Health delivery systems

Flashcard maker : Dennis Jennings
HMO act of 1973
Federal legislation enacted by the Nixon administration that provided loans and grants for the planning, development, and implementation of combined insurance and healthcare delivery organizations and required that a comprehensive array of preventative and primary care services be included in the HMO arrangement
Financial risk-sharing
A concept used by MCOs to transfer some measure of financial risk from insurers to beneficiaries. Such transfers of financial risk to beneficiaries commonly take the form of copayments and deductibles
Self-funded health insurance
A mechanism through which, the employer (or other group, such as a union or trade association) collects premiums and pools these into a fund or account that it uses to pay for medical benefit claims instead of using a commercial carrier
Department of Health and Human Services (DHHS)
The federal government’s principle agency concerned with health protection and promotion and provision of health and other human services to vulnerable populations.
Healthcare Effectiveness Data and Information Set (HEDIS)
Provides a standardized method for MCOs to collect, calculate, and report information about their performance to allow employers, other purchasers, and consumers to compare different health insurance plans.
Independent Payment Advisory Board (IPAB)
Created by the ACA. The mission of this entity is to recommend policies to Congress to curb Medicare spending including suggestions to improve coordination of care, eliminate waste, encourage best practices, and prioritize primary care.
Indemnity insurance
A form of insurance in which the insurance company sets allowable charges for services that it will reimburse after services are delivered and allows providers to bill patients for any uncovered excess costs.
Disease management programs
MCO programs that attempt to control costs and improve care quality for individuals with chronic and costly conditions through methods such as the use of evidence-based clinical guidelines, patient self-management education, disease registries, risk stratification, proactive patient outreach, and performance feedback to providers.
Emergency Medical Treatment and Labor Act (EMTALA)
This act requires hospitals to treat everyone who presents in their emergency departments, regardless of ability to pay. Stiff financial penalties, and as risk of Medicare decertification by hospitals inappropriately transferring patients, accompanies the EMTALA legal provisions.
Experience-rated insurance
Insurance plans in which insurance on historically documented patterns of healthcare service utilization for defined populations of subscribers to determine premium charges.
National Committee on Quality Assurance (NCQA)
Primary functions of this entity are accreditation of MCOs, PPOs, managed behavioral healthcare organizations, new health plans, and disease management programs; certifying organizations that verify provider credentials and consultation on physician organizations, utilization management organizations, patient-centered medical homes, and disease management organization and programs.
Bundled Payment for Care Initiatives (BPCI)
This initiative recognizes that separate Medicare fee-for-service payments for individual services provided during a beneficiary’s single illness often result in fragmented care with minimum coordination across providers and settings and results in rewarding service quantity rather than quality.
Community-rated insurance
Insurance plans in which all individuals in a defined group pay premiums without regard to age, gender, occupation, or health status. Community rating helped ensure nondiscrimination against groups with varying risk characteristics to provide coverage at reasonable rates for the community as a whole.
Consumer-Driven Health Plan (CDHP)
Developed in a reaction to the managed care backlash, the goals of these plans were to have employees take more responsibility for healthcare decisions and exercise more cost consciousness.
Balanced Budget Act of 1997
This act took important incremental steps by extending healthcare coverage to uninsured children through a $16 billion allocation for a new State Children’s Health Insurance Program (SCHIP). It also proposed to reduce growth in Medicare and Medicaid spending by $125.2 billion in 5 years.
As opponents feared, the Affordable Care Act changes the fundamental structure of the U.S. healthcare financing system.
True or False
False
The primary sources of public funding for healthcare expenditures are:
Medicare and Medicaid
Private health insurance in 2011 was the primary source of payment for healthcare services.
True or False
True
According to the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, in 2011, the largest percentage of the nation’s healthcare dollars were spent on:
hospital care
Persons (blank… hint: age group) account for more than one-third of all hospital stays and nearly one-half of all days of care in hospitals.
over the age of 65
\”Direct to consumer\” marketing of prescription drugs via television, radio, print, and online media has reduced the cost of prescription drugs.

True or False

False
This movement in insurance contributed to increase utilization of hospital services by removing financial barriers for middle-class working Americans for the first time.
Blue Cross
The HMO Act of 1973 provided loans and grants for the planning, developments, and implementations of combined insurance and healthcare delivery organizations.

