Health Care Systems Final Exam
According to the article "Evolving Models of Behavioral Health Integration in Primary Care", how many adults suffer from a diagnosable mental disorder in a given year? (Choose the single best answer) (note that the prevalence given in the TED Talk was slightly different) a. 1 in 4 b. 1 in 8 c. 1 in 10 d. 1 in 20
a. 1 in 4
What is the purpose of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)? a. Assessing patient satisfaction b. To provide bonuses to providers who keep their patients healthy c. To regulate fee-for-service provider reimbursement d. To reduce hospital readmissions
a. Assessing patient satisfaction
Many countries that utilize a national insurance model have a large focus around primary care using a variety of different models, such as gatekeeping. What aspect of the US healthcare system that may be improved upon by adopting a similar model? a. Fragmentation of care b. Cost containment c. Patient centered care d. All of the above
d. All of the above
Which of the following countries utilizes an insurance method in which all citizens are covered by a national insurance and private insurance may be purchased individually that could cover services that are also covered by the national health insurance? a. United States b. Germany c. Canada d. United Kingdom
d. United Kingdom
According to chapter 16 "Conflict and Change in America's Healthcare System," our major actors, or components, make up the US Healthcare System: the purchasers, insurers, providers, and suppliers. Often times, the provider also plays the role of the supplier. Which of the following is an example of this overlap? a. Health maintenance organizations (HMOs) acting as the insurers while also owning hospitals and primary care practices. b. Physicians referring patients to a physical therapy practice that they own. c. A pharmaceutical company CEO advertising a new drug to their spouse's patients. d. Insurers receive money from the government to pay the providers.
Unclear answer per Dr Brown a. Health maintenance organizations (HMOs) acting as the insurers while also owning hospitals and primary care practices.
Long-term care in the United States can be improved through all the following ways except A. Developing a social insurance program B. Financing long-term care to shift to community-based care C. Paying hospitals per procedure D. Training and supporting family members as caregiver
C. Paying hospitals per procedure
Which example best depicts "pay for performance"? A. A provider receives a bonus for implementing preventative care services within their practice. B. A provider receives bonuses based on the number of diabetic patients they see in a day. C. Physicians and other providers are paid based on the amount of patients they see in a day. D. A doctor gets paid every time a patient receives an MRI.
A. A provider receives a bonus for implementing preventative care services within their practice.
According to the article "Minority Participation in Senior Hospital Management", the trends in U.S. Hospital Workforce (2008-2014) show: (select the one best answer) (see Table 1 in the article) A. An increase in minority managers and an increase in female managers B. An increase in minority managers and a decrease in female managers C. A decrease in minority managers and an increase in female managers D. A decrease in minority managers and a decrease in female managers
A. An increase in minority managers and an increase in female managers
According to Chapter 7 of your textbook, all of these are the largest health professions except: (select the one best answer) A. Nurses B. Physicians C. Physical Therapists D. Pharmacists
C. Physical Therapists
Which of the following represents a scenario in which health providers exercise The Theory of Bad Apples? A. Dr. Dennery failed to order an MRI for a patient that came in with a head-injury after a minor car accident. Unfortunately, due to the lack of scanning, a minor brain bleed went undetected. As a result, Dr. Dennery was fired for incompetence. B. Dr. Lopez failed to order an MRI for a patient that came in with a head-injury after a minor car accident. Unfortunately, due to the lack of scanning, a minor brain bleed went undetected. As a result, the patient died and Dr. Lopez continued his daily regime. C. Dr. Smith failed to order an MRI for a patient that came in with a head-injury after a minor car accident. Unfortunately, due to the lack of scanning, a minor brain bleed went undetected. As a result, the attending doctor discussed the mistake with Dr. Dennery and put in place new protocol for head injuries. D. Dr. Gomes ordered an x-ray for a patient that came in with a head-injury after a minor car accident. Unfortunately, due to the lack of appropriate scanning, a minor brain bleed went undetected. As a result, he was reprimanded and continued on his day.
A. Dr. Dennery failed to order an MRI for a patient that came in with a head-injury after a minor car accident. Unfortunately, due to the lack of scanning, a minor brain bleed went undetected. As a result, Dr. Dennery was fired for incompetence.
Based on the TED Talk by Peter Saul, there have been advancements in care which have led to? A. Extending lives so that patients are living with chronic illnesses for longer B. Lifesaving miracles C. Shortened lives of patients D. More than 50% of patients dying at home
A. Extending lives so that patients are living with chronic illnesses for longer
What would be considered medical negligence? A. Failure to meet the standard of practice of an average qualified physician in the same specialty B. Untrained physicians C. Lack of patient compliance D. Misdiagnosis
A. Failure to meet the standard of practice of an average qualified physician in the same specialty
Pete is a healthcare proxy for his grandmother. In what way does Pete help his grandmother by being her health care proxy? A. He is able to make medical decisions for her when she cannot make those decisions for herself B. Pete reads the will at her funeral. C. Pete takes over financial decisions D. Ignoring all medical advice and using Wikipedia to answer all questions he may have
A. He is able to make medical decisions for her when she cannot make those decisions for herself
Health Workforce Issues According to Dr Gaumer's Blog on Health Workforce Issues, licensure will always cause wages to be ______ than they would otherwise be in that profession. (select the one best answer) A. Higher B. Lower C. No different D. Much lower
A. Higher
Patient is a 95-year-old female who has stage 4 stomach cancer. She has been in the ICU for 2 weeks and is continuing to decline. She currently has many lines and tubes, including a ventilator, G-tube, colostomy bag, urinary catheter, and HR monitor. Her doctor never asked her what she wanted at end of life care and decided to make his decision on her care. Although the patient is likely to die within 24 hours, he is continuing to treat her with expensive interventions. How could this situation BEST be prevented? A. Initiate "The Conversation" for end of life care in prior to hospitalization B. Contact the patient's next of kin to ask about continuation of care. C. Continue to utilize all extreme measures in attempt to prolong the patient's life as providers have the responsibility to "do no harm." D. This situation cannot be prevented and is up to the doctor to make the decision
