The Healthcare system

"Hispanics have lower death rates than whites despite the fact that their economic circumstances are considerably worse. This is known as the _

"Latino Paradox

Cabinet-level heads of federal executive departments are called

"Secretary"

The movement of people with serious mental illness from state institutions to nursing homes or jails and prisons is known as __.

"Transinstitutionalization"

Involuntary outpatient commitment is generally referred to by those who favor using it more frequently as

"assisted outpatient treatment"

The fiscal value of family caregivers is about:

$500 billion per year

126. Suicide is the ____ leading cause of death in the United States.

10th

Prior to the passage of the ACA, _ of the American population did not have health coverage. Since the ACA that has been reduced to _

16.3%, 8.1%

In 2010, roughly ___ million people were uninsured; by 2016, ___ million remained uninsured

50/28

Contributions to not-for-profit organizations are tax-exempt if and only if the organization is a

501(C)(3)/charitable_ corporation.

Employers provide health insurance to ___% of the American population.

55%

Current health spending in the US is

About $3.5 trillion

"Obamacare" refers to the _

Affordable Care___ Act of 2010

Rights for people with disabilities were established in 1990 via the _______

Americans with Disabilities_ Act

Teaching" hospitals but not "community" hospitals (circle all that apply):

Are affiliated with medical schools

The federal department within HHS with primary responsibility for health and behavioral health finance is __.

Center for Medicare and Medicaid Services

Psychiatric rehabilitation programs are accredited by __

Commission on Accreditation of Rehabilitation Facilities

The quality assurance approach that is based on the assumption that organizations can always improve is known as

Continuous Quality Improvement

After the Civil War, asylums that had been oriented towards "treatment" became:

Custodial care facilities

Health maintenance organizations usually do not

D. Pay physicians on a fee for service basis

A health care proxy may legally make decisions on behalf of a patient who is competent and able to communicate.

False

DUI laws are a key component of substance abuse policy in the United States

False

In the United States, a physician can override the decisions of a health care proxy regarding end-of-life decisions.

False

Most older adults are disabled and in need of help for basic activities

False

Physicians throughout the U.S. are legally permitted to increase pain medication for a terminal patient so as to bring about death quickly.

False

501(c)(3) status is granted by the ________ to organizations that are not-for-profit and _________

IRS, corporations

IDEA stands for _________.

Individuals with Disabilities Education Act

In order to be funded by Medicaid or Medicare, hospitals must be:

Licensed and accredited

Suicide is among the top three causes of death among adolescents. It occurs at a ____ rate than working age and older adults.

Lower

In 1965 the Social Security Act was amended to add financing of health care via ______ and ___________.

Medicaid,Medicare

Skilled nursing facilities are primarily funded by

Medicare

The two major sources of public funding for health care are _

Medicare_ and _Medicaid_.

MICA stands for _.

Mentally Ill and Chemically Addicted_.

"Cost containment" means:

Reducing the rate of growth of health care costs

SBIRT stands for ______

Screening, Brief Intervention, Referral to Treatment_

The technical term for nursing homes is _

Skilled nursing facility

SCHIP stands for

State Children's Health Insurance Program

The federal act that created the shift from institution-based to community-based mental health policy was the _____________ of _____.

The Community Mental Health Centers Act of 1963

The concept of mental illness emerged in America in the 18th century with the founding of _ _, America's first state hospital.

The Virginia Hospital

According to Bauman, having more social disadvantages increases the likelihood of having poor health

True

After the failure of deinstitutionalization some mental health advocates called for returning to the use of asylums.

True

Although marijuana is now legal for medical or even recreational purposes in several states, possession or sale is still a federal crime.

True

IDEA requires school districts to provide special education and related psychological services at no cost.

True

In the US the private sector provides more funding for health care than the public sector.

