weight do? A. Changes the moral value assigned to a benefit | B. Eliminates the need for judgment | C. Changes the patient's DNA | D. Guarantees equal outcomes

A. Changes the moral value assigned to a benefit | Why: It expresses how benefits should count morally, for example giving more weight to gains for the worse off. | Source: R ch. 3

Q020 [Rationing and fairness] Why is discounting future health ethically disputed? A. Money never has alternative uses | B. Discounting always raises future benefits | C. An equally large future benefit may be assigned lower present value solely because of timing | D. The future cannot contain health benefits

C. An equally large future benefit may be assigned lower present value solely because of timing | Why: Critics question pure time preference for health; defenders appeal to resource tradeoffs and other considerations. | Source: R ch. 3

Q021 [Rationing and fairness] What is the authors' response to the claim that QALYs make disabled people less valuable? A. Reject all quality-of-life improvement | B. Treat every outcome as identical | C. Distinguish the worth of persons from the quality of health outcomes | D. Agree and defend unequal moral worth

C. Distinguish the worth of persons from the quality of health outcomes | Why: Equal moral worth does not require denying that pain relief or restored function can improve someone's life. | Source: R ch. 4

Q022 [Rationing and fairness] A younger and an older patient each gain ten equal-quality years at equal cost. Benefit maximization alone: A. Must favor the younger person | B. Must favor the older person | C. Treats the gains as equal on the stipulated facts | D. Requires abandoning both

C. Treats the gains as equal on the stipulated facts | Why: If prospective gains and all other relevant factors are equal, their total health benefit is equal. | Source: R ch. 4

Q023 [Rationing and fairness] The fair innings argument appeals primarily to: A. Opportunity to have a complete life | B. A ban on all age-sensitive reasoning | C. A claim that all young patients have better prognosis | D. Economic productivity alone

A. Opportunity to have a complete life | Why: Its rationale is fairness over a lifetime rather than only the number of years an intervention produces. | Source: R ch. 4

Q024 [Rationing and fairness] Why do Bognar and Hirose criticize a sharp fair-innings cutoff? A. They reject all fairness | B. It treats all clinical evidence as useless | C. They think old age has no value | D. Valuable life and projects do not stop abruptly at one threshold

D. Valuable life and projects do not stop abruptly at one threshold | Why: A rigid cutoff gives implausibly discontinuous weight to open-ended plans and continued life. | Source: R ch. 4

Q025 [Rationing and fairness] Which position do the authors defend concerning disability objections to CEA? A. Only death prevention counts as effectiveness | B. Disability can never strengthen a claim | C. Every unequal priority is unjust | D. The objections do not decisively justify abandoning CEA

D. The objections do not decisively justify abandoning CEA | Why: They defend considering benefit while allowing fairness and severity to supplement the analysis. | Source: R ch. 4

Q026 [Rationing and fairness] The aggregation thesis permits: A. Ignoring every additional patient | B. Adding benefits across people and comparing totals | C. Treating numbers as morally irrelevant | D. Only within-person comparisons

B. Adding benefits across people and comparing totals | Why: Aggregation makes interpersonal totals morally relevant, including in many-small-versus-few-large benefit cases. | Source: R ch. 5

Q027 [Rationing and fairness] The number problem asks how to justify: A. Saving the greater number when individual claims are otherwise comparable | B. Giving all resources to the wealthy | C. Ignoring prognosis in all settings | D. Replacing justice with arithmetic alone

A. Saving the greater number when individual claims are otherwise comparable | Why: The challenge is whether and how additional claims count, especially for nonaggregative theories. | Source: R ch. 5

Q028 [Rationing and fairness] Which is the strongest example of leveling down? A. Helping the sickest patient | B. Improving everyone equally | C. Reducing severe illness | D. Worsening the healthier group without improving anyone else

D. Worsening the healthier group without improving anyone else | Why: The inequality gap shrinks, but nobody benefits. This challenges equality considered by itself. | Source: R ch. 5

Q029 [Rationing and fairness] Prioritarianism differs from a pure equality view because it: A. Forbids all aggregation | B. Always gives identical chances | C. Values benefits more when recipients are worse off, not simply a smaller gap | D. Treats all benefits as equally weighted

C. Values benefits more when recipients are worse off, not simply a smaller gap | Why: Priority attaches to how badly off the recipient is; it need not value equality through destroying anyone's health. | Source: R ch. 5