A. Initiate "The Conversation" for end of life care in prior to hospitalization
According to the article "A Vision for Getting Mental Health Care Right", historic payment models have siloed mental health care, promoting fragmentation of care. Their proposed solutions are aimed at the ultimate goal of....? A. Integrating mental health care with general health care B. Changing payment mechanisms for mental health care C. Eliminating the stigma of mental illness D. Better training providers on treating mental illness
A. Integrating mental health care with general health care
Dotty just recently left the hospital, she can't figure out which of her medications are new and feels very confused and overwhelmed. She also feels really insecure about getting up and moving about her home without someone home. Which of the following is a measures would have made Dotty's return home more manageable? A. Minimize disruption to the patient's life B. Aim for health C. Recognize and respect the caregivers D. Make the journey clear
A. Minimize disruption to the patient's life
According to the article "Regulating Health Professionals: A Review of the Empirical Literature", existing systems of licensure have: (select the one best answer) A. Not eliminated mistakes or poor judgement by providers B. Eliminated professional judgement errors and careless practice C. Eliminated mistakes or poor judgement by providers D. Resulted in more stringent regulatory practices
A. Not eliminated mistakes or poor judgement by providers
A 70-year-old patient, with diabetes, and a recent hip fracture is having difficulty bathing and getting in and out of bed. She lives alone. What service is she eligible for if she has Medicare only? A. Physical therapy B. Home health aide C. Nurses' aide D. Nothing
A. Physical therapy
Lindsay is a 52-year-old female who has new insurance coverage after starting a new job. She wants to stay with her previous PCP, but they are out of the "preferred network" and thus causing her to pay a higher share of cost. What care plan is this an example of? A. Preferred Provider Organization (PPO) B. Health Maintenance Organization (HMO) C. Medicare D. Medicaid
A. Preferred Provider Organization (PPO)
According to the article "Minority Participation in Senior Hospital Management", the job categories of greatest interest are: (select the one best answer) A. Senior Managers and Mid-level Managers B. CEOs and Boards of Trustees C. Floor managers and shift supervisors D. Executive/Senior Level Officials and Managers
A. Senior Managers and Mid-level Managers
Private insurers, Medicare, and Medicaid are replacing fee-for-service payment, which encourages use of more services. Does this tend to: A. Shift financial risk away from payers toward physicians and hospitals in an effort to control costs. B. Shift financial risk from hospitals and physicians towards patients in effort to control patient spending. C. Create no shift at all. D. Shift financial risk away from hospitals, physicians, and payers in an effort to control costs.
A. Shift financial risk away from payers toward physicians and hospitals in an effort to control costs.
According to Chapter 7 of your textbook,_______ is a growing profession with about half of practitioners in the fields of mental health and substance abuse. (select the one best answer) A. Social work B. Nursing C. Pharmacology D. Psychology
A. Social work
What percent of the population consumes 50% of healthcare spending? A. The top 3% of the population B. 50% of the population C. 63% of the population D. There is an equal distribution of healthcare spending across the population
A. The top 3% of the population
What is an important reason for distinguishing between frailty, comorbidity, and disability? A. There is evidence that each is preventable but requires different interventions B. They are all interrelated requirement the same intervention C. There is evidence that each is preventable and can all be treated with the same intervention D. They are not preventable however appropriate intervention can improve quality of life
A. There is evidence that each is preventable but requires different interventions
Mr. Smith is a 65-year-old and has lived with COPD for the past five years. He has difficulty preparing meals, walking up and the down stairs, and carrying his laundry. Mr. Smith's feels he would benefit having assistance at home to help him complete his daily tasks. As Mr. Smith's healthcare provider, Mr. Smith is wondering what his options are. A. These services are considered custodial care and are not covered by Medicare. You will need to hire a home health aide through a private agency to assist you. B. Medicare will cover PT services when you are living with a chronic illness C. Since these are skilled services, Medicare will provide VNA for Mr. Smith. D. Your wife can get trained and then paid to be your healthcare provider
A. These services are considered custodial care and are not covered by Medicare. You will need to hire a home health aide through a private agency to assist you.
According to Dr Gaumer's Blog on Health Workforce Issues, the outcome of the Nursing Shortage: (select the one best answer) A. Was the Nurse Training Act B. Higher wages for nurses C. A "wage war" between employers D. Patient suffering
A. Was the Nurse Training Act
Which of the following unit of payment methods would shift the most risk onto the provider? A. Fee for Service (FFS) B. Capitation Payments C. Per Diem Payments D. Cost Reimbursement
B. Capitation Payments
According to the article "Minority Participation in Senior Hospital Management", the analysis shows: (select the one best answer) A. A decrease in concentration of senior minority managers from 2008 to 2014 B. An increase in concentration of senior minority managers from 2008 to 2014 C. The concentration of senior minority managers has remained the same from 2008 to 2014 D. The concentration of senior minority managers decreased dramatically from 2008 to 2014
B. An increase in concentration of senior minority managers from 2008 to 2014
All of the following are services provided by Hospice EXCEPT FOR: A. Manage pain and non-pain symptoms B. Curative care C. Psychosocial and spiritual support D. Provide medications and medical supplies
B. Curative care
According to the article "Regulating Health Professionals: A Review of the Empirical Literature", the licensing process: (select the one best answer) A. Ensures competence B. Does not have a consistent set of interlocking relationships among curriculum content, credentialing, and subsequent practice performance C. Increases the quality of professional practice D. Is a predictor of practice performance
B. Does not have a consistent set of interlocking relationships among curriculum content, credentialing, and subsequent practice performance