True

Most older adults have chronic physical conditions

True

Possible loss of governmental benefits creates a disincentive to work for some people with disabilities

True

Some (but not all) private sector providers are for-profit and all public-sector providers are non-profit or governmental.

True

States have virtually no role in determining Medicare eligibility.

True

The ACA does not cover long-term custodial care

True

Co-location is an effective way of providing integrated care. (T/F)

True?

The federal department with primary responsibility for health, behavioral health and disability services is ______

U.S. Department of Health and Human Services

Identify 2 circumstances when a medical matter is not purely a private matter between doctor and patient.

_Abortion_ _Who gets a transplant_

CASAC stands for _

_Credentialed Alcoholism and Substance Abuse Counselor_

Identify three factors that explain the comparatively poorer health of children living in poverty compared with affluent children.

_Dangerous housing conditions_ _Limited education_ _High crime rates_

Black children and adolescents are likely to have poorer health than white. Identify two factors that may contribute to this disparity.

_Economic status_ _Social capital

Identify 4 social determinants of health disparities.

_Education_ _Jobs with good pay, good benefits, and safe working conditions_ _Housing_ _Access to healthy foods_

Identify 2 arguments against establishing federal single-payer healthcare in the U.S

_Employer-based health coverage is stable and should not be dropped_ b. _Projected administrative cost savings would probably not be enough to cover the costs of more health care for more people and the loss of funding by employers_

Identify two key elements of successful aging.

_Enough money_ __Adequate housing_

The "triple aim" is

_Improving the patient experience of care_ _Improving the health of populations_ _Reducing the per capita cost of health care_

Nursing homes expanded rapidly after the establishment of _____________ as a source of funding.

_Medicaid____________

Mental health professionals in NYS are licensed by ___________.

_NYS Department of Education__________.

Identify 4 social determinants of health in children and adolescents

_Poverty_ _Race_ _Education_ _Adverse Childhood Events (ACEs)_

Identify 4 developmental challenges of old age.

_Pride in the past_ _Satisfying and meaningful activity_ _Adapting to new family roles_ _Coping with losses of friends and family_

Identify 3 forms of mental disability

_Psychiatric disabilities_ _Intellectual or developmental disabilities_ _Dementia

Identify 2 forms of governmental income supports for people with disabilities

_SSDI_ _SSI_

. In the 19th century services for dependent populations were largely provided in specialized ___ such as orphanages, old age homes, and asylums

_institutions

Fee-for-service is payment for __. It creates incentives to _______and _______

a specific service, keep people hospitlized

The population of older adults in the U.S. will grow from about 50 million in 2015 to about ____ in 2060.

a. 100 million

The population of older adults in the U.S. will grow from about 15% in 2015 to about ____% in 2030.

a. 20%

109. Approximately 20-25% of the American population has a diagnosable mental or substance use disorder in any given year. Approximately ____ % of Americans have a serious mental illness. Approximately ___% have a serious and persistent mental illness.

a. 5%; 2%

The Affordable Care Act provided the following insurance reforms: (circle all that apply)

a. Coverage of pre-existing conditions is required b. Dropping people from coverage due to illness is forbidden d. Essential benefits are defined and required of plans sold through the health exchanges

104. The Affordable Care Act provided the following insurance reforms: (circle all that apply)

a. Coverage of pre-existing conditions is required b. Dropping people from coverage due to illness is forbidden\ d. Essential benefits are defined and required of plans sold through the health exchange

Cultural competence includes the following elements (circle all that apply):

a. Culturally sensitive diagnosis b. Culturally sensitive treatment c. Empowerment of minorities in the health system

Social determinants of health are sometimes referred to as _______ factors. (circle all that apply)

a. Distal c. Upstream

Organizations that deliver health or behavioral health services can be (circle all that apply):

a. Governmental b. Not-for profit c. For profit d. Public benefit corporations e. Owned by individuals or a partnership of individuals

