HealthCare Midterm Ch. 1-7
Which two functions are included in financing?
1. Purchase of health insurance 2. Payment for services delivered
For health insurance purposes, what is the threshold for full-time work under the Affordable Care Act?
30 hours per week
a specialist must:
A and B A. Do additional B. Gain certification
a job description for a physician would be to:
A and C A. Determine the significance of a patients health conditions C. Diagnose unusual conditions
A job description for a physician would be to:
A. Determine the significance of a patient's health condition. C. Diagnose unusual conditions. A and C.
A specialist must:
A. Do additional years of advanced residency training and practice in a specialty. B. Gain certification in an area of medical specialization. A and B.
Studies have shown that NPP services can:
A. Improve access to primary care. B. Spend more time with patients than physicians. Both A and B.
In Preindustrial America, medical training was received mainly through:
Apprenticeship with individual physicians.
Health Care Administrator
Are responsible for operational, clinical, and financial outcomes of the entire organization.
electronic medical records utilize which type of information system?
Clinical information system
The Health Insurance Portability and Accountability Act (HIPAA) was enacted to address which of the following?
Confidentiality of patients' health information.
A primary motivation in the development of managed care was to:
Contain costs and expenditures of health care.
In the U.S., competition among providers results in what conclusion?
Duplication of services and equipment.
Private health insurance first emerged as a result of:
Economic necessity.
Capitation is:
Financing of a managed care organization.
Public health professionals
Focus on the community as a whole rather than treating the individual.
Which of the following makes it illegal to gain access to personal medical information for reasons other than health care delivery, operations, and reimbursement?
Health Insurance Portability and Accountability Act
The health care subdivision of the U.S. economy continues to grow because:
Immigration continues to rise leading to a growth in population. Baby boomers hit retirement age in the year 2011 and beyond. Both A and B.
What is the purpose of a stop-loss provision in a health insurance plan?
It limits total out-of-pocket costs.
The government program designed to provide health care to people who are 65 years of age or older is called:
Medicare
What is the term for the consumer behavior that leads to a higher utilization of health care services when the services are covered by insurance?
Moral hazard
Which answer does not describe a negative consequence of specialty maldistribution?
More predictable hours and higher prestige for specialists.
you have decided to go to medical school. will you become a primary care physician or will you become a specialist? what are the major medical care distinctions between these two majors?
PCP: first contact/portal to the HCS, focuses on the person as a whole, health promotion/disease prevention,counseling, follow up, acute and chronic illnesses.
Which of the following IS one of the reasons why outpatient services have increased in popularity over the past 20 years?
Public/ private insurance reimbursement
Which of the following IS one of the reasons why outpatient services have increased in popularity over the past 20 years
Public/private insurance reimbursement.
Universal health insurance requires which of the following methods to limit the use of technology?
Supply-side rationing.
Open heart surgery would be an example of what type of care?
Tertiary
Which of the following was not a factor that led to the rapid expansion of employer-based health insurance?
The Congress mandated that employers offer health insurance.
The ideology system that emphasizes the well-being of the community over an individual is called:
The social justice system.
Which of the following is true in regards to health care today in the United States?
There are more specialty physicians than primary physicians.
Which of the following is true in regards to healthcare today in the us?
There are more specialty physicians than primary physicians.
The U.S. government plays a limited role in the health delivery system. The government's role in the arena of health care delivery consists of:
To be the responsible party for healthcare delivery through Medicare and Medicaid programs.
Which of the following are characteristics of the Medical Care Determinants of Health?
Whereas some services (preventive and primary care) contribute to general health status, others are more influential in end-of-life situations (hospice and long-term care).
The World Health Organization (WHO) defines health as:
a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity.
contain costs and expenditures of health care
a primary motivation in the development of managed care was to:
A sudden heart attack would be classified as a _________ condition.
acute
a sudden heart attack would be classified as _______ condition
acute
in preindustrial America, the destitute and disruptive elements of society were confined in a(n)
almhouse
in preindustrial America, medical training was received mainly through:
apprenticeship with individual physicians
Holistic medicine seeks to treat the individual in what manner?
as a whole person
holistic medicine seeks to treat the individual in what manner?
as a whole person
Which of the following has been the primary factor that has shielded the US health care system from a major overhaul?
beliefs and values
which of the following has been the primary factor that has shielded the US health care system from a major overhaul?
beliefs and values
Five core disciplines of public health include:
biostatistics
which of the following is not true about medical services in preindustrial America?