Mrs. Jones is recovering from a total hip replacement at BIDMC in Boston, her PT comes into the room and begins to fit her for her walker and proceeds to tell her about her hip precautions. The PT lists all her precautions, finished fitting her walker, says goodbye and tells Mrs. Jones she will see her tomorrow and leaves the room. What is the BEST answer that describes what Mrs. Jones' PT should have done prior to leaving the room? A. Give her the call button and make sure she's back in bed B. Have her demonstrate the skills she learned in the session and repeat her hip precautions (teach back method) C. Give her lunch and tell her she did a great job D. Ask her to fill out the HCAHPS survey
B. Have her demonstrate the skills she learned in the session and repeat her hip precautions (teach back method)
With lifestyle choices driving up to half the preventable deaths and disabilities in the US, what area of healthcare delivery system should resources be allocated to improve the overall lifestyle choices of the American public? A. Public health B. Primary care C. Secondary care D. Tertiary care
B. Primary care (should be correct per Dr. Brown - SHE WILL RE-WRITE THIS QUESTION)
According to Chapter 7 of your textbook,_______ represent the single largest health profession in the United States: (select the one best answer) A. Physicians B. Registered nurses C. Physician assistants D. Pharmacists
B. Registered nurses
There are 5 Conversation Ready principles that provide a framework for teams to use when initiating this talk with patients. All of the following are included in these principles EXCEPT: A. Engage B. Respect C. Communicate D. Connect
C. Communicate
According to Dr Gaumer's Blog on Health Workforce Issues, the result of the government intervention in the nursing shortage includes all except: (select the one best answer) A. Hospitals win B. The nursing workforce wins C. Universities that train nurses win D. The deans win
B. The nursing workforce wins
Moving forward clinicians hope to improve patient knowledge and awareness surrounding advanced directives and end of life care. All of the following would have to be implemented in order for advanced directive to be enacted appropriately EXCEPT: A. Documentation of a MOLST form B. The use of technology for patient education C. Increased transparency between PCPs and hospitalists D. Improved communication with family members and primary care givers
B. The use of technology for patient education
Medicare pays Simmons Hospital $7,699 for their beneficiary's total knee replacement. This payment was made up front to cover services rendered from the orthopedic surgeon, anesthesiologists, nursing, physical therapists and more. This is an example of a(n) ________ payment. A. Fee for service B. Bundled C. Out of pocket D. Pay for performance
B. bundled
Which of these systems of physician payment produces risk that is completely absorbed by insurance companies, governing agencies, or patients? A. Capitation B. Fee for service C. Payment per episode of illness D. Per diem
B. fee for service
Most medical errors in healthcare are caused by: A. Lack of healthcare provider training B. Lack of patient compliance C. Communication and coordination problems D. Technology malfunction
C. Communication and coordination problems
All of the following are examples of primary care EXCEPT: A. Educating patients on smoking cessation B. Ensuring patients are wearing helmets when riding bicycles and seat belts when riding in a car C. Care for patient in new acute renal failure requiring dialysis D. Checking that the patient's vaccinations are up to date
C. Care for patient in new acute renal failure requiring dialysis
Care that would be paid for by Medicare includes A. Blood pressure measurements, teaching patients better communication techniques, and assisting with laundry B. Listening to heart and lung sounds, working with patients to maximize function, and assisting a patient out of bed. C. Change wound dressing, perform gait training, and teach patients communication techniques. D. Assist patient with taking medications, bathing, and eating.
C. Change wound dressing, perform gait training, and teach patients communication techniques.
High quality care is care that assists healthy people to stay healthy, cures acute illnesses, and allows chronically ill people to live as long and fulfilling a life as possible. Which of the following is not a component of high quality care? A. Competent health care providers B. Adequate scientific knowledge C. Combining of financial and clinical decisions D. Organization of health-care institutions to maximize quality
C. Combining of financial and clinical decisions
Bill is an 87-year-old male who presents to the hospital with symptoms consistent with pneumonia and urinary tract infection (UTI). He receives x-rays, urinalysis, antibiotics, and a full metabolic workup. He is on continuous telemetry and receives continuous oxygen. After a few days, Bill is discharged and the hospital stay costs $25,000. Based on his diagnosis, Medicare paid a lump sum of $8,000 to the hospital for all the services provided during his hospital stay. This form of payment is defined as: A. Capitation B. Pay-for-Performance C. Diagnosis-Related Group (DRG) D. Fee-for-Service
C. Diagnosis-Related Group (DRG)
Upon initiation of The Conversation, the provider asks the patient what matters most to them. What principle of being Conversation Ready does this reflect? A. Exemplify B. Respect C. Engage
C. Engage
According to the article "Regulating Health Professionals: A Review of the Empirical Literature", all of these pertain to licensure except: (select the one best answer) A. Specifies the range or scope of tasks that can be performed B. Results in little vertical career development C. Helps professional's freedom of occupational choice D. Protects the earning power of those with the education and moral stature necessary to become licensed
C. Helps professional's freedom of occupational choice
A health system is the organization of all of the following EXCEPT... A. People B. Institutions C. Law enforcement D. Resources
C. Law enforcement
Physical disability in older adults is associated with all EXCEPT: A. Increased risk for mortality B. Hospitalization and high health-care costs C. Less of a need for long-term care D. Higher health care expenditures
C. Less of a need for long-term care
A 65-year-old female with worsening congestive heart failure presents to her annual physical and is now eligible for Medicare. She asks her primary care provider about Medicare's role in end of life care. The primary care provider would discuss all of the following EXCEPT: A. Medicare covers advanced care planning provided during your annual wellness visits. B. If you become terminally ill, Medicare will cover hospice care if a physician confirms you are expected to die within six months. C. Medicare will continue to cover curative care while on hospice. D. You may still have to pay co-payments for your current medications on Medicare.