Children exposed to adverse childhood events are more likely to (circle all that apply):

a. Have emotional and behavioral problems b. Have physical health problems c. Have encounters with the criminal justice system

Children and adolescents with "serious emotional disturbance" (circle all that apply):

a. Have serious problems functioning in normal ways b. Often get caught up in the juvenile justice system

In the class on aging, Prof. Friedman suggested that the health system for older adults should be shift from a system focused on acute care to a system focused on (circle all that apply):

a. Health maintenance b. Treatment of chronic conditions

The Community Mental Health Centers Act of 1963 called for construction of community mental health centers with a number of essential services including: (circle all that apply):

a. Inpatient and outpatient services d. Crisis, partial hospitalization, and community education services

Systems of care for children and adolescents with serious emotional disturbance:

a. Integrate mental health, education, child welfare, and juvenile justice systems

Medicare is subject to criticism by advocates for older adults because (circle all that apply):

a. It limits the use of palliative care b. It does not pay adequately for in home treatment

The Affordable Care Act increased health insurance coverage by (circle all that apply):

a. Mandating individuals to have coverage d. Providing subsidies to individuals and small businesses e. Expanding Medicaid

In addition to service organizations such as hospitals and community social work organizations, in which of the following fields/settings do social workers also work? (Circle all that apply.)

a. Military b. Private corporations c. Insurance Companies d. Managed Care e. Philanthropy

42. Hospitals can be (circle all that apply):

a. Not-for-profit b. For profit c. Government owned d. Public benefit corporations

Community organizations can be organized on the basis of (circle all that apply)

a. Population served, c. Type of service provided d. Geographic region served

Behavioral health providers can help to reduce the utilization of nursing homes by (circle all that apply):

a. Providing guidance regarding the management of behavioral problems at home in the community b. Treating depression and/or anxiety disorders for disabled people and for family caregivers d. Helping to arrange respite services

The main goal(s) of LTC reform is/are (circle all that apply):

a. Reduce social isolation b. Reduce use of nursing homes c. Improve the quality of nursing homes

An effective public health response to the opioid epidemic must include (circle all that apply):

a. Reducing supply by curtailing the manufacture and distribution of opioids in the US b. Reducing demand through effective advertising and public education d. Making treatment more available and affordable

Primary care physicians may be able to help to reduce the incidence of suicide in America by (circle all that apply):

a. Screening for depression b. Providing treatment with medications c. Providing coordinated care management

Mission statements are usually

a. Short statements about overall goals and purposes: about 2-3 sentences

Corporations have Boards of Directors/Trustees. Which of the following is not true?

a. The Board owns the organization.

Vertical" organizational structure refers to (circle all that apply)

a. The hierarchy of an organization b. The division of labor of an organization

David Satcher, former Surgeon General of the United States believes that the following would improve the health of African Americans (circle all that apply):

a. Universal health insurance b. Primary care medical home c. Proportionate representation of African Americans in health professions d. Elimination of bias in diagnosis and treatment

Determining that patients are getting the appropriate level of care is known as

a. Utilization review

Identify 4 roles that social workers play in community behavioral health organizations.

a. _Case management__________________ b. _Psychotherapy___________________ c. _Crisis intervention__________________ d. _Program development________________

Identify three reasons for Republicans opposition to the ACA

a. _Conservative antipathy to extensive governmental role in health care_ b. _Preference for state-based vs federal health plans_ c. _Concern about lack of control of rising federal costs_

The 2 primary goals of managed care are

a. _Cost containment (controlling health care costs)_ b. _managing quality of care_

Identify 2 arguments for establishing federal single-payer healthcare in the U.S.

a. _Covers all citizens and legal residents, which largely prevents people from going into medical bankruptcy or dying prematurely due to lack of ability to pay for coverage_ b. _Better cost control because the payer (i.e. government) has more power to negotiate or set prices_

Identify 4 functions that social workers serve in hospitals.