blue cross expanded to provide hospital insurance coverage
the health care subdivision of the US economy continues to grow because:
both A and B A. Immigration B. Baby boomers
studies have shown that NPP services can:
both and b
financing of a managed care organization
capitation is:
electronic medical records utilizes which type of information system?
clinical information system
the health insurance portability and accountability act (HIPAA) was enacted to address which of the following?
confidentiality of patients health information
in addition to assuming risk, managed care plans assume responsibility for what?
delivering health care
in the US we have an imbalance of specialty care and primary care. explain this phenomenon.
demographics-inner city to suburbs, development of medical technology, higher reimbursement for specialists, more predictable work hours, higher prestige among colleagues, geographic maldistribution, aggregate physician over supply
Which of the following would NOT be considered a category of health determinants?
disease prevention
which of the following would not be considered a category of health determinants?
disease prevention
in the US, competition among providers results in what conclusion?
duplication of services and equipment
private health insurance first emerged as a result of:
economic necessity
Which of the following is an example of social intervention
education
which of the following is an example of social intervention?
education
Air pollution and food & water quality would fall under which health determinant?
environment
air pollution and food and water quality would fall under which health determinant?
environment
list the four health determinant categories and provide an example of how the government is improving help in each determinant.
environment (FDA improve food safety) behavior and lifestyles (no smoking regulations) heredity (early heart disease management because of family history) medical care (expanding medicare enrollees)
Few efforts related to utilization control factors have been used to reduce length of stay at hospitals. T/F?
false
Going beyond the biomedical model to include social and behavioral sciences is a major front of development for community-oriented primary care
false
In addition to drugs and devices, the FDA also has the authority to review medical and surgical procedures for their safety and effectiveness. T/F
false
In postindustrial America, informal alliances between physicians and hospitals were outlawed? T/F
false
Medicare is designed specifically for three categories of people. Those with chronic heart disease are specifically covered.
false
PAHO moves focus from building primary care capacity and toward implementing disease specific interventions. T/F
false
T/F? Medicare provides medical benefits to only the elderly.
false
T/F? Mortality is a measurement of secondary care prevention.
false
T/F? Self insurance is generally used by individuals who cannot obtain health insurance through their employers.
false
Telephone triage, hospice services, and home health care are all examples of a mobile health care facility.
false
Telephone triage, hospice services, and home health care are all examples of a mobile health care facility. T/F?
false
The Pan-American Health Organization (PAHO) moved focus away from building primary care capacity and toward implementing disease-specific interventions.
false
True or False? Growth in technology is available to everyone.
false
True or False? In Postindustrial America, informal alliances between physicians and hospitals were outlawed.
false
True or False? Medical schools were first opened by local colleges to support the need of classroom facilities.
false
True or False? Medicare provides medical benefits to only the elderly.
false
True or False? Mortality is a measurement of secondary care prevention.
false
True or False? Self-insurance is generally used by individuals who cannot obtain health insurance through their employers
false
True or False? The term medical technology can be applied only to the products of biomedical research.
false
With regard to the legalities pertaining to the Affordable Care Act, the U.S. Supreme Court decided that federal sub
false
true or False? Barring major system changes, health service expenditures are projected to continue to decrease
false
Public health professionals:
focus on the community as a whole rather than treating the individual.
Which of the following IS a benefit of primary care?
gatekeeping
which of the following spreads risk among a large number of people?
group insurance
risk is generally predictable for what group?
groups of people
financing of health care aggregates into:
health care expenditures
which of the following makes it illegal to gain access to personal medical information for reasons other than health care delivery, operations, and reimbursement?
heath insurance portability and accountability act
What type of care is described as "end of life care?"
hospice
one mechanism to control the growth of technology would be to:
implement central planning
Which of the following (according to research/stats) is NOT an effect of increased primary care within a population?
increased morbidity
The U.S. safety net is for the nation's most vulnerable populations. Which of the following groups is not a vulnerable population?
insured employees
what is the main purpose of cost sharing?
it controls the utilization of health care
what is the purpose of a stop-loss provision in a health insurance plan?
it limits totals out of pockets
what was the role of a dispensary in preindustrial America?
it provided free outpatient services
what is self insurance?
large employers assume the risks and budget for medical claims
no central governing agency, little integration imperfect market conditions unequal access high on cost technology driven and focus on acute care multiple players market justice system and social justice systems conflict through the health care system access to healthcare selectively based on insurance coverage legal risk influence practice behavior
list the basic characteristics that differentiate the US health care delivery system form that of other countries
What type of justice is based on people's willingness and ability to pay?
market
what type of justice is based on peoples willingness and ability to pay?
market
what is the term for the. consumer behavior that leads to a higher utilization of health care services when the services are covered by insurance?
moral hazard
which answer does not describe a negative consequence of specialty maldistribution?
more predictable hours and higher prestige for specialists
NHI: the system is tax supported in which the government guarantees a basic package of health services to all citizens, but the actual care is delivered by private physicians of choice. NHS: this too is tax supported however the entire infrastructure is government controlled. Patients have no choice in choosing HC facilities, physicians, or providers.
most western european countries have national health care programs that provide universal access. how does the national health insurance system, such as the one adopted by the country of Canada differ from the national health system, such as the one structured in Great Britain?