Q030 [Rationing and fairness] Which claim about prioritarianism is correct? A. It always ignores numbers | B. It treats improvements for the better off as always worthless | C. It requires absolute priority to any tiny gain for the worst off | D. It can aggregate weighted benefits

D. It can aggregate weighted benefits | Why: Prioritarianism gives extra moral weight to the worse off while still permitting benefits to be added. | Source: R ch. 5

Q031 [Rationing and fairness] Leximin differs from maximin by: A. Comparing the next-worst position when the worst positions tie | B. Maximizing only total income | C. Ignoring the worst off entirely | D. Assigning equal value to all outcomes

A. Comparing the next-worst position when the worst positions tie | Why: Leximin continues through the ranked positions to resolve ties that maximin leaves. | Source: R ch. 5

Q032 [Rationing and fairness] A lottery gives each of six people one ticket and rescues the winner's entire group of five or one. The isolated person's rescue chance is: A. 5/6 | B. 1/2 | C. 1/5 | D. 1/6

D. 1/6 | Why: One of six tickets belongs to the isolated person; the other five send the rescue to the larger group. | Source: R ch. 5; original numerical application

Q033 [Rationing and fairness] Brute luck refers to: A. A deliberate unhealthy choice in every case | B. A treatment's budget impact | C. All informed voluntary gambles | D. Unchosen circumstances or outcomes in the theory's sense

D. Unchosen circumstances or outcomes in the theory's sense | Why: The concept contrasts with option luck from chosen risks, though the boundary is contested. | Source: R ch. 6

Q034 [Rationing and fairness] The abandonment objection challenges a rule that: A. Measures treatment benefit | B. Denies assistance to someone whose severe need is attributed to chosen risk | C. Counts benefits for several people | D. Allows rehabilitation

B. Denies assistance to someone whose severe need is attributed to chosen risk | Why: Strict responsibility-sensitive justice can leave a badly off patient without a claim to treatment. | Source: R ch. 6

Q035 [Rationing and fairness] Why is asking about smoking not necessarily blame-based rationing? A. Smoking never affects medicine | B. Any lifestyle question requires denying care | C. The question always settles desert | D. It may provide clinically relevant information about benefit or risks

D. It may provide clinically relevant information about benefit or risks | Why: Medical relevance and moral punishment are different uses of the same information. | Source: R ch. 6

Q036 [Rationing and fairness] The Whitehall findings suggest that: A. Income alone explains every health outcome | B. Only unemployed people experience health gradients | C. Health varies across occupational grades even with access to care | D. Equal clinical access guarantees equal health

C. Health varies across occupational grades even with access to care | Why: The gradient supports attention to wider determinants and is not reduced simply to insurance or smoking. | Source: R ch. 6

Q037 [Rationing and fairness] What conclusion do the rationing authors reach about responsibility for illness? A. It should be the only criterion | B. All health behavior is fully unchosen | C. It should not be central to allocating treatment | D. Every risky choice deserves denial of care

C. It should not be central to allocating treatment | Why: Their position reflects objections to blame-based allocation, not a denial that choices or prevention can matter. | Source: R ch. 6

Q038 [Rationing and fairness] What does the island example hold constant to isolate an ethical tradeoff? A. Disease risk and vaccine effectiveness across children | B. Transport costs across regions | C. The number living in each region | D. The number vaccinated under both programs

A. Disease risk and vaccine effectiveness across children | Why: Equal risk and effectiveness leave cost and distribution as the central differences. | Source: R ch. 1

Q039 [Rationing and fairness] Why does the mountain group cost more to vaccinate in the island example? A. Their lives have greater inherent worth | B. They face no disease risk | C. Reaching each child uses more resources | D. The vaccine works less well for them

C. Reaching each child uses more resources | Why: The example stipulates different delivery costs rather than different moral worth. | Source: R ch. 1

Q040 [Rationing and fairness] What is sacrificed when the island chooses equal regional vaccination chances? A. All disease prevention | B. The moral worth of coastal children | C. Some total vaccinations under the fixed budget | D. Every mountain child's eligibility

C. Some total vaccinations under the fixed budget | Why: Equal regional chances protect fewer children than the maximum-benefit program. | Source: R ch. 1