a. _Discharge planning___________________ b. _Work with patient and family to adapt to illness _____ c. _Crisis interventions__________________ d. _Administrative functions__________________

The 3 primary causes of death for older adults are

a. _Heart disease_ b. _Cancer_ c. _Respiratory disease_

43. Identify 4 sources of funding for hospitals (and other healthcare organizations

a. _Insurance___________________ b. _Private pay__________________ c. _Philanthropic support__________________ d. _Research grants___________________

Identify 3 major problems with the American health system that are addressed as part of health policy reform.

a. _Lack of universal coverage_ b. _Uneven quality of care_____ c. _Significant health disparities__

Identify three outcomes of deinstitutionalization.

a. _Living on welfare in poor housing_ b. _Living with over-burdened families_ c. _"Transinstitutionalizaiton" to nursing and adult homes_

96. Identify 3 ways to provide universal health coverage.

a. _National Health Plan____________________ b. _ Government based single payer c. _ Multi-payer systems _______________________

Wellness programs have been developed to reduce the mortality gap. Identify 2 health determinants addressed by such programs.

a. _Nutrition_ b. _Exercise_

Identify 3 key elements of a medical home.

a. _Personal physician______________________ b. _Coordination of Care______________________________ c. _ "Meaningful" use of electronic medical records_____________

What are the three essential components of rehabilitation?

a. _Skill development and assistive devices_ b. _Environmental accommodations_ c. _Supports_

Identify 4 types of professionals who work in community behavioral health organizations

a. _Social workers___________________ b. _Mental health counselors___________________ c. _Psychiatrists___________________ d. _Psychologists_

Identify 3 federal departments that play leading roles in mental health.

a. _The Substance Abuse and Mental Health Services Administration (SAMHSA)_ b. _The Center for Medicare and Medicaid (CMS)_ c. The Social Security Administration_

Identify 3 goals of health policy reform in the United States.

a. _Universal coverage for citizens and legal residents_____ b. _Cost containment_________ c. _Improved health________________

Identify two ways in which managed care organizations attempt to hold down health care costs

a. _Utilization management_ b. _Capitation_

Identify three strategies for achieving cost containment

a. _Utilization management_ b. _Capitation_ c. _Health Maintenance Organizations_

Identify three reasons for the shift from institution-based to community-based mental health policy.

a. _WWII discovery of high prevalence of mental illness b. _Scandalous conditions of state hospitals _____ c. _Harmful impact of institutionalization

Identify 2 major expected outcomes of care management for people with co-occurring conditions who are on Medicaid

a. _early identification_ b. _early intervention_

Health disparities are commonly viewed through the lens of race and ethnicity and/or economic circumstances, but they occur across a broad range of dimensions including (circle all that apply):

a. gender b. sexual orientation, c. immigration status d. language e. disability status f. mental status g. geography

Policy" includes (circle all that apply)

a. laws b. regulations c. broad visions of goals and systems

Case payment is payment for __. It creates incentives to __ and __.

an episode of illness or injury, rapidly discharge, underserve

The Boards of Directors of Community Health Centers must include ___________.

at least 50% patients

Per capita health spending in the US is approximately_______ per year

b. $10,000

Life expectancy at age 65 is:

b. About 2 years less for men than for women

In the first decade of the 20th century (circle all that apply):

b. Clifford Beers was discharged after 3 years of hospitalization and founded the National Committee on Mental Hygiene, now know as Mental Health America.

There is general agreement that mental health policy reform must include (circle all that apply)

b. Criminal justice reform D. Increased community services, especially housing

The prevalence of diagnosable mood and anxiety disorders:

b. Decreases with age

The problem of homelessness (circle all that apply)

b. Emerged about 10 years after deinstitutionalization began c. Emerged because of the loss of low rent housing units d. Emerged because of the loss of SSDI due to changes in eligibility standards for SSDI early in the 1980s.