C. Medicare will continue to cover curative care while on hospice.
According to Chapter 7 of your textbook, similar to physician assistants, ________ working in primary care settings typically perform approximately 80% of the types of tasks performed by physicians. (select the one best answer) A. Registered nurses B. Social workers C. Nurse practitioners D. Pharmacists
C. Nurse practitioners
The "flat of the curve" medicine is the idea that in the US: A. The more dollars spent the better the health outcomes B. The fewer dollars spent the worse the health outcomes C. Once a certain level money is spent additional dollars will not improve healthcare outcomes at the same rate that they did at the beginning D. None of the above
C. Once a certain level money is spent additional dollars will not improve healthcare outcomes at the same rate that they did at the beginning
In reducing medical errors, a whole systems approach is the most effective. In this approach, medical errors are not just the result of human error, but also the result of the systems in which humans work and interact. Understanding this, which of the following principles could a hospital apply to reduce medical errors? A.Individualize certain tasks to better suit specific patient needs. B. Have nurses record information outside of the patient room to reduce anxiety of the patient. C. Simplify the process, reduce handoffs between different providers and other healthcare prof D. Rely on caregiver vigilance as the primary strategy for preventing mishaps
C. Simplify the process, reduce handoffs between different providers and other healthcare prof
According to Dr Gaumer's Blog on Health Workforce Issues, in the health care business, we: (select the one best answer) A. Want government deciding prices of new technology B. Want government to decide what kinds of coverage packages there are for insurance C. Turn to government to help us get what we want D. Want government to decide what limits might be put on the services we want to buy
C. Turn to government to help us get what we want
According to the article "Mental Health Information about Mental Illness and the Brain", ___ of the 10 leading causes of disability are mental illnesses A. 1 B. 2 C. 3 D. 4
D. 4
According to the article "Minority Participation in Senior Hospital Management", overall, about __ percent of senior managers are white. (select the one best answer) A. 40 B. 50 C. 70 D. 90
D. 90
Which of these does not provide long-term care? A. Informal caregivers B. Community based and home health services C. Nursing homes D. Acute care settings
D. Acute care settings
Which of the following models is best for cost control? A. Fee for service B. Payment by episode of illness C. Per diem payments to hospitals D. Capitation payment
D. Capitation payment
Mary has multiple comorbidities, including diabetes mellitus, COPD, arthritis, and CHF. Though she visits her PCP for care, he sends her to multiple specialists to address each problem. This means that she sees her specialists more than her PCP. This is an example of: A. Integrative care B. Community based care C. Long term care D. Fragmented care
D. Fragmented care
According to the article "Regulating Health Professionals: A Review of the Empirical Literature", other regulatory mechanisms that control aspects of practicing behavior and manpower distribution and indirectly influence the competence of professionals and the costs of care include all of the following EXCEPT: (select the one best answer) A. Accreditation of training institutes B. Granting hospital admitting privileges C. Threats of malpractice action D. Granting reciprocity to foreign trained medical providers
D. Granting reciprocity to foreign trained medical providers
One of the 13 principles to reduce medical errors in hospitals is standardizing procedures. Which of the following is an example of this? A. Letting family members act as interpreters B. Allowing new hires to opt out of orientation based on previous experience C. Permitting providers to prescribe medication based on memory D. Having a hospital-wide admission protocol
D. Having a hospital-wide admission protocol
According to Chapter 7 of your textbook, the supply of nurses has ______ and the supply of practicing physicians has ______. (select the one best answer) A. Decreased, decreased B. Decreased, increased C. Increased, decreased D. Increased, increased
D. Increased, increased
According to Chapter 7 of your textbook, four year course of graduate study, competitive selection of students and emphasis on the scientific paradigms of clinical and laboratory science are the features that remain the standard of __________ education in the United States. (select the one best answer) A. Pharmacist B. Registered nurse C. Postdoctoral D. Medical
D. Medical
Based on your knowledge of the "flat of the curve" model, how would increasing the healthcare budget change the overall health of people? A. People would be healthier; money spent directly relates to health. B. People would be less healthy; generally high prices de-incentivizes providing quality care. C. People's health would not change D. People would initially be healthier as money spent increases, but eventually, a plateau would be reached where spending more money would not improve health
D. People would initially be healthier as money spent increases, but eventually, a plateau would be reached where spending more money would not improve health
According to Chapter 7 of your textbook, prescription refills, counting out pills, filling pill bottles, discussing drug interaction and alternative drug regimens are tasks performed by: (select the one best answer) A. Nurses B. Physicians C. Physicians assistants D. Pharmacists
D. Pharmacists
The US health system can be best described as: A. Mixed B. Fragmented C. Market-driven D. All of the above
D. all of the above
According to chapter 11 of your textbook, in the late 19th and early 20th centuries when the first epidemiologic evolution took place, the leading cause of death was infectious disease. These diseases were overtaken by chronic disease (non-communicable disease or NCDs) primary because of: a. Better sanitation and nutrition b. Better training of doctors c. The invention of Immunizations d. The invention of Antibiotics
a. Better sanitation and nutrition
According to the article "Mental Health Information about Mental Illness and the Brain", depression is: a. Diagnosed when a person has five or more of the symptoms (including a sad mood, energy loss, loss of interest in activities that one used to enjoy) nearly every day during a two-week period b. Impaired ability to regulate activity level, to attend to tasks, and to inhibit behavior c. Delusions and hallucinations d. Excessive anxieties that restrict their daily activities
a. Diagnosed when a person has five or more of the symptoms (including a sad mood, energy loss, loss of interest in activities that one used to enjoy) nearly every day during a two-week period
Johnny Appleseed, a patient of Dr. Orchard, is seen for recent onset of diabetes. Dr. Orchard spends 20 minutes performing an examination, finger-stick blood glucose test, urinalysis, and ECG. Each service has a fee set by Dr. Orchard: $100 for a complex visit, $10 for a finger-stick glucose test, $10 for a urinalysis, and $80 for an ECG. Because Mr. Appleseed is uninsured, Dr. Orchard reduces the total bill from $200 to $100. Which method of physician payment is exemplified in this scenario? A. Fee-for service B. Capitation C. Salary D. Payment per episode of illness
a. Fee-for service
Utilizing large investments of resources in new technologies may produce more marginal and difficult-to-measure improvements in the overall health of a population. This concept demonstrates: a. Flat of the curve b. Benefit of the curve c. Area under the curve d. Peak of the curve
a. Flat of the curve
In the article "The Affordable Care Act's Payment and Delivery System Reforms: A Progress Report at Five Years," the Affordable Care Act (ACA) contains provisions intended to resolve underlying problems in how health care is delivered and paid for. The provisions focus on three broad areas EXCEPT: a. Offer an assessment of the law's transformative-seeking reforms b. Testing new delivery models and spreading successful ones c. Encouraging the shift toward payment based on the value of care provided d. Developing resources for system wide improvement
a. Offer an assessment of the law's transformative-seeking reforms
What's the best model to help incentivize providers to deliver better quality care? a. P4P b. Capitation c. DRG d. Fee-for-service
a. P4P
Mary arrives at the outpatient physical therapy clinic for her appointment. She is told that she has a co-payment of $50. What is this an example of? a. Patient cost-sharing b. Supply limits c. Utilization management d. Capitation
a. Patient cost-sharing
According to the article "What Big Medicine Can Learn from the Cheesecake Factory", the theory of chain restaurant style production for health care includes all of the following EXCEPT: a. Physicians will be able to see more patients b. Care will be patient-centered instead of provider centered c. Care will focus on high value procedures d. Implementing standardization will help save money
a. Physicians will be able to see more patients
According to Professor Gaumer's Blog, what institution currently bears the greatest responsibility for treating individuals with mental illness? a. Prisons b. Hospitals c. Schools d. Community Health Centers
a. Prisons
With the creation of Blue Cross and Blue Shield (BCBS), the U.S.'s largest health insurance system, the provider-insurer pact was established where providers had legal control of insurers. Which of the following are likely under the premise that providers had direct control of insurers as with BCBS in the 1960's? a. Providers set generous rules of payment, and BCBS (the insurers) made payments without asking too many questions - this greatly benefitted the providers. b. Patients saw great increases in health care quality because providers were well paid and happy, therefore providing better care. c. Health costs nationwide were reduced as a result of this pact. d. Insurers began to focus on cost containment by way of implementing patient cost sharing stipulations.
a. Providers set generous rules of payment, and BCBS (the insurers) made payments without asking too many questions - this greatly benefitted the providers.