Q041 [Rationing and fairness] Why might earlier exclusion matter in a later island vaccination decision? A. Past allocation determines future vaccine efficacy | B. Fairness may consider the history of who received benefits | C. Delivery costs must disappear | D. The second disease cannot cause harm

B. Fairness may consider the history of who received benefits | Why: Repeatedly leaving the same group behind raises a distributional concern beyond each isolated total. | Source: R ch. 1

Q042 [Rationing and fairness] Which change would reduce scarcity without logically eliminating it? A. Increasing the available budget | B. Renaming rationing as access | C. Declaring every treatment a right | D. Avoiding explicit priorities

A. Increasing the available budget | Why: More funding expands possibilities but leaves choices among competing uses. | Source: R ch. 1

Q043 [Rationing and fairness] Why can spending on education be relevant to health rationing? A. Health spending competes with other activities that improve lives | B. Health has no moral importance | C. Education removes all illness | D. Education is a clinical treatment in every case

A. Health spending competes with other activities that improve lives | Why: Opportunity costs extend beyond the health sector. | Source: R ch. 1

Q044 [Rationing and fairness] Which claim needs an ethical premise rather than clinical evidence alone? A. A medicine requires refrigeration | B. Two clinics have different staffing levels | C. A patient has a fever | D. A larger survival benefit should determine priority

D. A larger survival benefit should determine priority | Why: Facts do not establish which differences ought to determine allocation. | Source: R ch. 1

Q045 [Rationing and fairness] A hospital declines to publish priorities. What can still happen? A. All decisions become value neutral | B. Scarcity disappears | C. Staff make implicit allocation decisions | D. Every eligible person receives immediate care

C. Staff make implicit allocation decisions | Why: Avoiding explicit rules can move rationing into less accountable individual choices. | Source: R conclusion

Q046 [Rationing and fairness] What does the WHO and UNAIDS 3 by 5 discussion illustrate? A. Urban residents always have stronger moral claims | B. Expansion through existing urban capacity can conflict with rural access | C. Technical plans contain no ethical judgments | D. HIV treatment has no delivery constraints

B. Expansion through existing urban capacity can conflict with rural access | Why: Speed and infrastructure advantages can come at a distributional cost. | Source: R ch. 1

Q047 [Rationing and fairness] Which is a limit on health access even when medication is free? A. Identical access in all regions | B. An unlimited supply of consultation time | C. Universal elimination of opportunity cost | D. Insufficient clinical staff and travel capacity

D. Insufficient clinical staff and travel capacity | Why: Price is only one access constraint; delivery and professional time remain scarce. | Source: R ch. 1

Q048 [Rationing and fairness] Why is private insurance coverage an allocation issue? A. Private insurers cannot set priorities | B. Only public spending can be rationed | C. It determines which services scarce pooled funds support | D. Coverage has no effect on access

C. It determines which services scarce pooled funds support | Why: Controlled allocation occurs in private as well as public systems. | Source: R ch. 1

Q049 [Rationing and fairness] A duty forbids using a patient merely as a means despite a larger benefit. Which approach fits? A. Deontological reasoning | B. Ability to pay | C. Unrestricted aggregate maximization | D. Pure time preference

A. Deontological reasoning | Why: Deontological approaches recognize duties or constraints beyond outcome totals. | Source: R ch. 1

Q050 [Rationing and fairness] What makes a principle worth testing against difficult cases? A. Ethical principles cannot be revised | B. Its implications may conflict with other justified commitments | C. Intuitions never require reasons | D. Every familiar policy is correct

B. Its implications may conflict with other justified commitments | Why: Testing cases examines consistency and helps refine moral judgments. | Source: R ch. 1

Q051 [Rationing and fairness] Why can two people with the same injury experience different losses? A. Only age determines health value | B. The injury has no physical properties | C. Quality of life is always identical | D. Their activities and opportunities may differ

D. Their activities and opportunities may differ | Why: The same impairment can affect a pianist and another worker differently. | Source: R ch. 2

Q052 [Rationing and fairness] Which best captures health's instrumental value? A. It matters only when it increases wages | B. It is identical to income | C. It helps people pursue valued activities | D. It eliminates all other goods

C. It helps people pursue valued activities | Why: Health can support goals beyond health itself. | Source: R ch. 2

Q053 [Rationing and fairness] What would intrinsic value of health mean? A. Every health state has identical value | B. Health matters only as a tool | C. Health is good in itself | D. Health can be measured only in dollars