The suicide rate of older adults is:

b. Greater than the general population

Per capita health spending in France, is approximately

b. Half that of the US

Federally Qualified Health Centers (FQHCs) get special Medicaid rates to cover the costs of serving people without adequate _________________. (circle all that apply)

b. Health insurance c. Ability to pay full charges

Common treatments for substance abuse include (circle all that apply)

b. Inpatient and outpatient rehab c. Outpatient treatment

In mental health policy, "recovery" means that a person:

b. Is able to lead a personally satisfying life

Laws can be made by (circle all that apply)

b. Legislatures d. Judges who establish legal precedents

People with mental illness experience a number of disparities including (circle all that apply):

b. Lower spending on research despite the fact that behavioral disorders are among the greatest causes of disability c. Discrimination in hiring and housing (Despite the ADA) d. Difficulty getting access to good physical health care

Improving "population health" requires

b. Making health care more accessible d. Making improvements in environment

93. __________ tends to have more public support than ___________ because it is a universal benefit to citizens while the latter is means-tested.

b. Medicare/Medicaid

It is widely believed that the opioid epidemic has been driven by: (circle all that apply)

b. Physicians who over-prescribe opioids d. Lack of alternatives for the treatment of pain

Public health seeks to

b. Prevent injury and illness d. Improve the health of specific populations

"General" hospitals but not "state" psychiatric hospitals (circle all that apply):

b. Provide medical care as well as psychiatric care c. Receive Medicaid for adults aged 22-64

Using situational ethics in medicine means (circle all that apply):

b. Recognizing that ethical principles are sometimes in conflict c. Making decisions on a case-by-case basis d. Using facts about condition, prognosis, patient choice, and other circumstances to make decisions about whether to provide or withhold treatment

The goal of deinstitutionalization was to reduce the occupancy of state psychiatric hospitals. This was done by: (circle all that apply)

b. Reducing admissions d.Reducing length of stay.

Patients who are most expensive for Medicaid have (circle all that apply)

b. Severe co-occurring disorders c. Frequent visits to emergency rooms d. Long inpatient stays

Ageism is (circle all that apply):

b. The identification of old age with disability d. The identification of old age with dependency

Opponents of involuntary outpatient commitment argue that (circle all that apply):

b. The personal right to liberty is violated if a person is institutionalized without being dangerous to self or others d. Coercive interventions alienate many people with mental illness who therefore avoid the mental health system

Capitation is payment for _______. It creates incentives to ______, ________ and ____________.

being responsible for health care, keep covered people healthy, to market to young people, to underserve

"Integrated treatment" refers to the coordination of ___________ and ___________ . (circle all that apply)

c. Behavioral and physical health services d. Mental health and substance abuse services

Assuring that staff are qualified is known as

c. Credentialing

A not-for-profit organization cannot (circle all that apply):

c. Distribute surpluses to owners

Funding for expanded outpatient services came primarily from

c. Medicaid

8. An organization's goals and purposes are referred to as its

c. Mission

In the United States, familial "obligation of support" includes:

c. Parents for minor children

Elder care managers

c. Provide or arrange supports for older people on behalf of their families

Health homes (circle all that apply)

c. Serve people who have co-occurring, severe co-occurring behavioral and physical disorders d. Serve people who are high cost to Medicaid

The Hill-Burton Act of 1946 provided _

capital to build hospitals

The IMD exclusion created an incentive for states to

care for people in the community rather than in institutions_.

Community health centers serve defined geographic regions known as ___________________.

catchment areas

Medicaid costs are highest for people with _

co-occurring serious mental/substance abuse disorder plus serious physical disorders

The Olmstead Decision of the Supreme Court requires states to provide supports to enable people with disabilities to live in the ________

community_ rather than in _institutions

About ___% of mass murders are committed by people with serious mental illness

d. 5-10%

It is estimated that between ___% and __% of people who complete suicide have a serious mental illness at the time.

d. 70-90%

148. A "health home" is an organization that directly provides _____________ for people with severe co-occurring disorders.

d. Care management

Legalization of substances that are currently illegal would

d. Necessarily distinguish between recreational and medicinal use

173. Alzheimer's Disease

d. Unfolds in stages

Psychotropic medications for older adults with mental disorders

e. None of the above

Most health economists believe that containing health care costs depends on modifying ________________

economic incentives.

