PICH Midterm, Delivering Health Care in America Chapter 3 and related info

Crude rate formula

can be calculated by taking the number of deaths caused by a disease and dividing that number by the total population at risk of contracting that disease. The decimal is then multiplied by a constant, usually 1,000 or 100,000, to give a whole number

A ____ provides medical services related to childbirth and nursing

certified nurse midwife

Which type of health care professional bases care on the belief that the body is self healing organism

chiropractor

A set proportion of the medical costs that someone insured must pay out of pocket is a

coinsurance

When providers deliver unnecessary services with the objective of protecting themselves against lawsuits, the practice is called

defensive medicine

The Resource Based Relative Value Scaled utilizes RVUs to

determine time, skill, and intensity it takes a physician to provide a service

For most privately insured Americans health insurance is

employer-based

Concerning the ACA, the supreme court determined that states could not be required to

expand medicaid

A health reimbursement arrangement (HRA) can be used in addition to or in place of insurance. It cannot be used to supplement an individual's retirement savings.

false

Medicaid recipients are fully classified as medically uninsured

false

QuadMed utilized comprehensive health clinics to improve the health care experience of their employees, but were unable to reduce their per employee health care expense

false

The US has a mainly public system of financing health care services

false

The US health care system is administratively controlled by an agency setup by the ACA

false

Socialized medicine is best described as

government run health insurance system covering the entire population for a well defined medical benefits package

Mortality rate formula

is calculated by taking all the deaths that occurred during a particular time period and dividing that number by the total size of the population during the same time frame. The resulting decimal is then multiplied by 1,000 or 100,000 to give a whole number.

Not having an established primary care physician can lead to

obtaining episodic care in the ED, a higher cost of care, an undiagnosed chronic health condition

CareOregon ultilized two programs to help optimize care for its enrollees: a multidisciplinary case management program for members at high risk of poor health outcomes and a ______ initiative in safety net clinics

patient centered medical home

The ACA mostly eliminated

preexisting conditions and benefit limits

_____ indicates the total number of cases of a disease at a specific point in time

prevalance

The role of the government in the US health care system is

regulator, major financer, medicare and medicaid reimbursement setter

In the US, federal qualified health centers are funded to

serve as a safety-net to those who have difficulty getting needed primary care.

The preindustrial era, asylums were built by _______ to accommodate patients with severe and chronic mental illnesses

state governments

___ refers to interventions that could prevent complications from chronic conditions and prevent further illness, injury, or disability

tertiary prevention

What is a major objective of the Affordable Care Act?

to provide insurance coverage

People in older age groups represent a higher risk for health insurance than those in lower age groups

true

The department of health and human services is the central agency that sets the controls for the health care industry

true

tax policy in the US provides and incentive to obtain employer paid health insurance

true

The elements of the Epidemiology Triangle of disease occurrence

-Environment -Agent -Host

A multiple payer system is more cumbersome than a single payer system:

-Government programs require extensive documentation proving services were provided before paying providers -There are numerous health plans, which is difficult for providers to handle -Payments are not standardized across health plans

A free market in healthcare requires:

-Independent actions between buyers (patients) and sellers (providers) -Adequate information for patients -Unencumbered interaction of the forces of supply and demand

The primary functions of managed care.

-Setting prices at which providers are paid -Achieving efficiencies -Controlling patients' utilization of services

The wellness model is built on:

-intervention -adequate public health and social services -understanding risk factors

If John works 32 hours per week in the ICU as a Nurse, he is considered a _________ FTE

.8

In the 2014 Mirror Mirror, the US ranked ____ among the 11 nations analyzed

11

What is meant by the term"continuum of health care services"?

A range of health care services that go beyond what hospitals and physicians provide

Which method of risk assessment is required by the ACA for individual and small group health insurance?

Adjusted community rating

Hospitals in the US evolved from

Almshouses

Historically, which interest group was the most powerful in opposing health insurance in the 1900s?

American Medical Association

The ownership of Canada's health care system is best described as:

Combination of private and public

Which of the following describes organized medicine

Concerted activities of physicians through the American Medical Association

A hospital may receive reimbursement from Medicaid that is less than the cost of care. This deficit may be mitigated by obtaining higher reimbursement from a private payer. This is known as

Cost shifting

According to the research on employee wellness initiatives, all of the incentives listed below have a significant impact on behavior change except

Employees feel they are improving their health

Blum described four major force fields that contribute to health and well being. Which of the below is the most important force field in this model?

Environment

A chronic condition is relatively severe, episodic, and often treatable

False

T/F A chronic condition is relatively severe, episodic, and often treatable

False

T/F Cultural beliefs have very little to do with health.

False

T/F In a single-payer system, the primary payer usually is an insurance company.

False

T/F The U.S had a mainly public system of financing health care services.