True or False

True
Beginning in 2014, the ACA requires most Americans to carry health insurance coverage or pay a penalty.

True or False

True
The ACA requires states to establish health benefit exchanges (American Health Benefit Exchanges) and create separate exchanges for small employers (Small Business Health Options Program) with up to 100 employees. What is the intent of these exchanges?
To create a competitive health insurance market
Pilot programs newly authorized or expanded by the ACA will experiment with approaches to payment reforms with the dual goals of increasing the speed with which physicians and hospitals receive their payments and increasing the number of urgent care centers.

True or False

False
The Affordable Care Act created the Independent Payment Advisory Board (IPAB), housed in the Executive Branch, to:
Address Medicare spending growth
The U.S. healthcare system is currently in a paradoxical state of:
superior technology entrenched in a profit-driven reward system with little regard for the value of services
One of the greatest challenges to the U.S. healthcare enterprise is breaking loose from old philosophies, value systems, and politics.

True or False

True
Part B, supplementary medical insurance
was structured as a voluntary program covering physician services and services ordered by physicians, such as outpatient diagnostic tests, medical equipment and supplies, and home health services.
The AMA was in favor of including a form of national health insurance in the Social Security Act of 1935.

True or False

False
An aim of managed care is to transfer some measure of financial risk to providers, and, to a lesser extent, to patients. Transferring financial risk to patients is accomplished by
requiring co-pays for specified services
Major drivers of U.S. health expenditures include
advancing medical technology, growth in the older populations, specialty medicine, labor intensity, and reimbursement system incentives
Although the ACA will enact sweeping U.S. healthcare system reforms, one fundamental element of the system that will remain unchanged is:
financing of healthcare expenditures through a combination of public and private sources
The managed care concept called \”capitation\” refers to:
physicians agreeing to provide all medical care an individual requires for a specific time period, for a prepaid fee.
The establishment of the Blue Cross for hospital care, and shortly thereafter , Blue shield for physicians’ services, signaled a new era in healthcare delivery and financing. Which of the following was NOT among their major impacts?
Americans were insulated from the knowledge of costs of care.

The use of hospitals increased greatly

Efforts to enact a national government health insurance plan were disempowered

For-profit insurers began to use \”experience\” rather than \”community\” ratings to establish premiums

For-profit insurers began to use \”experience\” rather than \”community\” ratings to establish premiums
The current highest personal-care expenditure in the United States is for:
hospital care
The basic concept of health insurance is antithetical to the premise on which personal or property insurance was historically defined because
other forms of insurance were intended to cover individuals against the low risk of unlikely events such as premature deaths or accidents, while health insurance provides coverage for unlikely events in addition to routine and discretionary services
By focusing on insured populations rather than individuals, managed-care organizations can project health service use by
demographic factors such as age, gender, and other factors
The 1973 HMO legislation responded to which of the following national concerns?

Insolvency of insurers providing employer-based contracts

Rising numbers of uninsured

Growing numbers of Medicaid-eligible citizens

Rapidly increasing Medicare expenditures and concerns about the quality of care

Rapidly increasing Medicare expenditures and concerns about the quality of care
Respite Care
Temporary surrogate care given to a patient when that patient’s primary caregiver must be absent. It includes any family managed care program that helps to avoid or forestall the placement of a patient in a full-time institutionalized environment by providing planned, intermittent caregiver relief.
Skilled nursing facility (SNF)
A facility, or distinct part of one, primarily engaged in providing skilled nursing care and related services for people requiring medical or nursing care, or rehabilitation services.
Continuing care retirement community (CCRC)
Residences on a retirement campus, typically in apartment complexes designed for functional older adults. Unlike ordinary retirement communities that offer only specialized housing, these offer a comprehensive program o social services, meals, and access to contractual medical services in addition to housing.
Naturally occurring retirement community (NORC)
Apartment complexes, neighborhoods, or sections of communities where residents have opted to remain in their homes as they age.
Deinstitutionalization
The movement through which severely mentally ill patients previously confined to large state or county psychiatric hospitals were discharged to community boarding or nursing homes.
Continuing life care community (CLCC)
The most expensive of CCRC options. These offer unlimited assisted living, medical treatment, and skilled nursing care without any additional charges as the resident’s needs change over time.
The 1935 Social Security Act established minimum standards of care requirements.