C. Health is good in itself | Why: Intrinsic value contrasts with the value of health as a means to other ends. | Source: R ch. 2

Q054 [Rationing and fairness] Why is health related quality of life narrower than overall well being? A. It excludes pain and functioning | B. Relationships and other nonhealth goods also contribute to well being | C. It measures only survival duration | D. It is simply household wealth

B. Relationships and other nonhealth goods also contribute to well being | Why: Health contributes to life quality without exhausting everything that matters. | Source: R ch. 2

Q055 [Rationing and fairness] Which pair belongs to the EQ 5D dimensions? A. Occupation and education | B. Self care and usual activities | C. Height and blood type | D. Income and political influence

B. Self care and usual activities | Why: The instrument also includes mobility, pain or discomfort, and anxiety or depression. | Source: R ch. 2

Q056 [Rationing and fairness] What is the difference between describing and valuing a health state? A. Description identifies features while valuation assigns relative value | B. Description establishes ethical priority automatically | C. Both tasks measure treatment cost | D. Valuation supplies a diagnosis only

A. Description identifies features while valuation assigns relative value | Why: A descriptive system does not by itself determine the value assigned to each state. | Source: R ch. 2

Q057 [Rationing and fairness] What is a limitation of a simple rating scale? A. It directly measures DNA | B. Equal numerical gaps need not represent equally valued changes | C. It cannot order any states | D. It eliminates framing effects

B. Equal numerical gaps need not represent equally valued changes | Why: A rating number is not automatically an interval measure of health value. | Source: R ch. 2

Q058 [Rationing and fairness] Which elicitation method is particularly sensitive to attitudes toward risk? A. Standard gamble | B. EQ 5D state description alone | C. Counting days in hospital | D. Clinical blood pressure measurement

A. Standard gamble | Why: The standard gamble compares a certain state with uncertain outcomes. | Source: R ch. 2

Q059 [Rationing and fairness] Which elicitation method exchanges duration against quality? A. Time trade off | B. Blood oxygen monitoring | C. A lottery among transplant candidates | D. A waiting list

A. Time trade off | Why: The respondent compares longer impaired life with shorter full health. | Source: R ch. 2

Q060 [Rationing and fairness] Why might public respondents value a disability differently from patients? A. All patients give the same score | B. Public judgments contain no stereotypes | C. Patients cannot report any preferences | D. They may lack experience of adaptation and daily functioning

D. They may lack experience of adaptation and daily functioning | Why: Lived experience can change assessments of quality of life. | Source: R ch. 2

Q061 [Rationing and fairness] What is a reason to consult the public on health state values? A. Patients' experiences are irrelevant | B. Voting determines biological effectiveness | C. Shared resources raise questions about society's judgments | D. Public respondents always predict clinical outcomes correctly

C. Shared resources raise questions about society's judgments | Why: Public involvement has a legitimacy argument, though information and bias remain concerns. | Source: R ch. 2

Q062 [Rationing and fairness] Why is adaptation not a simple answer to every valuation dispute? A. It proves all disability is harmless | B. It guarantees identical preferences | C. It can reflect effective coping or constrained expectations | D. It makes clinical evidence unnecessary

C. It can reflect effective coping or constrained expectations | Why: Adaptation can improve well being while also complicating comparisons and interpretation. | Source: R ch. 2

Q063 [Rationing and fairness] Which condition could produce a large disease burden despite few deaths? A. A condition with no symptoms or duration | B. A common persistent disabling condition | C. A disease that affects nobody | D. An intervention with no effect

B. A common persistent disabling condition | Why: DALYs include nonfatal health loss as well as premature mortality. | Source: R ch. 2

Q064 [Rationing and fairness] What does a QALY weight of 0.6 describe? A. A 60 percent chance of receiving care | B. A model's value for a health state | C. A mandatory age priority | D. A person's fraction of moral worth

B. A model's value for a health state | Why: Health state valuation is not a ranking of people as persons. | Source: R ch. 2

Q065 [Rationing and fairness] How does HALE differ from unadjusted life expectancy? A. It accounts for time spent in different health states | B. It counts only health spending | C. It removes all uncertainty about survival | D. It measures the number of hospitals

A. It accounts for time spent in different health states | Why: HALE adjusts expected years for health quality or loss. | Source: R ch. 2