False

T/F Under the medical model, health is defined as a complete state of physical, mental, and social well- being, and not just the absence of disease or infirmity.

False

In 1984, Australia switched:

From privately financed system to the Medicare program

having a higher concentration of physicians/100,000 population in an urban setting is an example of

Geographic maldistribution

In which country are employers required by law to contribute toward health insurance for their employees?

Germany

National healthcare programs in other countries often use which mechanism below to control total health care expenditures?

Global Budgets

National health care programs in other countries often use the following mechanism to control total health care expenditures?

Global budgets

Which of the following countries has a National Health System (NHS)?

Great Britain

Which of the following countries has an NHS?

Great Britain

If national health expenditures amount to 18% of the GDP, what does this mean?

Health care consumes 18% of the total economic production

Characteristic of a socialized health insurance system

Healthcare is financed through government-mandated contributions by employers and employees

The primary functions of managed care include all of the following except:

Improving quality

One risk to the success of the ACA is known as churning or the process of

Individuals purchasing insurance only after they have a health care need

What is not true about the PACE program -Participants must be 55 or older -Programs assume full financial risk for enrolled patients -Interdisciplinary rounds are held on each participant and only include the physician, nurse, social worker, and rehab therapist - Remains financially viable by providing care to a medicare population at less cost than if they were not a part of the program

Interdisciplinary rounds are held on each participant and only include the physician, nurse, social worker, and rehab therapist

In order for an employee wellness program in an organization to be successful, what key factors are needed

Leadership buy in and involvement Outcomes measurement Ease of use for employees

An emphasis on individual responsibility for one's health care best fits under the ____ model of health care distribution

Market justice

The government health coverage program for the elderly and certain people with disabilities is called

Medicare

The principal source of funding for graduate medical education is

Medicare

_____ can be described as a sickness and disease

Morbidity

Which of the following is not true about the patient protection and ACA of 2010? Not a single republican voted for it Most americans supported it after Legislation was supported by AMA The US SC upheld the individual mandate

Most Americans supported the legislation once they found out what was in it

Supply-side rationing is also referred to as:

Nonprice and planned rationing

A ____ is more towards health promotion/education and are typically in primary care setttings

Nurse practioner

A ____ therapist helps people improve their ability to perform tasks associated with daily living

Occupational

A _____ studies the characteristics, causes and progression of diseases

Pathologist

Reimbursement is associated with which of the quad functions?

Payment

A _____ therapist provides care for individuals with movement dysfunction

Physical

Demand-side rationing is the same thing as:

Price rationing

Supplier-induced demand is created by:

Providers

A ______ performs diagnosis and treatment by the use of X-rays and radioactive materials

Radiologist

Which of the following is the best example of an iatrogenic illness

Sarah picks up a case of C diff while she is a patient at her local hospital iatrogenic - illness caused by medication or physician

___ refers to early detection and treatment of disease

Secondary prevention

Healthcare is considered a social good to:

Social justice

The ACA is an example of?

Social justice

The elements of the Epidemiology Triangle of disease occurrence include all of the following except:

Society

A multiple payer system is more cumbersome than a single player system for all of the following reasons except:

Some healthcare services are covered fro people in the north, but not in the south.

Holistic health adds which element to the World Health Organization definition of health?

Spiritual

The flexner report published in 1910 reported on

Standards of training in medical schools

Which of the following is a characteristic of a national health insurance system?

The government finances health care through general taxes and healthcare is delivered by private providers

The Ridic, Gleason article "Comparisons of Health Care Systems in the US, Germany and Canada" observed that the US stands out as the country with:

The highest expenditures on health care

Incidence is

The number of new cases occurring during a specified period divided by the population at risk

As the health care delivery system developed in the US, it emphasized specialization over primary care

True

In the preindustrial era, much of the medical care in the US as provided by nonphysicians

True

In the preindustrial period, Europe was more advanced than the US in medical science

True

T/F Capitation is a payment mechanism in which all health care services are included under one set fee per covered individual.

True

T/F Generally, people with better education have higher incomes and better health status.

True

Under community rating people are charged the same premium regardless of health risk

True

Which of the following is not a behavioral risk Irresponsible motor vehicle use Inadequate physical exercise Unsafe neighborhoods Alcohol Abuse

Unsafe neighborhoods

The employer paid benefit that compensates workers for medical expenses and wages lost due to work related injuries or illnesses

Worker's compensation

An insurance company refusing to insure an individual because of a pervious cancer diagnosis is an example of

a preexisting condition

The primary functions of managed care include all of the following

achieving efficiencies, setting prices at which providers are paid, controlling patients' ultilization of services

A free market requires

adequate information for patients, independent actions between buyers and sellers, unencumbered interaction of the forces of supply and demand