According to the article "A Vision for Getting Mental Health Care Right", all of the following are options that states could employ to make access to mental health care easier EXCEPT? a. Separate mental health care from physical health services b. There should be no wrong door for accessing mental health care c. States should empower regulatory agencies to enforce their parity laws d. Co-pays for mental health services should be the same as physical health services
a. Separate mental health care from physical health services
According to the article "From Treating the Sick to Managing Community Health: Hospitals' New Role in Managing Population Health" hospitals are starting to focus resources on "pre-primary care", or efforts referred to as primary prevention in your textbook. Why is this change happening now? a. The implementation of the Affordable Care Act is moving payment models from a fee-for-service basis to a quality/outcomes basis b. There are more sick people in the community and hospitals have realized that care is more effective there c. Communities are demanding a change from the old medical model of downstream treatment that only occurs once severe medical issues have developed d. Technology is allowing for better interventions that were not possible in the past
a. The implementation of the Affordable Care Act is moving payment models from a fee-for-service basis to a quality/outcomes basis
Chapter 11 of your textbook argues that secondary prevention is currently our best method of addressing breast cancer because: a. The risk factors are not full known b. The risk factors are not the same for everyone c. The disease is found in women only, so it is not cost effective to pay for a primary prevention campaign d. The disease is so serious that we need to catch it early
a. The risk factors are not full known
In his TED Talk, Atul Gawande says that the independent doctor, "cowboy" mentality developed at a time when: (select the one best answer) a. There weren't many treatment options and it was possible for an individual doctor to know everything they needed to know to make reasonable treatment decisions. b. Doctors were significantly better trained than the other healthcare professionals on the team c. Healthcare treatments didn't cost as much, so the consequences of making mistakes was relatively low d. It was more difficult to get into medical school and doctors were more respected
a. There weren't many treatment options and it was possible for an individual doctor to know everything they needed to know to make reasonable treatment decisions.
A patient arrives to a hospital-based primary care office 15 minutes late for their appointment. According to the patient cycle of service model, what would be the best way to approach this situation? a. Understand how much time may have been dedicated to their hospital visit, and inquire as to what caused their delay. b. Charge the patient a fee for missing their appointment c. Inform them that they will have to reschedule the appointment d. Inform the patient of the clinic policy for late appointments.
a. Understand how much time may have been dedicated to their hospital visit, and inquire as to what caused their delay.
A patient marked their experience as "poor" on the HCAHPS survey, with an especially low ranking in the "Discharge Information" category. The patient is a type II diabetic using injectable insulin for the first time. Which of the following strategies would NOT be a good strategy to prepare the patient for discharge? a. Waiting until 30 minutes before discharge to show them so it is fresh in their mind b. Demonstrate how to inject their insulin on day 1 of their admission, and recheck their knowledge the next day with the patient demonstrating proper use of drawing up insulin and self-administration. c. Providing them with a handout on how to inject insulin d. Bringing in any family members who are present to assist
a. Waiting until 30 minutes before discharge to show them so it is fresh in their mind
MR, a 62-year-old patient was involved in a motor vehicle accident that caused him to have a significant blood loss requiring a blood transfusion. MR is alert, oriented, and able to make his needs known to his healthcare team. Upon consenting for the blood transfusion, MR tells the provider that receiving blood is against his religion and he refuses the transfusion. The provider illustrates the risks and potential outcomes of not receiving the blood, but MR ultimately decides that he does not want the blood. There are four basic principles of medical ethics, which one of the principles is illustrated in this patient scenario? a. Nonmaleficence b. Autonomy c. Beneficence d. Justice
b. Autonomy
Identify the principles of medical ethics in the following case. A 97-year-old F has late stage cancer that has metastasized, she has poor quality of life and her prognosis is <6 months. She is confused and unable to understand the severity of her condition. Despite no curative treatment, her husband and decision maker wishes to have surgery to remove the tumor. The neurosurgeon refuses as it will cause the patient more suffering and will not help her situation. a. Autonomy vs. Beneficence b. Autonomy vs. Non-maleficence c. Beneficence vs. Non-maleficence d. Justice vs. Beneficence
b. Autonomy vs. Non-maleficence
According to the article "Adherence and health care costs", patient nonadherence to taking prescribed medications is associated with all of the following EXCEPT: a. Avoidable health care costs b. Avoidable side effects c. Progression of disease d. Poor therapeutic outcomes
b. Avoidable side effects
All of the following are examples of social determinants of health, except: a. Economic stability b. Birth order c. Education d. Social and community context
b. Birth order
Which model uses an insurance system where insurers are called "sickness funds," where these funds are jointly financed by employers and employees through payroll deduction? a. Beveridge Model b. Bismarck Model c. National Insurance Model d. Out-of-Pocket Model
b. Bismarck Model
According to Dr Gaumer's blog post "New Directions for the Healthcare Industry and Population Health Management", the ultimate form of risk bearing by providers occurs when they are paid via: a. Bundled payments b. Capitation c. Fee for service d. Pay for performance (P4P)
b. Capitation
Which of these is NOT a method of cost containment a. Supply limits b. Fee for service c. Increased preventive care d. Global budgeting
b. Fee for service
There are many ways to incentivize better patient centered care. Which scenario below is the BEST way to assure that healthcare professionals can achieve this objective? a. Lower the cost of healthcare and decrease hospital bills b. Financial incentives for doctors and hospitals to provide better care c. Increase the amount of nurses and personnel per patient d. Increase spending on programs to teach personnel how to provide more palliative care to their patients
b. Financial incentives for doctors and hospitals to provide better care
There were two male patients, both 62, patient X has BCBS insurance and patient Y is uninsured due to unemployment. They both presented to the ED with abdominal pain and are treated by Dr. Smith. To ensure that both Patient X and Y are treated fairly and equally requires all concepts except: a. Justice b. Fiscal rationing of services c. Beneficence d. Recognition of implicit bias
b. Fiscal rationing of services
According to "The Affordable Care Act's Payment and Delivery System Reforms: A Progress Report at Five Years", a number of the ACA's reforms seek to transform primary care by encouraging a patient-centered medical home model. Which of the following scenarios best exemplifies this model of care? a. Having a greater number of specialty care offices available within the patient's network. b. Interdisciplinary care teams (doctors, nurses, PT/OT/SLP, nutrition, etc.) that offer extended office hours and have increased communication between providers and patients. c. Increasing the availability of home health aides. d. Increased time allotted for patient evaluations and discharges.
b. Interdisciplinary care teams (doctors, nurses, PT/OT/SLP, nutrition, etc.) that offer extended office hours and have increased communication between providers and patients.