True or False

False
Which of the following statements describes one provision of the 1965 Medicare and Medicaid legislation?

In-home care delivery

Funding sources for the elderly, disabled, or impoverished to receive care.

Established licensure and credentialing requirements for caregivers of Medicare and Medicaid receipients

Funding sources for the elderly, disable, or impoverished to receive care
For an individual who requires 24 hour supervision, assistance with daily living activities, medication supervision, socialization, and intermittent medical care, which mode of long-term care would be most appropriate?
Assisted living facility
Nursing home occupancy rates decreased from 1995-2010.

True or False

True
Recent research indicates decreased quality of life and longevity when older adults are allowed to remain in their own residences.
False
Residence and services must be paid for with an entrance fee and monthly charges are a characteristic of
Continuing care retirement community
According to the AARP, as of 2010 95% of LCTI policies cover ONLY care in nursing homes

True or False

False
Why did the CLASS act have to be abandoned?
The act’s voluntary enrollment did not provide an adequate population base to evenly spread financial risk
The ACA currently promotes institutionalized care wherever possible

True or False

False
A key trend driving the future of long-term care
Due to changes in reimbursement, hospitals are discharging medically fragile patients earlier than ever, thus calling for an increased focus on providing a continuum of care
Which of the following societal factors increases the need for formal long-term care services?

women working outside the home
high divorce rates
smaller family size
all of these are correct

all of these are correct
Long-term care and nursing-home reform legislation of the 1970’s occurred as a response to which of the following:
widespread media reports and congressional hearings on nursing-home and residential-care facility abuses and negligence

inadequate reimbursement for appropriate care in institutional settings

national recognition of inadequate quality assurance and monitoring systems in the long-term care industry

both media reports on abuse and recognition of the need for better quality assurance

both media reports on abuse and recognition of the need for better quality assurance
The history of institutional long-term care in the United States began with
communal-care settings operated by charitable community members and government-supported almshouses.
Which of the following was not a driver of expanded home-care services during the 1980s through the 1990s?

Assertions by increased numbers of older persons of their desire to remain in their own homes for care, whenever possible

Audits documenting significant fraud and abuse of Medicare billing

Decreased availability of informal caregivers available to assist their family members

The Olmstead Supreme Court decision upholding the right of citizens to receive care in the community

Audits documenting significant fraud and abuse of Medicare billing
What best describes the informal long-term care system?
Care and assistance provided in the home by family members and friends
The development of formal home-care services such as those provided by the Visiting Nurses Association, originated as
a social response to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseases.
The major distinction between skilled-nursing and residential-care facilities is that skilled-nursing facilities:
provide care primarily for people requiring intensive nursing, rehabilitation, or related services
The hospice movement is concerned with care for terminally ill patients. Which of the following is not a major goal of hospice care?

decreasing costs of care for the terminally ill by avoiding use of expensive technology

providing an alternative to the curative/intervention approach of medical care for the terminally ill

providing state-of-the-art pain relief interventions while supporting the patient and his/her family through the life-death transition

supporting terminally ill patients’ sense of independence throughout their dying process

decreasing costs of care for the terminally ill by avoiding use of expensive technology
Long-term care is best described as
services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needs
The enactment of Medicare and Medicaid in 1965 affected the long-term care industry in many ways. Which of the following was not an effect of the Medicare and Medicaid enactment on the long-term care industry?

provision of more stable reimbursement sources than previously available from private pay and charitable sources

prohibition of for-profit providers’ participation in Medicare and Medicaid long-term care reimbursement

establishment of minimal standards of care to qualify for Medicare and Medicaid reimbursement

provision of resources for older and disabled Americans and those lacking the ability to pay for care