Q066 [Rationing and fairness] Why can two elicitation methods yield different values? A. Both are free from respondent preferences | B. The condition must have changed biologically | C. Their framing and underlying assumptions differ | D. One necessarily measures moral worth

C. Their framing and underlying assumptions differ | Why: Risk attitudes and time preferences affect different elicitation methods. | Source: R ch. 2

Q067 [Rationing and fairness] What does a negative health state value in some systems imply? A. A disease has negative financial cost | B. The person lacks rights | C. The state is valued below death within that measurement convention | D. Care should automatically be withdrawn

C. The state is valued below death within that measurement convention | Why: A scale convention does not establish a treatment or rights conclusion. | Source: R ch. 2

Q068 [Rationing and fairness] What is the appropriate direction for evaluating DALYs averted? A. More averted DALYs always mean greater loss | B. Averted DALYs count hospital staff | C. Only total dollars matter | D. More averted DALYs indicate greater modeled benefit

D. More averted DALYs indicate greater modeled benefit | Why: DALYs are burden, so preventing them is a health gain. | Source: R ch. 2

Q069 [Rationing and fairness] Why should remaining reference life expectancy be used for YLL when supplied? A. It reflects expected remaining years at the age of death | B. It removes the need for a reference population | C. It measures disability duration only | D. It is always age at birth minus age at death

A. It reflects expected remaining years at the age of death | Why: Conditional remaining expectancy differs from life expectancy at birth. | Source: R ch. 2

Q070 [Rationing and fairness] Why can a cheaper treatment be ethically preferable if effectiveness is equal? A. Its patients have greater inherent worth | B. Expensive care cannot produce benefit | C. It frees resources to benefit other patients | D. Cost alone establishes every fair choice

C. It frees resources to benefit other patients | Why: Opportunity cost gives an ethical reason to avoid unnecessary expense. | Source: R ch. 3

Q071 [Rationing and fairness] Which is required for an incremental comparison? A. Only the new option's purchase price | B. Costs and outcomes of both options | C. An assumption that every benefit is equal | D. Only the number of hospital beds

B. Costs and outcomes of both options | Why: An ICER compares differences in costs and benefits. | Source: R ch. 3

Q072 [Rationing and fairness] What does a cost effectiveness threshold represent? A. A decision rule about acceptable resource cost per added benefit | B. A biological constant shared by all countries | C. The highest possible treatment effect | D. The market price of a human life

A. A decision rule about acceptable resource cost per added benefit | Why: Thresholds depend on decisions and resource constraints rather than fixed biology. | Source: R ch. 3

Q073 [Rationing and fairness] Why can a favorable cost per QALY coexist with a large budget impact? A. Cost effectiveness guarantees a small total bill | B. QALYs measure only fixed costs | C. Population size never affects spending | D. A low cost per person can add up across many eligible people

D. A low cost per person can add up across many eligible people | Why: Efficiency per unit and total affordability answer different questions. | Source: R ch. 3

Q074 [Rationing and fairness] What was Oregon trying to expand through its coverage reform? A. Every possible service without limits | B. The moral worth of some patients | C. Only private hospital profits | D. The population eligible for coverage

D. The population eligible for coverage | Why: The historical example links broader eligibility with a limited prioritized package. | Source: R ch. 3

Q075 [Rationing and fairness] What was ranked in the early Oregon approach discussed in the book? A. Citizens' inherent social worth | B. Clinicians' salaries | C. Patients' political preferences | D. Condition and treatment pairs

D. Condition and treatment pairs | Why: Ranking service benefits is distinct from assigning worth to individual people. | Source: R ch. 3

Q076 [Rationing and fairness] What organization illustrates pharmaceutical priority setting in New Zealand? A. COVAX | B. ACIP | C. PHARMAC | D. The Gray Panthers

C. PHARMAC | Why: The book uses PHARMAC and Herceptin funding to discuss evidence and political pressure. | Source: R ch. 3

Q077 [Rationing and fairness] What controversy illustrates the interaction of evidence and advocacy in New Zealand? A. The abolition of pharmaceutical budgets | B. The duration of publicly funded Herceptin treatment | C. Replacement of every clinical trial with a vote | D. A ban on all generic medicines

B. The duration of publicly funded Herceptin treatment | Why: The historical example concerns nine weeks versus twelve months of funding. | Source: R ch. 3