According to the article "From Treating the Sick to Managing Community Health: Hospitals' New Role in Managing Population Health" hospitals are starting to focus resources on "pre-primary care", or efforts referred to as primary prevention in your textbook. Why is this change happening now? a. Better coordinated services b. Investment in more population screening initiatives c. Data systems to track care quality and costs d. Control of partnerships with physicians
b. Investment in more population screening initiatives
According to Chapter 11 of your textbook, the individual model of chronic disease prevention is not the most effective method of prevention. The individual model (also known as the medical model) assumes that individuals play a major role in causing their own illnesses by engaging in poor lifestyle behaviors. It further assumes that that the individual can change their own behavior to reduce their disease risk. Alternatively, a population-based model is more effective because: a. Compared with the individual model, it leads to a larger reduction in risk factors such as cholesterol levels and blood pressure in high risk members of the population b. It reduces exposure on a population level to the environmental risk factors that promote poor lifestyle habits c. Many people don't have access to good primary care health care and prescription medications d. It targets large groups of people at high risk of disease development
b. It reduces exposure on a population level to the environmental risk factors that promote poor lifestyle habits
In the late 1950s, which percentage of the elderly had health insurance? a. 50% b. Less than 15% c. Less than 30% d. 100%
b. Less than 15%
According to Professor Gaumer's Blog, what institution bore the greatest responsibility for treating individuals with mental illness from the time of the Civil War until the 1960s? a. Prisons b. Mental Hospitals c. Community Health Centers d. Schools
b. Mental Hospitals
According to the TED Talk on Brain Science, why should we change the way we think about mental illness and call it a brain disorder? a. For brain disorders, behavior is the first thing to change and that has widespread impact on the population b. New tools can show us the presence of brain changes long before behavioral symptoms emerge c. We now have effective means of early intervention to prevent and treat disease before it is serious d. Thinking of the disease as a brain disease will reduce stigma and encourage treatment
b. New tools can show us the presence of brain changes long before behavioral symptoms emerge
Mr. Simmons is a 42-year-old male who comes into the ED with suspected myocardial infarction. Looking back at his medical record, you note that his blood pressure at his last well-visit 6 months ago was 170/92 (highly elevated blood pressure), with no medication adjustments or referrals made to a dietitian or cardiac rehab. He reports that his provider sent him for an EKG, but did not provide any education about prevention of cardiac disease with dietary changes or other lifestyle modifications. This is an example of what factor that contributes to health spending growth? a. Aging of the population b. Poor allocation of our health spending c. Great primary care utilization d. Administrative waste
b. Poor allocation of our health spending
Why are healthcare prices so high in the U.S.? a. Patients in the United States are richer than patients in other parts of the world so are willing to spend more b. Prices of most health care products and services are not regulated by the government c. The United States government does not invest excessive amounts of money into research and development of new technologies d. The United States regulates pharmaceuticals companies
b. Prices of most health care products and services are not regulated by the government
According to the, "WHO Report: Closing the gap in a generation health equity through action on the social determinants of health," the Commission's overarching recommendations for closing the health gap and creating health equity include all of the following EXCEPT: a. Improve daily living conditions b. Provide additional resources to those who can afford private health insurance c. Measure and understand the problem and assess the impact of action d. Tackle the inequitable distribution of power, money and resources
b. Provide additional resources to those who can afford private health insurance
According to the article "Seven facts about America's mental health-care system", the Community Mental Health Centers Act of 1963: a. Shifted patients to inpatient settings for treatment b. Shifted patients to community settings for treatment c. Started psychiatric institutions for the mentally ill d. Lowered costs for mental health services
b. Shifted patients to community settings for treatment
According to Professor Gaumer's Blog, deinstitutionalization began in the 1960s with the plan of doing what? a. Helping families treat individuals in their homes b. Shifting treatment of mentally ill individuals to community health centers c. Shifting treatment of mentally ill individuals to special schools d. Helping mentally ill individuals in group settings
b. Shifting treatment of mentally ill individuals to community health centers
Which of the following is an example of "flat of the curve medicine"? a. Adding an additional dose of pain medicine when the maximum dose has already been reached b. Spending additional money on health care yielding smaller and smaller increments in health c. Further developing new medicines to treat diseases that do not already have sufficient treatment options d. Shifting medical care to a patient-centered model
b. Spending additional money on health care yielding smaller and smaller increments in health
What is the major difference between health care financing in the U.S. compared to health care financing in other developed nations like Canada, The UK, Germany, and Japan? a. The United States does not have government financed health insurance, while other developed nations do b. The United States has many methods of financing healthcare, while other developed nations have a more unified method c. The United States has a unified method of financing healthcare, while other developed nations have many d. The United States has government financed health insurance, while other developed nations do not
b. The United States has many methods of financing healthcare, while other developed nations have a more unified method
According to the article "What Big Medicine Can Learn from the Cheesecake Factory", The Cheesecake model represents: a. An establishment that provides great customer service, as hospitals should b. The best prospect for molding the disconnected pieces within healthcare into a system that better serves patients c. Better training models to improve the knowledge of the healthcare team d. A hospital that offers a wide variety of services to patients and can take more market share
