question

Under the Hill-Burton Act, federal grants were given on the basis of

answer

bed-to-bed population ratios

question

The first proprietary hospitals in the United States were established by

answer

physicians

question

True or False? In recent years, the nonprofit hospital sector has continued to gain market share.

answer

False

question

Which entity in hospital governance is legally responsible for the hospital's operations?

answer

The board of trustees

question

True or False? The proliferation of health care delivery through managed care created a decreased demand for primary care physicians.

answer

False

question

Ethics committees are

answer

multidisciplinary

question

According to US law, nonprofit organizations

answer

are tax exempt

question

What is the meaning of "excess capacity" in the health care inpatient sector?

answer

empty beds

question

True or False? Children, in general, incur higher use of hospital services than the elderly.

answer

False

question

True or False? Primary care practice in most industrialized countries is public.

answer

False

question

True or False? Historically, outpatient care has been independent from services provided in health care institutions.

answer

True

question

What is gatekeeping

answer

The process by which primary care physicians refer patients to specialists

question

What does "PPS" stand for?

answer

Prospective Payment System

question

What financial benefit does a small rural hospital gain by qualifying for the designation, Critical Access Hospital?

answer

it can receive cost-plus reimbursement under Medicare Part A

question

True or False? Quality of health care is the main distinguishing factor between a general hospital and a specialty hospital.

answer

False

question

How is community-oriented primary care (COPC) different from primary care?

answer

COPC adds a population-based approach to identifying and addressing community health problems

question

True or False? According to guidelines established by the AMA, osteopaths cannot practice in non-osteopathic general hospitals.

answer

False

question

The first voluntary hospitals in the United Stated were financed

answer

through local philanthropy

question

The most prominent reason for the decline in the number of procedures performed in hospitals is

answer

most of these procedures were shifted to outpatient setting

question

Emergency departments, in most cases, are equipped to provide

answer

secondary and tertiary care services

question

For whose financial benefit are proprietary hospitals operated?

answer

stockholders

question

True or False? A nonprofit hospital is prohibited by law from making a profit

answer

False

question

Hospice services are primarily for people with

answer

terminal illnesses

question

In a hospital classified as short stay, the ALOS is not more than

answer

25 days

question

Which ownership type constitutes the largest group of hospitals and hospital beds in the United States?

answer

private nonprofit

question

True or False? Men report more chronic illness than women

answer

False

question

Which of the following is a typical setting for ambulatory care services?

answer

sports medicine clinics

question

True or False? Managed care has emphasized the use of alternative services to acute hospital care whenever appropriate.

answer

True

question

The proportion of a hospital's capacity that is actually utilized.

answer

occupancy rate

question

Under the Hospital Survey and Construction Act of 1946, the responsibility for hospital planning

answer

was given to the states

question

True or False? Delivery of health care with a central focus on specialization cannot maximize health.

answer

True

question

Which of the following cannot be classified as a community hospital?

answer

long-stay hospital

question

What is the likely impact of the ACA on primary care?

answer

increase

question

Historically, inpatient care developed ________ outpatient care.

answer

after

question

A hospital that is accredited by the Joint Commission

answer

is deemed to have met certification requirements

question

Average daily census is a measure of a hospital's

answer

number of inpatients served daily

question

Countries whose health systems are oriented more toward primary care achieve

answer

a higher satisfaction with health services among their populations

question

Which principle of ethics requires caregivers to involve the patient in medical decision making?

answer

autonomy

question

What is the main drawback of a living will?

answer

it cannot cover all possible situations

question

Which of the following is true about church-affiliated hospitals?

answer

They may emphasize the sponsoring organization's spiritual and dietary principles

question

What is palliation?

answer

pain and symptom management

question

Which of the following is a reason for the growth in outpatient services?

answer

-Managed care -New technology -Patient preference

question

True or False? Not all health care organizations receive deemed status after they have been accredited by the Joint Commission.

answer

True

question

What has been the effect of intense consolidation in certain hospital markets?

answer

dilution of competition

question

True or False? Stark Laws prohibit self-referrals except when a referring physician has an ownership interest in the whole hospital.

answer

True

question

To participate in Medicare and Medicaid, a health care facility must be

answer

certified

question

Which of the following is not used in pharmaceutical management?

