Healthcare Delivery Final Exam

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Under the Hill-Burton Act, federal grants were given on the basis of
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bed-to-bed population ratios
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The first proprietary hospitals in the United States were established by
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physicians
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True or False? In recent years, the nonprofit hospital sector has continued to gain market share.
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False
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Which entity in hospital governance is legally responsible for the hospital’s operations?
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The board of trustees
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True or False? The proliferation of health care delivery through managed care created a decreased demand for primary care physicians.
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False
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Ethics committees are
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multidisciplinary
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According to US law, nonprofit organizations
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are tax exempt
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What is the meaning of “excess capacity” in the health care inpatient sector?
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empty beds
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True or False? Children, in general, incur higher use of hospital services than the elderly.
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False
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True or False? Primary care practice in most industrialized countries is public.
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False
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True or False? Historically, outpatient care has been independent from services provided in health care institutions.
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True
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What is gatekeeping
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The process by which primary care physicians refer patients to specialists
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What does “PPS” stand for?
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Prospective Payment System
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What financial benefit does a small rural hospital gain by qualifying for the designation, Critical Access Hospital?
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it can receive cost-plus reimbursement under Medicare Part A
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True or False? Quality of health care is the main distinguishing factor between a general hospital and a specialty hospital.
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False
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How is community-oriented primary care (COPC) different from primary care?
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COPC adds a population-based approach to identifying and addressing community health problems
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True or False? According to guidelines established by the AMA, osteopaths cannot practice in non-osteopathic general hospitals.
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False
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The first voluntary hospitals in the United Stated were financed
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through local philanthropy
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The most prominent reason for the decline in the number of procedures performed in hospitals is
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most of these procedures were shifted to outpatient setting
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Emergency departments, in most cases, are equipped to provide
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secondary and tertiary care services
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For whose financial benefit are proprietary hospitals operated?
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stockholders
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True or False? A nonprofit hospital is prohibited by law from making a profit
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False
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Hospice services are primarily for people with
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terminal illnesses
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In a hospital classified as short stay, the ALOS is not more than
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25 days
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Which ownership type constitutes the largest group of hospitals and hospital beds in the United States?
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private nonprofit
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True or False? Men report more chronic illness than women
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False
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Which of the following is a typical setting for ambulatory care services?
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sports medicine clinics
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True or False? Managed care has emphasized the use of alternative services to acute hospital care whenever appropriate.
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True
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The proportion of a hospital’s capacity that is actually utilized.
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occupancy rate
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Under the Hospital Survey and Construction Act of 1946, the responsibility for hospital planning
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was given to the states
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True or False? Delivery of health care with a central focus on specialization cannot maximize health.
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True
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Which of the following cannot be classified as a community hospital?
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long-stay hospital
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What is the likely impact of the ACA on primary care?
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increase
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Historically, inpatient care developed ________ outpatient care.
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after
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A hospital that is accredited by the Joint Commission
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is deemed to have met certification requirements
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Average daily census is a measure of a hospital’s
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number of inpatients served daily
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Countries whose health systems are oriented more toward primary care achieve
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a higher satisfaction with health services among their populations
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Which principle of ethics requires caregivers to involve the patient in medical decision making?
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autonomy
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What is the main drawback of a living will?
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it cannot cover all possible situations
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Which of the following is true about church-affiliated hospitals?
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They may emphasize the sponsoring organization’s spiritual and dietary principles
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What is palliation?
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pain and symptom management
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Which of the following is a reason for the growth in outpatient services?
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-Managed care -New technology -Patient preference
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True or False? Not all health care organizations receive deemed status after they have been accredited by the Joint Commission.
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True
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What has been the effect of intense consolidation in certain hospital markets?
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dilution of competition
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True or False? Stark Laws prohibit self-referrals except when a referring physician has an ownership interest in the whole hospital.
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True
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To participate in Medicare and Medicaid, a health care facility must be
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certified
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Which of the following is not used in pharmaceutical management?
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disease management
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One goal of ______ in pharmaceutical management is to change physicians’ future prescribing habits if necessary.
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retrospective utilization review
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Closed-panel plan
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The enrollee is restricted to the providers on the panel
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Gatekeeping heavily depends on the services of a
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primary care physician
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Self-care with professional support
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disease management
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PPOs differentiated themselves by offering _____ option to enrollees.
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open-panel
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In which HMO model is the choice of physicians likely to be most restricted?
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staff model
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Prospective utilization review includes
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precertification
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A network model HMO
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contracts with more than one group practices
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A managed care organization functions like
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an insurer
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True or False? All MCOs are now required to be accredited by the National Committee for Quality Assurance.
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False
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Which HMO model is likely to require heavy capital outlays to expand into new markets?
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Staff model
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When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?
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mental health
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PPOs were created by ____ in response to HMOs’ growing market share.
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insurance companies
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What payment method is used in Primary Care Case Management to reimburse physicians?
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fee for service
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Sharing of existing resources without joint ownership of assets.
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alliance
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True or False? Disease management is highly individualized.
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False
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True or False? The objective of horizontal integration is to control the geographic distribution of a service.
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True
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An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.
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acquisition
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Who employs the physicians in the group practice model?
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the group practice
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A hybrid between an HMO and a PPO.
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a point-of-service plans
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Physicians are employees of the HMO.
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staff model
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True or False? Diversification is not achieved through horizontal integration.
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True
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Antitrust legislation is intended to provide checks against
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anti-competitive behavior
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True or False? In the IPA model, the IPA rather than the HMO contracts with the physicians.
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true
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Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization?
answer