b. The best prospect for molding the disconnected pieces within healthcare into a system that better serves patients
According to Professor Gaumer's Blog, deinstitutionalization was ineffective at meeting the need for mental health treatment primarily because why? a. Community health care providers were poorly trained to treat individuals with mental illness b. The funding mechanism was shifted from direct funding to block grants to the states c. Health insurance companies refused to pay for mental health treatment d. Stigma kept individuals from seeking treatment for mental illness
b. The funding mechanism was shifted from direct funding to block grants to the states
According to Professor Gaumer's Blog, deinstitutionalization began in the 1960s because of all of the following EXCEPT? a. The discovery of medications that could alter behavior of mentally ill individuals b. The release of a documentary that exposed the abuses committed in Mental Hospitals c. The news coverage of the treatment of President Kennedy's sister in a Mental Hospital d. A plan to federally fund community-based mental health treatment
b. The release of a documentary that exposed the abuses committed in Mental Hospitals
All of the following are one of the four major actors in the US healthcare system EXCEPT: a. Suppliers b. Unions c. Providers d. Insurers
b. Unions
According to chapter 11 of your textbook, all of the following are examples of primary prevention interventions to reduce the incidence of illness in the population EXCEPT: a. Water purification systems in underdeveloped nations b.Screening and treatment of hypertension c. Increased tobacco taxes to reduce the purchase of cigarettes d. Mass education on the dangers of high-fat diets
b.Screening and treatment of hypertension
An entity formed by health care providers—from primary care physicians and specialists to hospitals and postacute care facilities—that agree to collectively take responsibility for the quality and total costs of care for a population of patients is an example of an: a. HMO b. PPO c. ACO d. In-network provider
c. ACO
According to Professor Gaumer's Blog, which of these is a reason the current state of mental health treatment in America is not good: a. Mental illnesses do not affect many people b. Mental illness has minimal impact on individuals affected c. Access to mental health care services is very limited in many areas d. Little is known about what to do with people who have mental illnesses
c. Access to mental health care services is very limited in many areas
According to the article "Evolving Models of Behavioral Health Integration in Primary Care", collaborative and integrated care: a. Are terms used consistently in in the field and are interchangeable b. Both involve behavioral health working within and as a part of primary care c. Are terms not used consistently in the field and this has led to confusion d. Both involve behavioral health working with primary care
c. Are terms not used consistently in the field and this has led to confusion
According to the article "Adherence and health care costs", the most common reasons that patients did not take their medications included all of the following EXCEPT: a. High cost b. Perceived side effects c. Could not get to the pharmacy d. Forgetfulness
c. Could not get to the pharmacy
According to the article "Evolving Models of Behavioral Health Integration in Primary Care", mental illness most often begins: a. Late in life b. At any time c. Early in life d. At birth
c. Early in life
According to Dr Gaumer's blog post "New Directions for the Healthcare Industry and Population Health Management", all of these are steps that help providers mitigate financial risk except: A. Get more efficient b. Get more integrated c. Get smaller and more nimble d. Get more control of clinical operations and utilization of services
c. Get smaller and more nimble
According to chapter 11 of your textbook, in the middle of the 20th century when the second epidemiologic evolution took place, the leading cause of death was: a. Infectious diseases b. Accidents c. Heart disease d. Cancer
c. Heart disease
Which of the following factors does not drive growth of new medical technology? a. Consumer demand for better health b. Health insurance simultaneously paying for new technologies and hiding the real cost from patients c. Hospitals trying to decrease costs d. Investment in Research & Development
c. Hospitals trying to decrease costs
To enable healthcare consumers to fully engage in their healthcare, payors and providers must deliver in all of the following ways EXCEPT: a. Know consumers and what drive their behaviors b. Guide consumers toward the information they need to make better decisions c. Inspire consumers to seek alternative options for healthcare d. Engage consumers to help prepare them for and enable behavior change
c. Inspire consumers to seek alternative options for healthcare
Two patients are admitted at the same time to the ER: 30 y/o M with a history of substance abuse who presents for alcohol detox and a 65 y/o F with Stage IV cancer who is having adverse effects from chemo. The nurse could tend to the cancer patient first, but decides to find 2 open beds so both patients can receive care quickly. What ethical principle does this MOST represent? a. Nonmaleficence b. Autonomy c. Justice d. Beneficence
c. Justice
According to the TED Talk "How do we Heal Medicine?", healthcare professionals need to think of themselves as "pit crews" instead of cowboys. Gawande's rationale for the pit crew mentality is: a. If the team acts like a pit crew, the patient and their family will know what to expect of their health care team and their course of treatment and will have a better ability to figure out when a treatment is off course. b. Good health care requires specialization, but healthcare providers need to be better at "staying in their own lane" and not trying to do someone else's job. c. Knowledge and technology have brought complexity and specialization, so in order to function well within a system we need to recognize that we play a distinct role in that system and understand what everyone else on the team is doing to interact effectively and keep an eye on the big picture. d. The volume of care that healthcare facilities provide require providers to be more efficient.
c. Knowledge and technology have brought complexity and specialization, so in order to function well within a system we need to recognize that we play a distinct role in that system and understand what everyone else on the team is doing to interact effectively and keep an eye on the big picture.