answer

disease management

question

One goal of ______ in pharmaceutical management is to change physicians' future prescribing habits if necessary.

answer

retrospective utilization review

question

Closed-panel plan

answer

The enrollee is restricted to the providers on the panel

question

Gatekeeping heavily depends on the services of a

answer

primary care physician

question

Self-care with professional support

answer

disease management

question

PPOs differentiated themselves by offering _____ option to enrollees.

answer

open-panel

question

In which HMO model is the choice of physicians likely to be most restricted?

answer

staff model

question

Prospective utilization review includes

answer

precertification

question

A network model HMO

answer

contracts with more than one group practices

question

A managed care organization functions like

answer

an insurer

question

True or False? All MCOs are now required to be accredited by the National Committee for Quality Assurance.

answer

False

question

Which HMO model is likely to require heavy capital outlays to expand into new markets?

answer

Staff model

question

When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?

answer

mental health

question

PPOs were created by ____ in response to HMOs' growing market share.

answer

insurance companies

question

What payment method is used in Primary Care Case Management to reimburse physicians?

answer

fee for service

question

Sharing of existing resources without joint ownership of assets.

answer

alliance

question

True or False? Disease management is highly individualized.

answer

False

question

True or False? The objective of horizontal integration is to control the geographic distribution of a service.

answer

True

question

An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.

answer

acquisition

question

Who employs the physicians in the group practice model?

answer

the group practice

question

A hybrid between an HMO and a PPO.

answer

a point-of-service plans

question

Physicians are employees of the HMO.

answer

staff model

question

True or False? Diversification is not achieved through horizontal integration.

answer

True

question

Antitrust legislation is intended to provide checks against

answer

anti-competitive behavior

question

True or False? In the IPA model, the IPA rather than the HMO contracts with the physicians.

answer

true

question

Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization?

answer

IPA model

question

True or False? In the 1990s, managed care was widely credited for enabling small employers to offer health insurance coverage to their employees.

answer

False

question

Which of these organizations was specifically created to bring management expertise to physician group practices?

answer

Management services organizations

question

What main disadvantage does an HMO have when using the IPA model?

answer

If a contract is lost, the HMO loses a large number of participating physicians

question

Closely associated with concurrent UR is the function of

answer

discharge planning

question

Discounted fees are

answer

a modified form of fee for service

question

Two organizations cease to exist, and a new corporation is formed.

answer

merger

question

With the growth of managed care, the balance of power in the medical marketplace swung toward

answer

the demand side

question

Fee for service promoted

answer

both moral hazard and provider-induced demand

question

Capitation is best described as

answer

fixed monthly fee for member

question

Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments?

answer

Balanced Budget Act of 1997

question

Among HMOs, which model is the most successful in terms of the share of all enrollments?

answer

IPA model

question

Which HMO model is likely to provide the greatest control over the practice patterns of physicians?

answer

staff model

question

True or False? By prescribing minimum medical loss ratios in health plans, the ACA will limit the percentage of premium revenue a health plan can use for administration, marketing, and profits.

answer

True

question

Regional health systems are often

answer

vertically integrated

question

True or False? A triple-option plan includes indemnity insurance as an option.

answer

True

question

True or False? The majority of Medicaid beneficiaries and enrollees in Medicare Advantage plans receive health care services through HMOs.

answer

True

question

The Newborns' and Mothers' Health Protection Act of 1996 prohibits a health plan to offer less than _____ of inpatient stay following a normal vaginal delivery.

answer

48 hours

question

Managed care was initially welcomed by

answer

employers

question

How does risk adjustment affect payments to managed care plans?

answer

risk adjustment takes into account the enrollees' health status

question

Under capitation, risk is shifted

answer

from the MCO to the provider

question

True or False? Under a payment arrangement in which physicians are paid a fixed salary and performance-based bonuses, risk is shifted from the MCO to the physicians.

answer

True

question

What type of integration is represented by a chain of nursing homes?

answer

horizontal integration

question

True or False? One distinguishing feature of HMOs is that they use discounted fees as the primary method of paying providers.

answer

False

question

True or False? By law, an HMO is prohibited from having an exclusive contract with a group practice.

answer

False

question

True or False? Research shows that quality of care has declined as managed care has continued to grow.