Republicans often argue in favor of changing Medicaid from a(n) __ to ______.

entitlement, federal block grants to the states

Management and oversight of health, behavioral health, and disability services are the responsibility of

executive_ branch of government

Public policy is made by the _ branches of government.

executive_, _legislative_, and _judiciary_

Regulations are made by the ______ pursuant to laws made by the_______ branch of government.

executive________ _legislative_

medicare is funded by the

federal

medicare is primarily administered by the ______ government

federal

Medicaid is funded by the __ level(s) of government

federal, state

Medicaid is primarily administered by _government(s).

federal, state, local

Public policy is made by the _levels of government.

federal_, _state_, _county_, and _municipal__ levels of government

A "freestanding" community organization is not part of a

hospital

Hospital insurance was created during the 1930s by ___ so that potential hospital patients could ______.

hospitals, be funded

The "IMD Exclusion" in Medicaid means that the federal government will not share the costs for treatment in

institutions for the mentally diseased"_.

The two major private sources of funding for health care are

insurance, self-pay

One reason for the push to integrate physical and behavioral health services is the "mortality gap", i.e. the difference in ___ between people with serious mental illness and the general population.

life expectancy

Lobbying for changes in law to improve health care is an example of

macro practice.

Conservatives who reject governmental health planning and rate setting prefer _________ approaches.

market-based

"Behavioral health services" refer to a combination of

mental health_ and _substance abuse_ services.

Managing a health home is an example of

mezzo_ practice

Social work practice in the fields of health, mental health, and disabilities is sometimes divided into

micro", "mezzo", and "macro

Case management is an example of

micro_ practice

Mental illness often exacerbates serious physical illnesses and contributes to premature __ and __.

mortality, placement in nursing homes_.

Performance based payments link payment to ________.

outcomes

"Patient centered" care is care organized to benefit ____ rather than _the provider_

patients

Accreditation is done by _______ using _____________

private, national/international organizations, national/international professional__ standards

NASW and The AMA are both _

professional_______ associations.

Social casework was psychologized largely due to the influence of ___________ theory.

psychoanalytic_

NYC Health + Hospitals is a __

public benefit_________ corporation

The Social Security Act of 1935 brought about a major change in the function of social work agencies from providing __ to increasingly providing _

relief, casework

Utilization management is a form of managed care. In addition to limiting the amount of service provided, it limits health care costs by __

setting prices with providers that are lower than the market rate

Accountable care organizations create an incentive to hold down Medicare costs by _________.

sharing year-to-year savings with the providers

2 examples of governmental health/behavioral health services organizations are _ _ and ________.

state psychiatric centers, VA

Hospitals are accredited by ________.

the Joint Commission

Community mental health organizations in NYS are licensed by __ _______________.

the Office of Mental Health

In NYS hospitals are licensed by _______.

the State Department of Health

Community health organizations in NYS are licensed by __ ___

the State Department of Health___

Different types of advocacy organizations represent different interest groups. Trade associations represent Professional associations represent Unions represent

the interests of organizations__. professionals_. the workers_______.

Program and professional licensing is done by _______ using ____________ standards.

the state governments ,minimum_

The original function of hospital and psychiatric social workers was _

to assist in the transition from acute care to return home or to long-term care

The American Hospital Association and The Coalition of Behavioral Health Organizations of NYC are both ______

trade______ associations

Definition of disability for SSDI and SSI differs from the definition in the ADA in that to be eligible for SSDI or SSI, a person must be unable to _______.

work_