Quiz Questions

Risk is generally predictable for which group? a. Groups of people b. Providers c. Individuals d. Underwriters

What is the purpose of a stop-loss provision in a health insurance plan? a. It limits total out-of-pocket costs b. It ensures that the provider will not suffer a loss c. It protects the insurance underwriter d. It excludes certain types of risks from coverage

What is self-insurance? a. A type of managed care plan b. Any nonpublic insurance c. Large employers assume risks and budget for medical claims d. Insurance plans available to the self-employed

For health insurance purposes, what is the threshold for full-time work under the Affordable Care Act? a. 24 hours per week b. 30 hours per week c. 20 hours per week d. 36 hours per week

Medicare is designed specifically for three categories of people. Those with chronic heart disease are specifically covered. True or False

Which of the following eliminates the need for Medigap coverage for Medicare beneficiaries? a. Part C b. Part A c. Part D d. Part B

The Rand Health Insurance Experiment demonstrated that utilization could be lowered through cost sharing. True or False

The United States does not have publicly financed insurance specifically for the unemployed.

Under Medicare Part A, a beneficiary can have an unlimited number of benefit periods.

What type of care is described as "end of life care?" a. Hospice b. Preventive c. Tertiary d. Home health

Which of the following is true in regards to health care today in the United States? a. Primary care receives a higher reimbursement in professional fees b. There are more primary care physicians than specialty physicians c. Outpatient care is slowing decreasing d. There are more specialty physicians than primary physicians

Characteristics of the medical home strategy include multidisciplinary practice-based teams and coordinated care. True or False

Going beyond the biomedical model to include social and behavioral sciences is a major front of development for community-oriented primary care. True or False

Telephone triage, hospice services, and home health care are all examples of a mobile health care facility. True or False

Mortality is a measurement of secondary care prevention.

The medical home model emphasizes having a primary care physician as a usual source of care and emphasizes team-based care True or False

Few efforts related to utilization control factors have been used to reduce length of stay at hospitals.

What is one aspect in which managed care differs from conventional insurance? a. Responsibility for delivery of services b. Payments to providers c. Collection of premiums d. Assumption of risk

The CMS uses which of the following as an overall measure of a health plan's quality? a. Accreditation by the NCQA b. A star rating system c. HEDIS data d. Self-reporting

What was the consumers' main gripe against managed care during the 1990s? a. Increased risk sharing b. Lack of choice of providers c. Rising premiums d. Rising deductibles

In which type of utilization management is a primary care physicians opinion necessary in referring a patient to a specialist?

Precertification is associated with which type of utilization review? a. Retrospective b. Concurrent c. Prospective d. Gatekeeping

In which of the following plans can an MCO lose a large number of physicians if a contract is lost? a. HMO IPA model plans b. PPO plans c. HMO group model plans d. POS plans

Most Medicare beneficiaries receive their health care through managed care plans. True or False

A PPO plan is a hybrid between HMO and POS plans.

Research shows that there are issues with access to both primary and specialty care in Medicaid managed care. True or False

When did hospitals begin to attract well to do patients who could afford to pay privately? a. When physicians opened their own clinics b. When charitable contributions would not pay their bills c. When the board of trustees were composed of wealthy donors d. When hospitals offered superior medical services and surgical procedures that could not be offered at home

Who opened the first proprietary hospitals? a. Physicians b. Wealthy patrons c. Community foundations d. Trustees

What triggered the downsizing phase in the U.S. hospital industry during the 1980s? a. Prospective payment system b. Managed care c. Medicare and Medicaid d. Hill-Burton Act

4. DRG-based reimbursement necessitated hospitals to do what? a. Admit a greater number of Medicare patients than before b. Reduce the length of stay for hospitalized patients c. Admit a smaller number of Medicare patients than before d. Admit new patients at a faster rate than before

Most federal hospitals in the United States serve: a. The general public b. The U.S. military c. Employees of the U.S. government d. Veterans

A large number of which of the following have closed because there was no need for separate institutions? a. Children's hospitals b. Teaching hospitals c. Rural hospitals d. Osteopathic hospitals

The internal revenue code forbids nonprofit hospitals to make a profit. True or False

Compared to general hospitals, specialty hospitals offer services that are clinically superior. True or False

Women are admitted to hospitals more often than men after adjusting for childbearing. True or False

Long-term care services often interface with what type of care? a. Various non-long-term care services b. Secondary care c. Rehabilitation d. Primary care

Severe activities of daily living limitations often indicate the need for what service? a. Supportive community-based long-term care b. Institutionalization c. Supportive social services d. Hospitalization

What is the main goal of long-term care as it relates to a patient's function? a. Promote independence b. Adapt to change c. Provide assistance d. Restore function

When living in a long-term care facility, a patient's personal dignity is part of which of the following? a. Social dimension b. Instrumental activity of daily living c. Quality of life d. Palliation