answer

False

question

Which type of MCO has achieved the greatest success in employment-based enrollment?

answer

PPOs

question

True or False? The emergence of PPOs was triggered by competition between HMOs and commercial insurance companies.

answer

True

question

Cost-effective management of care for patients who have complex medical conditions.

answer

case management

question

A new corporation created by two partnering organizations remains independent.

answer

joint venture

question

Closed-panel plan.

answer

The enrollee is restricted to the providers on the panel

question

True or False? The four main HMO models differ according to payment arrangements with physicians.

answer

False

question

Gatekeeping ______ secondary care services.

answer

requires a referral for

question

An experienced health care professional, such as a nurse practitioner, coordinates an individual's total health care.

answer

case management

question

True or False? Case management is mainly recommended for patients who need secondary and tertiary care more often than primary care.

answer

True

question

Under the fee-for-service system, providers had the incentive to

answer

deliver more services than what would be medically necessary because a greater volume would increase their revenues

question

Cognitive impairment puts an individual at a high risk for

answer

functional decline

question

True or False? Facility licensing regulations are consistent nationwide.

answer

False

question

True or False? The predominant users of long-term care services are the elderly.

answer

True

question

True or False? Subacute care is designed for patients who remain critically ill during the postacute phase of illness.

answer

True

question

True or False? Most nursing home care in the U.S. is financed by Medicare.

answer

False

question

True or False? Elderly in the lowest socioeconomic status are at the greatest risk of need for LTC services.

answer

True

question

Hospital-based transitional care units must be certified as

answer

SNF

question

A facility that is certified as SNF can

answer

admit only Medicare patients

question

Most of the expenditures for long-term care services, both community-based and in institutions, is paid by

answer

Medicaid and other public sources

question

What is the purpose of incorporating evidence-based practices into the delivery of long-term care?

answer

to improve the quality of care

question

True or False? Respite care includes only community-based long-term care services.

answer

False

question

A long term-care facility must be certified in order to

answer

admit Medicare and/or Medicaid patients

question

True or False? Most people needing long-term care need it for more than 90 days.

answer

True

question

True or False? The number of informal caregivers in the United States has been gradually increasing.

answer

False

question

True or False? AIDS is now classified as a chronic condition

answer

True

question

What is the key determinant of the need for long-term care?

answer

Dependency because of inability to perform tasks of daily living

question

True or False? Nursing facilities must be certified by the state in which they operate.

answer

False

question

Decline in ADLs is likely to be most pronounced in

answer

patients needing nursing home care

question

Which of the following is likely to result in fewer unmet needs and better utilization of services for HIV/AIDS patients?

answer

Case management

question

True or False? In a skilled nursing facility, Medicare covers only short-term rehabilitation or convalescence.

answer

True

question

Which part of Medicare covers SNF services?

answer

Part A

question

Basic assistance with ADLs is provided mainly by

answer

paraprofessionals

question

True or False? Medicare only pays for short-term stays in an adult foster care home.

answer

False

question

In recent years, the prevalence of psychiatric diagnoses in nursing homes

answer

has increased

question

Which type of long-term care service is predominantly used in the United States?

answer

informal care

question

Rational integration between long-term care and non-long-term care services

answer

facilities the delivery of total care

question

In long-term care case management, services of freestanding case managers are used in the _____ model.

answer

brokerage

question

Which is the largest payer for home health services?

answer

Medicare

question

True or False? Most institutionalized long-term care patients have a diagnosis of dementia.

answer

True

question

Most of the funding for meals-on-wheels is authorized under

answer

the Older Americans Act

question

In recent years, the quality of care in nursing homes

answer

has increased

question

In the delivery of long-term care, customized interventions are carried out according to

answer

a plan of care

question

True or False? In recent years, the number of nursing home beds per 1,000 elderly population has declined.

answer

True

question

True or False? In certified nursing care facilities, different levels of services are delivered to Medicare and Medicaid patients based on the source of financing.

answer

False

question

True or False? Private pay patients may be admitted to a certified nursing care facility.

answer

True

question

The elderly do not constitute a homogeneous group; hence

answer

a variety of long-term care services are necessary

question

Approximately how many adult Americans have a mental disorder in any one year?