The concerted activities of physicians through the AMA came to be called:
organized medicine
the concerted activities of physicians through the AMA came to be called:
organized medicine
a doctor of osteopathic medicine believes in:
preventive and holistic medicine
health insurance desensitizes both consumers and providers against what?
price
what is voluntary health insurance?
private health insurance
what two functions are included in financing?
purchase of health insurance payment for services delivered
universal health insurance requires which of the following methods to limit the use of technology?
supply-side rationing
what is the term for the development and dissemination of technology?
technology diffusion
which is the general term for the delivery of medical care when the provider and client are separated by distance?
telemedicine
education reform for training physicians in postindustrial America was based on:
the European model
current legislation regarding new drugs in the US requires that:
the FDA reviews the safety and effectiveness of a new drug before it is marketed
to be the responsible party for health care delivery through medicare and medicaid programs
the US government plays a limited role in the health care system. the governments role in the arena of health care delivery consists of:
insured employees
the US safety net is for the nations most vulnerable populations. which of the following groups is not a vulnerable population?
which of the following was not a factor that led to the rapid expansion of. employer based health insurance?
the congress mandated that employers offer health insurance
medicare
the government program designed to provide health care to people who are over 65 years of age or older is called
the social justice system
the ideology system that emphasizes the well being of the community over an individual is called:
explain how the US has both market and social justice aspects of healthcare.
the social justice aspect of healthcare would include medicare and medicaid since they are both accessible forms of social insurance for certain populations. the market justice can be viewed by examining employer based insurance programs or independent plans purchased by individuals. either way your coverage depends on the ability to work for that employer or have the disposable income to purchase individual policies.
American medical graduates increasingly choose to become specialists rather than primary care physicians. T/F?
true
Characteristics of the medical home strategy include multidisciplinary practice -based teams and coordinate care. T/F?
true
Characteristics of the medical home strategy include multidisciplinary practice-based teams and coordinated care.
true
European countries that have national health insurance limit the use of medical technology. T/F?
true
In preindustrial America, even untrained people could practice medicine? T/F
true
Medicaid is a government based program intended to cover the eligible poor determined by income level? T/F
true
Private health insurance originated to cover only inpatient hospital services? T/F
true
T/F? All working individuals are subject to the Medicare tax.
true
T/F? Areas in which primary care has a stronger presence have much lower health care costs.
true
T/F? Under Medicare Part A, a beneficiary can have an unlimited number of benefit periods.
true
The US lacks checks and balances to determine the appropriateness of high cost services? T/F
true
The purchase price of equipment represents lesser costs that costs associated with utilization of technology. T/F?
true
True or False? European countries that have national health insurance limit the use of medical technology.
true
True or False? In Preindustrial America, even untrained people could practice medicine.
true
True or False? Medicaid is a government-based program intended to cover the eligible poor determined by income level
true
True or False? Most MDs are specialists and most DOs are generalists.
true
True or False? NPP practice in many areas in which physicians practice; however NPPs do not have a medical degree.
true
True or False? One of the healthy people 2020 goals is to increase quality and years of life.
true
True or False? Part B of Medicare requires premium contributions from the beneficiaries.
true
True or False? The Rand Health Insurance Experiment demonstrated that utilization could be lowered through cost sharing.
true
True or False? The purchase price of equipment represents a lesser cost than the costs associated with utilization of technology.
true
True or False? Under Medicare Part A, a beneficiary can have an unlimited number of benefit periods.
true
true or false? NPP practice in many areas in which physicians practice; however NPP's do not have a medical degree.
true
true or false? most MD's are specialists and most DO's are generalists.
true
true or false? the US government improves society's health by influencing health determinants.
true
true or false?one of the healthy people 2020 goals is to increase quality and years of life.
true
false
true or false? barring major system changes, health service expenditures are projected to continue to decrease.
false
true or false? growth in technology is available to everyone.
what is meant by the term technological imperative?
use technology despite its cost