prohibition of for-profit providers’ participation in Medicare and Medicaid long-term care reimbursement
Disability-adjusted life years (DALYS)
The total number of years lost to illness, disability, or premature death within a given population
Comorbidity
When two disorders or illnesses occur in the same person, simultaneously or one after another, they are called comorbid. In particular, many people addicted to drugs are also diagnosed with other mental disorders
Recovery Oriented Systems of Care (ROSC)
A holistic, integrated, person-centered and strength-based approach to mental health interventions. This approach views recovery as a process of pursuing a fulfilling life and seeks to enhance a person’s positive self-image and identity through linking their strengths with family and community resources.
\”Carve-out\”
A process through which insurers outsource subscribers’ mental illness care oversight to firms specializing in managing service use for mental health diagnoses.
Nonquantitative treatment limitations (NQTLs)
Limitations or restrictions of covered insurance benefits which though not numerically expressed, otherwise limit the scope or duration of benefits for treatment.
National alliance on mental illness
A grassroots organization dedication to advocating for access to services, treatment, supports, and research for the mentally ill.
Mental health parity
Equating annual and aggregate lifetime insurance coverage limits for mental health services with annual and aggregate lifetime insurance coverage for medical care.
Managed behavioral healthcare organization (MBHO
A corporate entity to which a health plan may outsource the management of mental health services for its subscribers. This entity assumes the financial risks and benefits of managing treatment budgets and authorization for access to mental health services.
\”Mental health care\” now is often referred to as \”behavioral health care,\” with psychiatric care, a medical susceptibility, being but one aspect of an integrated approach to needed services.

True or False

True
The paradigm for service provision has shifted from a (blank), which formerly used a diagnostic-anchored, \”problem-based\” list, to a model that is \”strength-based\”.
Treatment-plan model
In the first half of the 19th century, the vast majority of persons with mental illness had access to kind but firm treatment while engaged in work, education, and recreation.

True or False

False
After World War I, thousands of soldiers returned suffering fro \”war neurosis\”, also called \”shell shock\”. What current condition is synonymous with these disorders?
Post traumatic stress disorder
Well-designed epidemiologic studies estimate that approximately (blank) adults suffers from a diagnosable mental disorder in a given year.
1 in 4
Neuropsychiatric disorders are the leading cause of disability in the United States and Canada, surpassing cardiovascular disease and cancer.

True or False

True
In 2011, which group of individuals in need of mental health care were the least served?
Traditionally underserved groups
In 2011, among the subgroup with the greatest need for treatment (those diagnosed with a serious mental illness), almost 95% received some form of treatment.

True or False

False
Clinical research involving children and adolescents suffering from mental illness has:
lagged considerably behind that for adults
Substance abuse is a chronic brain disease, like many other psychiatric disorders.

True or False

True
Very few long-term care psychiatric inpatient facilities remain, with most care being provided within the community.

True or False

True
Many people with serious mental illness have transitioned from the psychiatric and behavioral health sector into the human services sector, specifically into
the criminal justice and prison system
The ACA’s targeted improvements of health outcomes through improved quality of care and efficiencies through Accountable Care Organizations and their integration and coordination of health services that will benefit mental health services.

True or False

True
Many of the medications used to treat serious mental illness pose an increased risk for the development of (blank), whereas others have complex interactions with other medications that the person may be taking for nonpsychiatric conditions.
type 2 diabetes
Mental health services are funded almost exclusively through federal moneys.

True or False

False
The Mental Health Parity Act of 1996 was approved by the U.S. congress with overwhelming bipartisan support. What did this legislation do?
It equated aggregated lifetime limits and annual limits for mental health services with aggregate lifetime and annual limits for medical care.
The shift to a recovery model of care provides for a strength-based system, individualized in accord with client-directed life goals and objectives.

True or False

True
As new initiatives and healthcare laws are implemented, it is expected that overall health services will
be improved by ensuring increased access to psychiatric and behavioral health services
The World Health Organization ranking of the leading causes of disability in the United States and Canada places neuropsychotic disorders at what level?
First
During the 1960s, one factor that enabled persons with mental illness to move from large institutions to community settings was:
the development of effective pharmacologic treatments for many disorders
Which of the following is not a reason why access to adequate mental health treatment for children and adolescents is particularly problematic?