answer

one in four

question

Lack of insurance can result in

answer

-Decreased utilization of lower cost preventive services -Increased need for more expensive, emergency health care -The spread of infectious diseases

question

True or False? The health status of American Indians no longer lags significantly behind other racial/ethnic groups.

answer

False

question

What is the major health challenges of the migrant population?

answer

HIV/AIDS

question

True or False? Uninsured people are more likely to postpone seeking medical care, compared to insured people.

answer

True

question

Approximately what percentage children under age 18 are uninsured?

answer

6%

question

True or False? The ACA will make everyone insured.

answer

False

question

In 2010, Asian Americans accounted for approximately what percent of the U.S. population?

answer

4%

question

True or False? More women than men will suffer from major depression in their lifetimes.

answer

True

question

Which racial/ethnic group is growing the fastest?

answer

Hispanic

question

Which racial/ethnic group has the highest rate of low birth weight infants?

answer

Black or African American

question

True or False? The United Nations contends that greater gender equality will lead to profound and positive impacts on children's well-being and development.

answer

True

question

True or False? Educational attainment varies very little among Asian American subgroups.

answer

False

question

Most uninsured adults are employed but are not covered because

answer

-Their employer does not offer health benefits -They do not qualify because they do not work an adequate number of hours or have not been with the employer long enough -They cannot afford to pay their portion of the premium or purchase insurance on their own

question

Approximately how many Americans are uninsured?

answer

46 million

question

Which legislation created the State Children's Health Insurance Plan (SCHIP)?

answer

Balanced Budget Act of 1997

question

In the absence of specific therapy to interrupt transmission of HIV, an infected woman has what percent chance of having a child born with HIV?

answer

25%

question

True or False? Black Americans are more likely to be economically disadvantaged than white Americans.

answer

True

question

What does the federal Ryan White CARE Act fund?

answer

Development of treatment and care options for persons with HIV and AIDS

question

True or False? Rural areas are particularly good places for managed care implementation.

answer

False

question

Among women, which racial/ethnic group has the highest percentage distribution of AIDS?

answer

Black, non-Hispanic

question

Which racial/ethnic group is least likely to use mammography?

answer

Hispanic

question

True or False? The 2010 U.S. Census allowed respondents to choose one or more races when they self-identify.

answer

True

question

Children under age 18 comprise approximately what percentage of the homeless population?

answer

40%

question

True or False? Many Hispanic families who immigrated to the U.S. may not qualify for Medicaid.

answer

True

question

What does "MUA" stand for?

answer

Medically Undeserved Area

question

A disease is considered chronic if it is observed for at least how long?

answer

3 months or longer

question

Which of the following is not considered a "New Morbidity"?

answer

childhood leukemia

question

Which racial/ethnic group is most likely to drink alcohol?

answer

White

question

True or False? Black Americans are more likely to be economically disadvantaged than white Americans

answer

True

question

Which racial/ethnic group has the highest rate of uninsurance?

answer

Hispanic

question

Which racial/ethnic group is growing the fastest?

answer

Hispanic

question

What is the primary purpose of certificate-of-need statutes?

answer

To control capital expenditures by health facilities

question

What is the Health Plan Employer Data and Information Set (HEDIS)?

answer

a quality report card

question

The Donabedian Model includes all of the following elements except

answer

costs

question

True or False? Managed care increased the rate of growth in health spending between 1993 and 2000.

answer

False

question

What is the main reason for the lack of success of health care cost control efforts in the U.S.?

answer

cost shifting by providers

question

A service is cost-efficient when

answer

The benefit received is greater than the cost incurred to provide the service

question

True or False? The U.S. is likely to achieve socialized medicine under the ACA.

answer

False

question

What are administrative costs?

answer

Costs associated with management of the financing, insurance, delivery, and payment functions of health care

question

True or False? Access, quality, and cost are three unrelated components.

answer

False

question

Medical cost inflation is influenced by all of the following factors except

answer

Decrease in uninsured

question

Expenditures (E) equal

answer

Price (P) times Quantity (Q)

question

Which age group in the U.S. has had the highest average annual percent growth over the past 30 years?

answer

Over 85

question

What are small area variations?

answer

Geographic variations in health care practice

question

What does the ACA mostly likely to accomplish?

answer

expand access

question

According to Anderson and Aday, which of the following is an element of "realized access"?