IPA model
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True or False? In the 1990s, managed care was widely credited for enabling small employers to offer health insurance coverage to their employees.
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False
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Which of these organizations was specifically created to bring management expertise to physician group practices?
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Management services organizations
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What main disadvantage does an HMO have when using the IPA model?
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If a contract is lost, the HMO loses a large number of participating physicians
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Closely associated with concurrent UR is the function of
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discharge planning
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Discounted fees are
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a modified form of fee for service
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Two organizations cease to exist, and a new corporation is formed.
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merger
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With the growth of managed care, the balance of power in the medical marketplace swung toward
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the demand side
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Fee for service promoted
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both moral hazard and provider-induced demand
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Capitation is best described as
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fixed monthly fee for member
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Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments?
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Balanced Budget Act of 1997
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Among HMOs, which model is the most successful in terms of the share of all enrollments?
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IPA model
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Which HMO model is likely to provide the greatest control over the practice patterns of physicians?
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staff model
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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.
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True
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Regional health systems are often
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vertically integrated
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True or False? A triple-option plan includes indemnity insurance as an option.
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True
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True or False? The majority of Medicaid beneficiaries and enrollees in Medicare Advantage plans receive health care services through HMOs.
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True
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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.
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48 hours
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Managed care was initially welcomed by
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employers
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How does risk adjustment affect payments to managed care plans?
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risk adjustment takes into account the enrollees’ health status
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Under capitation, risk is shifted
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from the MCO to the provider
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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.
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True
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What type of integration is represented by a chain of nursing homes?
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horizontal integration
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True or False? One distinguishing feature of HMOs is that they use discounted fees as the primary method of paying providers.
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False
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True or False? By law, an HMO is prohibited from having an exclusive contract with a group practice.
answer

False
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True or False? Research shows that quality of care has declined as managed care has continued to grow.
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False
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Which type of MCO has achieved the greatest success in employment-based enrollment?
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PPOs
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True or False? The emergence of PPOs was triggered by competition between HMOs and commercial insurance companies.
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True
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Cost-effective management of care for patients who have complex medical conditions.
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case management
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A new corporation created by two partnering organizations remains independent.
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joint venture
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Closed-panel plan.
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The enrollee is restricted to the providers on the panel
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True or False? The four main HMO models differ according to payment arrangements with physicians.
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False
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Gatekeeping ______ secondary care services.
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requires a referral for
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An experienced health care professional, such as a nurse practitioner, coordinates an individual’s total health care.
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case management
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True or False? Case management is mainly recommended for patients who need secondary and tertiary care more often than primary care.
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True
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Under the fee-for-service system, providers had the incentive to
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deliver more services than what would be medically necessary because a greater volume would increase their revenues
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Cognitive impairment puts an individual at a high risk for
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functional decline
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True or False? Facility licensing regulations are consistent nationwide.
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False
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True or False? The predominant users of long-term care services are the elderly.
answer