Q078 [Rationing and fairness] Why was NICE relevant to the postcode lottery discussion? A. It set every country's health budget | B. National assessment could reduce local variation in coverage | C. It guaranteed that all services would be funded | D. It allocated care by housing prices

B. National assessment could reduce local variation in coverage | Why: The ethical issue was inconsistent access across locations. | Source: R ch. 3

Q079 [Rationing and fairness] What is the role of the Disease Control Priorities Project in the book? A. Determining each patient's inherent worth | B. Creating a universal bedside rule for every patient | C. Eliminating local capacity differences | D. Providing comparative evidence to support priority setting

D. Providing comparative evidence to support priority setting | Why: Evidence summaries assist decisions but require local application. | Source: R ch. 3

Q080 [Rationing and fairness] What does an equity weight change directly? A. The patient's measured chronological age | B. The chemical action of treatment | C. The moral contribution assigned to a health gain | D. The actual number of clinical staff

C. The moral contribution assigned to a health gain | Why: Weighting changes how gains count in ethical evaluation. | Source: R ch. 3

Q081 [Rationing and fairness] Why is an unweighted QALY total not entirely value free? A. QALYs contain no empirical information | B. It proves equality is unimportant | C. Equal weight for each QALY is itself an ethical choice | D. It always prioritizes the worst off

C. Equal weight for each QALY is itself an ethical choice | Why: The aggregation rule embeds a judgment about which differences matter. | Source: R ch. 3

Q082 [Rationing and fairness] What is a practical advantage of explicit equity weights? A. They determine treatment efficacy | B. They remove ethical disagreement | C. They make tradeoffs more visible | D. They guarantee universal agreement

C. They make tradeoffs more visible | Why: Explicit weights can expose how much aggregate benefit is traded for priority. | Source: R ch. 3

Q083 [Rationing and fairness] What is a limitation of informal equity adjustments? A. They never involve judgment | B. Their reasons and consistency may be difficult to inspect | C. They always calculate exact probabilities | D. They cannot affect access

B. Their reasons and consistency may be difficult to inspect | Why: Less formal methods may hide variation in decision making. | Source: R ch. 3

Q084 [Rationing and fairness] How does risk adjustment differ from pure time preference? A. Risk concerns uncertainty while time preference concerns timing itself | B. Time preference measures treatment compatibility | C. Both always measure age prejudice | D. Risk adjustment assigns equal probability to every outcome

A. Risk concerns uncertainty while time preference concerns timing itself | Why: An uncertain future benefit and a certain later benefit raise different issues. | Source: R ch. 3

Q085 [Rationing and fairness] What is one standard reason for discounting money? A. Inflation measures moral worth | B. All future people have fewer rights | C. Future medicines never work | D. Money available now can be invested

D. Money available now can be invested | Why: Investment opportunities help explain financial discounting, unlike an automatic moral discount on health. | Source: R ch. 3

Q086 [Rationing and fairness] A future benefit is certain and identical to a present one. What is contested? A. Whether the future benefit exists at all | B. Whether it involves health | C. Whether timing alone justifies lower moral value | D. Whether either patient is a person

C. Whether timing alone justifies lower moral value | Why: The ethical dispute concerns pure time preference for health. | Source: R ch. 3

Q087 [Rationing and fairness] Why is rejecting every cost comparison ethically risky? A. It can ignore benefits forgone by other patients | B. It guarantees maximum fairness | C. It removes rationing | D. It ensures treatment for everyone

A. It can ignore benefits forgone by other patients | Why: Resources consumed by one intervention cannot also support every alternative. | Source: R ch. 3

Q088 [Rationing and fairness] Does the rationing book regard cost effectiveness as a complete ethical rule? A. No, fairness and distribution also matter | B. Yes, no other consideration is relevant | C. No, evidence about benefit is irrelevant | D. Yes, only treatment price matters

A. No, fairness and distribution also matter | Why: The authors defend cost effectiveness as important but insufficient alone. | Source: R chs. 3 and 4

Q089 [Rationing and fairness] What is the strongest response to the claim that all quality adjustment devalues people? A. Some persons have fewer rights by definition | B. Health outcomes can differ in quality while people remain equally worthy | C. Disability can never cause suffering | D. All health states must receive the same score