Clinical research involving children has lagged behind that for adults

inadequate number of well-trained child and adolescent psychiatrists

parental reluctance to acknowledge mental health problems in their children

few practitioners access research findings on treatment efficacy

parental reluctance to acknowledge mental health problems in their children
Throughout the 1960s and 1970s, federal and state governments expanded community mental health centers and services based on what untested assumption?
Severe mental illness did not differ qualitatively from lesser forms of mental distress and early intervention could prevent development of major psychiatric disorders
The term \”non-parity\” as it applies to insurance coverage for mental health services, is best defined as
insurers using different and unequal systems to cover mental health from those used for medical care.
The term for two or more illness diagnoses occurring at the same time in the same individual is
comorbidity
In colonial America, mental health \”treatment consisted of:
confinement in homes, in jails, or in almshouses, where patients suffered severely
National awareness of the needs of persons with mental illness rose sharply in the aftermath of World War I because
thousands of soldiers returned from the war suffering from \”war neurosis\” or \”shell shock\” –> PTSD
In the late 1970s and early 1980s, efforts of advocacy groups such as the National Alliance on Mental Illness, the National Institutes of Health, and clinical researchers ultimately demonstrated that
psychiatric disorders are biologically based illnesses requiring targeted treatments, not unfocused \”talk\” therapies
Many factors are associated with lack of access to mental health care. One reason why only about one -third of those in need of mental health services actually receives them is
fear of family and social stigmatization
Ecological models
Models that identify causes of public health problems. These models take into account the vast number of determinants that impact the health status of groups of people and facilitate decisions about the most expeditious path to developing effective interventions.
This organization is charged with developing and leading a national prevention strategy and making recommendations to the President and Congress for federal policy changes that support public health goals.
National Prevention, Health Promotion, and Public Health Council
Public Health is defined as a community’s response to health problems faced by individuals

True or False

False
Which of the following health determinants relates to individual health rather than population or group health

emotional wellness
physical environment
human biology and genetics
cultural norms

emotional wellness
Due to the burgeoning need for healthy soldiers and laborers to support economic growth, maintaining public health became the focus in Europe in the late 16th and 17th centuries

True or False

True
Which ancient society is credited with introducing government involvement in public health?
Romans
The driving force behind the development of governments role in public health in the 1700s and 1800s arose out of the need to keep U.S. seamen healthy

True or False

True
Lemuel Shattuck discovered that morbidity and mortality in different locations had a direct correlation to the (blank) of a particular community and therefore argued that the government must take more responsibility for public sanitation
environment
What is an advantage the VHA healthcare system has over private medicine
the lifelong relationship formed with patients increases health and longevity due to fewer medical errors and better preventative care.
City and county public health hospitals are only required to provide general, outpatient care services to their jurisdictions.

True or False

False
Which of the following is NOT a service provided by government-supported public hospitals?

medical school teaching programs

cosmetic surgery for underinsured and underserved populations disfigured by trauma or preventable disease

financially unattractive care services such as burn care, psychiatric medicine or trauma care

crisis response in case of emergency or disaster

cosmetic surgery for underinsured and underserved populations disfigured by trauma or preventable disease
When Ronald Reagan was elected in 1980, the federal government took over responsibility for funding and operation of the public health service

True or False

False
The decline of Public Health Service in the 1960’s
When new programs for improving medical care were established, they came under the administration of other federal agencies rather than being controlled by the Public Health Service
After two failed attempts to improve the effectiveness of public health services, the final Healthy People 2010 report noted that over 71% of the targets had seen progress.

True or False

True
Which of the following is a core function of public health identified by the 1990 Public Health Service Healthy People 2000 DHHS report

Assurance
Enforcement
Financing
Leadership

Assurance
What best summarizes the relationship public health and private medicine up until the establishment of the ACA
the relationship was contentious, with little collaboration
Three percent of U.S. healthcare spending is devoted to private medicine.

True or False

False
Allowing the government to establish more public health initiatives will result in the adoption of socialized medicine

True or False

False
Which of the following is a positive outcome of the collaboration of public and private medicine?

Immunizations
Drug screenings
Mental health evaluations
Blood donations

Immunizations
Preventative medical services have been demonstrated to be more cost effective than tertiary care

True or False

True
Which of the following is an outcome of the lack of balance in the U.S. medical system?

rising health care expenditures
rising numbers of cancer related deaths
rising investments in hospital neonatal intensive care units
rising incidence of heart disease in women over the age 40

rising investments in hospital neonatal intensive care units
Behavior and environment are responsible for more than 70% of all preventable mortality

True or False

True
When it comes to serving particular needs of disenfranchised populations
a multidisciplinary approach that focuses on helping patients change lifestyle and behavior to improve overall health is necessary
Voluntary agencies work mainly in the hospital setting to serve the needs of people with specific conditions such as AIDS, cerebral palsy, and other chronic conditions, while medical research, health education, disease prevention, rehabilitation and terminal care are left to city and county public health departments.