answer

Type, site, and purpose of health services

question

True or False? Since 1975, the rates of change in medical inflation have remained consistently and continuously above the rates of change in the CPI.

answer

False

question

Approximately what percentage of GDP is spent on health care in 2009?

answer

17%

question

True or False? Critical pathways are outcome-based and patient-centered case management tools that facilitate coordination of care.

answer

True

question

The distinction between predisposing and enabling conditions can be applied to assess the _______ of a health care system.

answer

equity

question

What is Gross Domestic Product (GDP)?

answer

A measure of all the goods and services produced by a nation in a given year

question

True or False? Prevention and lifestyle behavior changes to promote health are not major foci of the medical model.

answer

True

question

What is a PRO?

answer

Peer Review Organization

question

True or False? Medicare trustees project that the trust fund will be depleted by 2010.

answer

False

question

True or False? Health care costs for the elderly are nearly 3 times more than those for the non-elderly.

answer

True

question

True or False? Compared to other nations, the U.S. uses a larger share of its economic resources for health care.

answer

True

question

True or False? Whether payment for health care services is made by the government or by a private insurance company, individual patients pay a price far higher than the actual cost of the service.

answer

False

question

What does the Consumer Price Index (CPI) measure?

answer

general inflation

question

What is the purpose of clinical practice guidelines?

answer

-To provide a plan to manage a clinical problem based on evidence or consensus -To lower costs -To improve outcomes

question

What is meant by the term "health care costs"?

answer

-The price of health care -How much a nation spends on health care -Cost of producing health care

question

What was the main purpose of the 1946 Hill-Burton Act?

answer

Expansion of the availability of health services and improved hospital facilities

question

What is the role of states in U.S. health policy?

answer

-Financial support for the care and treatment of the poor -Oversight of health care practitioners and facilities - Quality assurance

question

True or False? Government spending for health care in the U.S. has been largely confined to filling the gaps left by the private sector.

answer

True

question

What does "CON" stand for?

answer

Certificate of Need

question

True or False? The legislature is responsible for implementing legislation.

answer

False

question

What is incrementalism?

answer

Small policy changes that reflect a compromise amongst different groups' demands

question

True or False? The U.S. Constitution requires that all bills involving taxation must originate in the U.S. House of Representatives.

answer

True

question

All of the following were identified by the Institute of Medicine (Crossing the Quality Chasm, 2001) as areas for quality improvement, except

answer

efficacy

question

What is the main purpose of the Agency for Healthcare Research and Quality?

answer

To conduct and support research with respect to health care services and procedures

question

For what is the National Health Planning and Resources Development Act of 1974 noted?

answer

The shift from improvement of access to cost containment as the principal theme in federal health policy

question

True or False? Historically, Presidents have not had a substantial impact on national health policy.

answer

False

question

Which of the following is a power of Congress?

answer

-power of taxation -Power to use any reasonable means not prohibited by the Constitution to carry out the will of the people -power to spend

question

Which of the following branches of government is a supplier of policy?

answer

-executive -legislative -judicial

question

Which major public insurance program was legislated in 1965?

answer

Medicare and Medicaid

question

Which of the following is a health policy challenge faced by state governments?

answer

-protecting public health -subsidizing costs of caring for the uninsured -financing health services for the poor

question

Which piece of legislation had important implications for rural hospitals?

answer

Omnibus Budget Reconciliation Act (OBRA) of 1986

question

Why was SCHIP created?

answer

To provide health insurance to low-income children who do not qualify for Medicaid

question

All of the following are elements of the policy cycle, except

answer

policy evaluation

question

True or False? All states are required to have the same set of eligibility requirements for Medicaid.

answer

False

question

True or False? With the passage of ACA of 2010, all Americans will soon have health insurance coverage.

answer

False

question

In what way does research influence policymaking?

answer

-prescription -documentation -analysis

question

True or False? Currently, the states' role in health policy is limited mostly to basic public health functions.

answer

False

question

Employer-provided health insurance benefits arose in the mid-20th century as a result of

answer

A Supreme Court ruling that health insurance could be included in the collective bargaining process

question

What is an interest group?

answer

An independent, non-governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers

question

What was the main purpose of the Kerr-Mills program (1960)?

answer

Provision of federal grants to state government programs assisting the elderly

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