B. Health outcomes can differ in quality while people remain equally worthy | Why: Equal respect for persons does not require indifference to health improvements. | Source: R ch. 4

Q090 [Rationing and fairness] Which is a serious distributional concern about quality adjustment? A. A quality score literally changes citizenship | B. Health gains can never be compared | C. Every disabled person must be denied care | D. Some disabled groups may systematically receive lower estimated gains

D. Some disabled groups may systematically receive lower estimated gains | Why: A systematic disadvantage requires ethical scrutiny beyond rejecting a caricature of QALYs. | Source: R ch. 4

Q091 [Rationing and fairness] What distinguishes population service ranking from bedside patient ranking? A. Both necessarily rank social worth | B. Population analysis ignores all benefit | C. One compares interventions across groups while the other chooses among individuals | D. Bedside choices never use evidence

C. One compares interventions across groups while the other chooses among individuals | Why: A coverage assessment does not automatically dictate every individual triage decision. | Source: R ch. 4

Q092 [Rationing and fairness] Why can severity matter alongside capacity to benefit? A. Severity eliminates opportunity cost | B. Severity and benefit are identical measures | C. A worse starting position can strengthen a fairness claim | D. Only severity determines actual treatment efficacy

C. A worse starting position can strengthen a fairness claim | Why: The authors allow attention to the worse off while recognizing gains. | Source: R ch. 4

Q093 [Rationing and fairness] When could benefit maximization favor an older patient? A. Only when every prognosis is identical | B. Only when the older patient is richer | C. Never under any circumstances | D. When that patient has the larger relevant expected gain

D. When that patient has the larger relevant expected gain | Why: Benefit maximization depends on expected outcomes, not a categorical age ranking. | Source: R ch. 4

Q094 [Rationing and fairness] Which argument could favor a younger patient despite equal future health gains? A. A rule based solely on cheaper medicines | B. A claim that equal worth requires random choice always | C. Pure gain maximization alone | D. Fair innings

D. Fair innings | Why: Fair innings concerns opportunities already available across a lifetime. | Source: R ch. 4

Q095 [Rationing and fairness] What is a major problem with a sharp fair innings cutoff? A. Claims may change abruptly at an arbitrary birthday | B. All older people have completed every valued project | C. It prevents any concern for lifetime fairness | D. It makes younger patients immortal

A. Claims may change abruptly at an arbitrary birthday | Why: Open ended projects and continued relationships challenge abrupt thresholds. | Source: R ch. 4

Q096 [Rationing and fairness] How can gradual age weighting differ from denying older people all benefit? A. Benefits can retain positive value at every age | B. Older patients cease to have rights | C. Every older patient gets zero weight | D. Only chronological age is ever relevant

A. Benefits can retain positive value at every age | Why: Gradual weights can vary priority without eliminating the value of later life. | Source: R ch. 4

Q097 [Rationing and fairness] What justification for older DALY age weights do the authors criticize? A. The idea that children have opportunities ahead | B. The distinction between health and moral worth | C. Productivity and social role arguments favoring young adulthood | D. The need to count nonfatal illness

C. Productivity and social role arguments favoring young adulthood | Why: Productivity weighting can undervalue children before their adult opportunities occur. | Source: R ch. 4

Q098 [Rationing and fairness] Why should a disease burden estimate not be mistaken for a complete allocation rule? A. The largest burden is always untreatable | B. All burden estimates are meaningless | C. Disease burden already includes every ethical value | D. Burden does not by itself show treatability or resource cost

D. Burden does not by itself show treatability or resource cost | Why: Priority setting also requires benefits, costs, feasibility, and fairness. | Source: R chs. 2 to 4

Q099 [Rationing and fairness] What concern can catastrophic medical spending add to allocation analysis? A. Protection from severe financial harm | B. Proof that only wealthy patients benefit | C. Evidence that QALYs measure bank balances | D. A reason to ignore health gains entirely

A. Protection from severe financial harm | Why: Financial protection can matter beyond a simple health benefit ratio. | Source: R ch. 4

Q100 [Rationing and fairness] Why does equal treatment effectiveness not settle every age related dispute? A. Prognosis becomes impossible to estimate | B. All ethical theories then agree | C. Lifetime fairness may remain contested | D. Chronological age becomes a quality score

C. Lifetime fairness may remain contested | Why: Equal prospective gains leave room for disagreement about lifetime opportunity. | Source: R ch. 4