To quality for home health care under Medicare, skilled nursing services must be: a. Nonmedical b. Full-time with rehabilitation c. Full-time and ongoing d. Part-time or intermittent

What is the purpose of skilled nursing facility certification? a. It is required to legally operate a nursing home b. It enables a facility to serve both Medicare and Medicaid clients c. It enables a facility to be operated as a skilled nursing facility d. It enables a facility to serve Medicare

Most long-term care services are provided informally by family and friends. True or False

The IADL scale incorporates activities that are necessary for living independently in the community True or False

A license to operate a long-term care facility is issued by the U.S. Department of Health and Human Services True or false

What is the term for the rapid and cumulative physical and emotional changes that characterize childhood? a. Dependency vulnerability b. Developmental vulnerability c. Homelessness d. New morbidities

Easy access to transportation is a challenge that faces rural health True or False

Which of the following is a major health concern for women? a. Women have a higher chance of developing more acute and chronic illnesses b. Nearly one-third of women have less than ninth-grade education c. Life expectancy is 8 years shorter than men d. AIDS is the leading cause of death

Mental disorders are common psychiatric illnesses affecting which group? a. The uninsured b. Children c. Ethnic minorities d. Adults

What causes AIDS? a. HIV b. Lack of insurance c. CDC d. Infectious air-born pathogen

Uninsured individuals typically tend to be: a. Women b. Urban dwellers c. Middle class d. Young adults (ages 25-40)

Let's move is an initiative designed to promote a healthy start in life for children, from pregnancy through early childhood; to serve healthier food in schools; and to increase physical activity. T/F

The nation's mental health system is composed of three subsystems based on the severity of the mental health condition T/F

Vulnerability represents a personal deficiency inherent to certain populations T/F

The rate of growth in health spending in the United States slowed to its lowest level during what time period? a. 2002-2010 b. 1973-1983 c. 1993-2000 d. 1980-1988

Which of the following contributes to high health care costs? a. Uniform practice standards b. Single payer insurance c. Alternative model of health care d. Growth of technology

According to Donabedian, in order to help define and measure quality in health care organizations, you must examine three domains. One of those domains is a risk T/F

Which of the following describes access to care? a. It is often predicted by income and occupation b. It is rarely predicted by race or income c. Access for disadvantaged populations was absent from legislative history until the ACA d. It is distinguished from acceptability of services

Emphasis on desired health outcomes is one implication of the Institute of Medicine's definition of quality. T/F

Accountable care organizations are: a. Designed to improve access to care for children and pregnant women b. Known for increasing health expenditures and sometimes reducing quality c. Designed to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes d. Focused on reducing medical malpractice

The U.S. health care system is centrally planned by the government. T/F

The United States has the highest per capita health spending but poorer health relative to other developed countries T/F

Managing delivery of care for chronic conditions through a system focused on disease treatment has been feasible and successful in recent years in the United States. T/F

What type of allocative tool spreads benefits throughout society? a. Redistributive b. Direct c. Distributive d. Indirect

How does health care policy-making operate in the United States? a. Exactly every 10 years b. Starts in the western states and moves east c. Incrementally d. Large changes at a time

Providing all funding for graduate medical residents is an essential role that individual states play in health care policy-making T/F

What two main concerns dominate the debate today over Medicare reform policy? a. Provide comprehensive coverage; raise the age limit b. Increase spending; decrease nursing home coverage c. Decrease spending; cover children d. Decrease spending; provide comprehensive coverage

How was the Medicare PPS system designed to curb escalating health care costs? a. By providing extensive coverage to the elderly b. By eliminating sales taxes on health care products c. By providing a general fee schedule for services d. By providing children tax breaks

After the ACA was enacted, individuals with higher incomes may still have trouble paying deductibles and premiums T/F

The U.S. health care delivery system is centrally controlled T/F

The CHIP is focused on the health care of children T/F

The American public generally accepts the idea of universal health coverage and the federal government managing the health care delivery system. T/F

Manufacture of generic and other drugs by Asian countries is currently a substantive global health issue. T/F

In a single-payer national health care system, the government generally controls the location of physicians. T/F

What is the main function of the allied health professional in the teamlet model? a. Acts as a health coach b. Evaluates health needs in the community c. Performs administrative duties d. Does an initial evaluation before referring the patient to a physician

Creating tax incentives is a recommendation by the national academy of sciences to alleviate nurse shortages. T/F

One challenge facing primary care physicians is the need for training that will enable them to function as: a. Activists b. Specialists c. Comprehensivists d. Generalists

What is the main objective of rational drug design? a. To find new drug therapies to target certain noninfectious diseases b. To match medicines with gene variations among patients c. To shorten the drug discovery process d. To reduce unwanted side effects

The U.S. Supreme Court is divided along ideological lines. T/F

Research shows that today's health care professionals are adequately trained in geriatrics. T/F

No international agency has the authority to enforce compliance with the international health regulations T/F