What type of international healthcare system does Medicare correspond with? a. Beveridge Model b. Bismarck Model c. National Insurance Model d. Out-of-Pocket Model
c. National Insurance Model
How do other countries avoid the 'Flat of the Curve" problem that the US has? a. Other countries spend more per person b. Other countries provide more medical care per person c. Other countries regulate provider fees and budget spending d. Other countries have better doctors
c. Other countries regulate provider fees and budget spending
According to the article "Adherence and health care costs", strategies for improving medication adherence include all EXCEPT: a. Reminders b. Education c. Reinforcing the regimen d. Team based care
c. Reinforcing the regimen
Which of the following is an example of painful cost-containment? a. Reducing administrative waste b. Restricting price increase c. Sacrificing quantities of medically beneficial services d. Eliminating inappropriate and effective services
c. Sacrificing quantities of medically beneficial services
According to the article "A Vision for Getting Mental Health Care Right", Congress enacted legislation to mandate that health insurance had to cover mental health care in a similar manner to physical health care. The Mental Health Parity and Addiction Equity Act did not have the impact hoped for because why? a. The legislation was not passed b. The legislation was deemed unconstitutional by the Supreme Court c. The legislation was never enforced d. The legislation was overturned by the next Congress
c. The legislation was never enforced
According to the article "From Treating the Sick to Managing Community Health: Hospitals' New Role in Managing Population Health" all of these are challenges of community health programs and care processes EXCEPT: a. Time and staff needed to develop programs b. Lack of direct reimbursement c. The perception that they are not valuable d. Healthcare provider time needed to implement programs
c. The perception that they are not valuable
Chapter 11 of your textbook argues that individuals who are in lower socioeconomic classes bear a disproportionate burden of chronic disease (they are more likely to get sick with a chronic disease). Why? a. They have less access to primary care b. They have less access to specialty care c. They have more exposure to lifestyle risk factors d. They are less likely to seek health care
c. They have more exposure to lifestyle risk factors
According to the TED Talk on Brain Science, mental illnesses are the number one cause of morbidity because? a. They are highly prevalent in the population b. They are more disabling than other diseases by their nature c. They start very early in life and people suffer with them for a long time d. They are brain disorders and impact every aspect of the individual's health
c. They start very early in life and people suffer with them for a long time
According to Chapter 8 of the book, all of these contribute to the high cost of healthcare in the US EXCEPT a. Administrative costs b. Inappropriate and unnecessary care c. Transportation d. Price inflation
c. Transportation
According to the article "Seven facts about America's mental health-care system", access to mental health care is: a. The same as other types of medical services b. Better than other types of medical services c. Worse than other types of medical services d. Not possible without insurance
c. Worse than other types of medical services
According to the article "Evolving Models of Behavioral Health Integration in Primary Care", as many as ___ percent of primary care visits stem from psychosocial issues.(Choose the single best answer) a. 10 b. 20 c. 50 d. 70
d. 70
According to the TED Talk on Brain Science, ____ percent of suicides are related to mental illness: a. 20 b. 40 c. 75 d. 90
d. 90
Which of these scenarios would be most likely to take place under a "pay for performance" incentive model? a. A physician orders multiple tests (MRIs, X-rays, blood tests, etc) on a patient who presents with a mild headache for thoroughness of care b. A PCP recommends that any of her patients with abnormal lab results be admitted to the hospital c. A clinic performs unnecessary medical procedures on patients to increase provider revenue d. A hospital receives high patient satisfaction ratings and the providers receive a bonus at the end of the year
d. A hospital receives high patient satisfaction ratings and the providers receive a bonus at the end of the year
According to the article "Mental Health Information about Mental Illness and the Brain", which of the following is categorized as mental illness: a. Parkinson's disease b. Alzheimer's Disease c. Multiple Sclerosis d. ADHD
d. ADHD
According to the article "Adherence and health care costs", a patient-related determinant of adherence is: a. Provider b. Disease c. System d. Behavioral
d. Behavioral
The benefits of having a Medicare Quality Incentive Program include all of the following EXCEPT: a. Provides financial incentive for change in the hospital b. Helps the hospital understand which measures they can improve c. Gives patient information about standards of care at each facility d. Complex patients are more likely to be admitted for care
d. Complex patients are more likely to be admitted for care
According to chapter 11 of your textbook, nearly half of deaths from cardiovascular disease are attributable to high blood pressure (hypertension). What dietary practice very common in industrialized countries is a major risk factor for developing hypertension? a. Consuming high amounts of added sugar b. Consuming dairy in our adult years c. Consuming high amounts of refined grains d. Consuming high amounts of sodium
d. Consuming high amounts of sodium
Racial and ethnic disparities that occur in the health care system are caused by all EXCEPT: a. Health care provider bias b. Socioeconomic differences c. Differentiation in access to care d. Cultural competency of providers
d. Cultural competency of providers
According to the article "Seven facts about America's mental health-care system", patients fail to pursue treatment due to attitudes toward mental health including all of the following EXCEPT: a. Want to solve the problem on their own b. Thought the problem would get better on its own c. Felt the cost is too high d. Felt they could not find an appropriate provider
d. Felt they could not find an appropriate provider
n 2000, African American infants in Boston were five times as likely to die as white infants. This is an example of: a. Health care bias b. Health inequalities c. Health inequities d. Health disparities
d. Health disparities
In his TED Talk, Atul Gawade lays out a three part plan for "healing" medicine. His three parts are: a. Identify gaps in care, figure out solutions, implement Incorrect b. Identify failures, create checklists, evaluate c. Identify gaps in care, redistribute resources, evaluate d. Identify failures, figure out solutions, implement
d. Identify failures, figure out solutions, implement
According to chapter 11 of your textbook, in the middle of the 20th century when the second epidemiologic evolution took place, chronic disease (also known as non-communicable diseases or NCDs) were the leading cause of death. Risk factors for NCDs include: a. Low utilization of primary care b. Poor access to hospitals c. Poor access to prescription medications d. Low intake of fruits and vegetables
d. Low intake of fruits and vegetables
According to Dr Gaumer's blog post "New Directions for the Healthcare Industry and Population Health Management", integrated Primary Care vitally includes: a. Rehab b. Specialists c. Outpatient d. Mental Health
d. Mental Health
According to Dr Gaumer's blog post "New Directions for the Healthcare Industry and Population Health Management", the number one source of disease burden in the US is: a. Back and join disease b. Cancer c. Cardiovascular disease d. Mental Health
d. Mental Health
The follow are past models/mandates that have been proposed as U.S. health care reform EXCEPT: a. Single-payer model of national health insurance (NHI) b. Employer-mandate model of NHI c. Individual-mandate model of NHI d. PCP-mandate model of NHI
d. PCP-mandate model of NHI
According to the article "Seven facts about America's mental health-care system", the larger payor for services for mental health care is: a. Private insurance b. Mainly paid for out of pocket c. Not covered by insurance d. Paid for by the government
d. Paid for by the government
According to chapter 11 of your textbook, all of the following are examples of secondary prevention efforts EXCEPT: a. Prenatal care b. Regular breast examinations and mammograms c. Regular screening for hypertension d. Public School health classes
d. Public School health classes
Which is NOT a category of national insurance plans? a. Employer-mandated private health insurance plans b. Individual-mandated health insurance plans c. Government-financed health insurance plans d. State-financed health insurance plans
d. State-financed health insurance plans
According to the article "What Big Medicine Can Learn from the Cheesecake Factory", when the regional Cheesecake Factory manager is asked how he would address the difficulties he encountered with care for his mother in the hospital, what does he say he would do to fix it? a. Train the medical staff on better communication skills with the family and from provider to provider b. Provide better equipment and technology that addresses the patient's particular needs c. Train the medical staff on better patient care d. Study what the best people are doing, standardize it and bring it to everyone to execute
d. Study what the best people are doing, standardize it and bring it to everyone to execute
Which part of the US healthcare system most represents the Beveridge model? a. Private insurance with co-pays and deductibles b. Fee for service c. Medicare/Medicaid d. The VA
d. The VA
According to the article "Seven facts about America's mental health-care system", all of the following are frequently cited barriers to treatment of mental health EXCEPT a. Cost b. Access c. Attitudes about mental illness d. Training of health professionals
d. Training of health professionals