True or False

False
Nonprofit foundations such as the Robert Wood Johnson Foundation, the Commonwealth Fund, and the Pew Charitable Trusts, provide funds on a (blank) basis, spurring hospitals and agencies to accelerate health delivery service improvement pursuits that would otherwise be neglected or slow to develop.
Competitive
States are uniform in how they fund and organize public health, dividing responsibility into each of 6 entities: health departments, social service, welfare, aging, and Medicaid.

True or False

False
Which of the following is a public health responsibility of the federal government?

surveying the populations health status and needs
distributing welfare to those in need
overseeing mental health delivery services
ensuring the appropriate distribution of Medicare services and prosecuting fraudulent use of funds

distributing welfare to those in need
Cause of the decline of public health services in the 1980s and 1990s
outsourcing to private providers left many local health departments with minimal staff, public presence, and funding
Privatization of public health services during the 1980s and 1990s improved quality and efficiency and was more cost effective over time.

True or False

False
Recent studies suggest that more early deaths can be prevented by population-wide health initiatives rather than by medical treatment.

True or False

True
Which of the following is a government objective in protecting public health?

Create a broader public health infrastructure to respond to disasters

re-organize public health into state-controlled entities to improve control and efficiency

combine public health organizations, structures, procedures, and jurisdictions into one national entity under the leadership of the DHS

Create a broader public health infrastructure to respond to disasters
The (blank) was established by the CDC in 1990 to address the infrastructure and system deficiencies cited by the \”Future of Public Health\” IOM report
National Public Health Leadership Institute
The public health code of ethics differs from the code of medical ethics because of its focus on institutions’ interactions with communities rather than individuals

True or False

True
The Prevention and Public Health Fund is the nation’s first mandatory funding stream established to improve public health

True or False

True
The main objective of Title V of the ACA’s public health legislation is to
increase the public health workforce
The ACA’s emphasis on linking prevention with financial reimbursement is not expected to positively affect systemic change in U.S. public health

True or False

False
What is expected to be the main advancement of change in the U.S. public health system?
shifting focus from curative medical care to developing and funding preventative measures
Ecological models as applied to public health are best described as
Models that take into account the vast number and interdependence of factors or determinants that impact the health status of group of people.
As a professional health-oriented discipline, public health is unique in what way?
It uses an interdisciplinary approach and methods with emphasis on preventive strategies, links with government and politics and dynamic adaptations to new problems.
The federal government’s principal agency concerned with health protection, promotion and provision of services to vulnerable populations is the department of:
Health ad Human services
Overall success in meeting Healthy People 2010 goals for improved health status of Americans is best described as:
A disappointment because health disparities have not changed for 80% of heath objectives and have increased for an additional 13%.
The September 11, 2001 terrorist attacks highlighted which or the following about the U.S. public health system?
Inadequate numbers of skilled public health professionals such as nurses, epidemiologists and lab workers.
Which of the following is NOT suggested as possible reason for the sometimes contentious relationship between public health leadership and private medicine?
Substandard training of public health physicians compared with training of private practitioners.
\”Public Health\” is most broadly defined as
Community efforts to cope with health problems arising from people living in groups
Colonial America’s public health practices in the form of almshouses and town-employed physicians were modeled upon:
England’s \”Poor Laws\”
One reason why public health suffers from a poor public image is that
public health’s major triumphs, such as the virtual eradication of vaccine-preventable childhood diseases, have resulted in those diseases’ disappearing from the public’s awareness and political consideration.
Government-supported public hospitals frequently provide which of the following services that are financially unattractive to other community hospitals?
Burn care, psychiatric care, and trauma care
Relentless pursuit of technological solutions and greater investments in research and medicine will solve the deficiencies in the current U.S. healthcare system

True or False

False
The (blank) was a response to the U.S. healthcare systems inability to reach major portions of the public and rising healthcare costs.
ACA
Factors such as a sluggish economy, rising healthcare costs, inflated health insurance premiums, and decreasing government budgets are causing;
a decline in healthcare insurance coverage for many Americans
The ACA is encouraging participation in health coverage by offering percentage reimbursement programs to low- and moderate-income individuals and families.