True
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True or False? Subacute care is designed for patients who remain critically ill during the postacute phase of illness.
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True
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True or False? Most nursing home care in the U.S. is financed by Medicare.
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False
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True or False? Elderly in the lowest socioeconomic status are at the greatest risk of need for LTC services.
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True
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Hospital-based transitional care units must be certified as
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SNF
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A facility that is certified as SNF can
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admit only Medicare patients
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Most of the expenditures for long-term care services, both community-based and in institutions, is paid by
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Medicaid and other public sources
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What is the purpose of incorporating evidence-based practices into the delivery of long-term care?
answer

to improve the quality of care
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True or False? Respite care includes only community-based long-term care services.
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False
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A long term-care facility must be certified in order to
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admit Medicare and/or Medicaid patients
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True or False? Most people needing long-term care need it for more than 90 days.
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True
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True or False? The number of informal caregivers in the United States has been gradually increasing.
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False
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True or False? AIDS is now classified as a chronic condition
answer

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

Dependency because of inability to perform tasks of daily living
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True or False? Nursing facilities must be certified by the state in which they operate.
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False
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Decline in ADLs is likely to be most pronounced in
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patients needing nursing home care
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Which of the following is likely to result in fewer unmet needs and better utilization of services for HIV/AIDS patients?
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Case management
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True or False? In a skilled nursing facility, Medicare covers only short-term rehabilitation or convalescence.
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True
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Which part of Medicare covers SNF services?
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Part A
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Basic assistance with ADLs is provided mainly by
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paraprofessionals
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True or False? Medicare only pays for short-term stays in an adult foster care home.
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False
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In recent years, the prevalence of psychiatric diagnoses in nursing homes
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has increased
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Which type of long-term care service is predominantly used in the United States?
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informal care
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Rational integration between long-term care and non-long-term care services
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facilities the delivery of total care
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In long-term care case management, services of freestanding case managers are used in the _____ model.
answer

brokerage
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Which is the largest payer for home health services?
answer

Medicare
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True or False? Most institutionalized long-term care patients have a diagnosis of dementia.
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True
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Most of the funding for meals-on-wheels is authorized under
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the Older Americans Act
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In recent years, the quality of care in nursing homes
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has increased
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In the delivery of long-term care, customized interventions are carried out according to
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a plan of care
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True or False? In recent years, the number of nursing home beds per 1,000 elderly population has declined.
answer

True
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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.
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False
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True or False? Private pay patients may be admitted to a certified nursing care facility.
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True
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The elderly do not constitute a homogeneous group; hence
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a variety of long-term care services are necessary
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Approximately how many adult Americans have a mental disorder in any one year?
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one in four
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Lack of insurance can result in
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-Decreased utilization of lower cost preventive services -Increased need for more expensive, emergency health care -The spread of infectious diseases
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True or False? The health status of American Indians no longer lags significantly behind other racial/ethnic groups.
answer

False
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What is the major health challenges of the migrant population?
answer

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

True
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Approximately what percentage children under age 18 are uninsured?
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6%
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True or False? The ACA will make everyone insured.
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False
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In 2010, Asian Americans accounted for approximately what percent of the U.S. population?
answer

4%
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True or False? More women than men will suffer from major depression in their lifetimes.
answer

True
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Which racial/ethnic group is growing the fastest?
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Hispanic
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Which racial/ethnic group has the highest rate of low birth weight infants?
answer

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

False
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Most uninsured adults are employed but are not covered because
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-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
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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%
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True or False? Black Americans are more likely to be economically disadvantaged than white Americans.
answer

True
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What does the federal Ryan White CARE Act fund?
answer

Development of treatment and care options for persons with HIV and AIDS
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True or False? Rural areas are particularly good places for managed care implementation.
answer

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

Black, non-Hispanic
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Which racial/ethnic group is least likely to use mammography?
answer

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

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

40%
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True or False? Many Hispanic families who immigrated to the U.S. may not qualify for Medicaid.
answer

True
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What does “MUA” stand for?
answer

Medically Undeserved Area
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A disease is considered chronic if it is observed for at least how long?
answer

3 months or longer
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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
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True or False? Black Americans are more likely to be economically disadvantaged than white Americans
answer

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

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

False
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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
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A service is cost-efficient when
answer

The benefit received is greater than the cost incurred to provide the service
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True or False? The U.S. is likely to achieve socialized medicine under the ACA.
answer

False
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What are administrative costs?
answer

Costs associated with management of the financing, insurance, delivery, and payment functions of health care
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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
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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
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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
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Approximately what percentage of GDP is spent on health care in 2009?
answer

17%
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True or False? Critical pathways are outcome-based and patient-centered case management tools that facilitate coordination of care.
answer

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

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

True
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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
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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
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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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