True or False

False
Refusing Medicare and Medicaid to healthcare providers for treatment leading to unambiguous, serious, and preventable adverse events is
a measure the DHHS has taken to improve the rates of medical error
During the 1980s and 1990s (blank) took over healthcare insurance providers and temporarily stemmed the escalating costs of healthcare
managed care organizations
The joining of ACOs with healthcare organizations decreases market competition and may create dangerous market power

True or False

True
What spurred the rapid increase of home healthcare agencies since the year 2000?
Implementation of Medicare reimbursement for home health care
The cost of providing comparable care in ambulatory or outpatient facility is higher than hospital care and yields lower customer satisfaction

True or False

False
Significant improvement in patient outcomes has been reported as a result of the implementation of the MRI technology.

True or False

False
Factors such as an increase number of women working outside the home, rising divorce rates, and rising numbers of single-parents families are placing added strain on the health care system because
lack of available caregivers will decrease while instances of preventable illness rise within vulnerable populations such as children and elderly
The current U.S. healthcare system deals most effectively with chronically ill patients, when compared to acute illness and injury that respond to curative care.

True or False

False
Changes resulting from the implementation of the managed care organizations during the 1990s caused a shortage of
primary care physicians
hospitalists are expected to be the highest valued component of the reformed health system

true or false

false
Employers are not required to provide health benefits under the ACA

true of false

false
what do experts believe will be an outcome of current ACA requirements for employers regarding provision of health insurance to employees?
only small firms are expected to drop coverage, while medium- and large-sized firms will opt to provide coverage
Describe the future of traditional acute-care hospitals in the delivery system?
Hospitals will become high level and intensive care units and full-service facilities
What is one of the main obstacles faced by health information systems designers?
treatment system disorganization
The focus of the ACA’s public health is on enhancing and developing preventative health strategies.

true or false

true
To address the needs of underserved populations and health disparities, the ACA is working to
increase workforce numbers of adequately trained medical care professionals in underserved areas
what is a social factor regarding the elderly that will increase demand for change in the coming years?
growing need for long-term care solutions for chronically ill patients
A main principle of the ACA is to actively manage and improve the quality of medical services, delivery processes, and outcomes

True or False

False
Attempts at health care system reforms of the basic problems of cost, quality and access have consistently demonstrated that which of the following results?
changes in any one of the 3 basic problems produces unintended consequences with one or more of the other two
Nurses may be among the best prepared to respond to delivery system reforms because
their training emphasizes behavioral and preventive aspects of health care and they are experienced with coordinating teamwork with other professionals
In its landmark report on hospital errors, \”To Err is Human,\” the Institute of Medicine emphasized that errors in care most typically originate from which one of the following sources?
Deficiencies in the systems of care
Changes in the health care delivery system are resulting two new, emerging roles for physicians. These are
hospitalist and physician manager/administrator
The ACA core principle that offers potential to begin closing the gap between public health and medicine is
reimbursement incentives aligned with population health status rather than individual health outcomes
One challenge to achieving the anticipated contributions of health information technology to the quality and cost-effectiveness of health care is
fragmented patient information produced by a disorganized treatment system
A joint effort with the nation’s hospitals to publicize information on quality care.
Hospital Quality Information Initiative
An online, peer-reviewed medical journal that allows physicians and healthcare providers to discuss medical errors in a blame-free environment
Morbidity and mortality rounds on the web
Established to evaluate and make recommendations regarding how to plan for the nation’s healthcare workforce needs and adequately prepare them to provide quality care.
National health care workforce commission
Intended to provide resources to stem rising healthcare costs, promote healthy lifestyle education, bolster preventative care services, and improve government response to public health threats.
Prevention and public health fund
Chaired by the U.S. surgeon general to build and administer a National Prevention Strategy, make recommendations to the President and Congress for future policy changes, and oversee public health activities of multiple agencies.
National Prevention, Health Promotion, and Public Health Council

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