Econ exam 2
In which of the following health insurance plans, would you pay the most out-of-pocket when using health services? a. Bronze b. Silver c. Gold d. Platinum e. In each of these, you would pay the same amount out of pocket when using health insurance.
A. BRONZE
Fee-for-service reimbursement a. Creates strong incentives for care coordination. b. Contributes to the national difficulty containing health care costs. c. Both A and B d. Neither A nor B
B. Contributes to the national difficulty containing health care costs.
Global budgets in health care a. Create financial incentives to reduce avoidable health care utilization b. Create financial incentives to coordinate care c. Both a and b d. Neither a nor b
BOTH A AND B a. Create financial incentives to reduce avoidable health care utilization b. Create financial incentives to coordinate care
ACO shared savings program a. Creates opportunities for nurses to influence the value of care provided through care coordination and care design b. Require that quality thresholds be met before savings from expected expenditures are shared among the payer and ACO c. Both a and b d. Neither a nor b
BOTH A AND B: a. Creates opportunities for nurses to influence the value of care provided through care coordination and care design b. Require that quality thresholds be met before savings from expected expenditures are shared among the payer and ACO
Cost sharing a. Include copayment and deductibles b. Is a strategy to encourage consumers of health care to consider the cost and value of care when using/purchasing health care services c. Both a and b d. Neither a nor b
BOTH A AND B: a. Include copayment and deductibles b. Is a strategy to encourage consumers of health care to consider the cost and value of care when using/purchasing health care services
Linking reimbursement to achievements of quality metrics a. May result in better health care outcomes b. May create metric driven behavior that creates metric driven patient harm c. Both A and B d. Neither A nor B
BOTH A AND B: a. May result in better health care outcomes b. May create metric driven behavior that creates metric driven patient harm
In addition to employing physicians and nurses, patient-centered medical homes rely on a. Community health teams b. Health coaches c. Both a and b d. Neither a nor b
C. BOTH A AND B: a. Community health teams b. Health coaches
The cost of health care a. Is borne by society in the financial form of taxes or insurance premiums b. Is actually revenue to the provider c. Both a and b d. Neither a nor b
C. BOTH A AND B: a. Is borne by society in the financial form of taxes or insurance premiums b. Is actually revenue to the provider
Third-party payers a. Spread financial risk among individuals in the insurance pools b. Are called third parties because they are not the first or second party, that is, not the buyer or seller c. Both a and b d. Neither a nor b
C. BOTH A AND B: a. Spread financial risk among individuals in the insurance pools b. Are called third parties because they are not the first or second party, that is, not the buyer or seller
Nursing Skills valued in a reformed health care system include a. Care processing reengineering b. Care coordination c. The use of data d. All of the above
D. ALL OF THE ABOVE
Which of the following statements about the patient protection and affordable care act of 2010 is TRUE? a. As passed, included an individual mandate, which was deemed unconstitutional in 2012. b. As passed, included an employer mandate, which was deemed unconstitutional in 2012. c. As passed, included provisions to merge Medicare and Medicaid. d. As passed, included strategies to stabilize the health insurance market.
D. As passed, included strategies to stabilize the health insurance market.
Which of the following statements about the patient protection and affordable care act of 2010 is NOT true? a. It represents the most sweeping health reform law since the intro of Medicare and Medicaid in 1965. b. It includes a tax on tanning beds. c. It includes payment reform that attempts to remove perverse incentives for higher cost, lower quality care. d. It includes a public option whereby people can opt-in to Medicare, regardless of age.
D. It includes a public option whereby people can opt-in to Medicare, regardless of age.
Fee for service reimbursement a. Creates financial incentives to reduce avoidable health care utilization b. Creates financial incentives to coordinate care c. Both a and b d. Neither a nor b
D. NEITHER a nor b
10. In which of the following health insurance plans, which would you pay the least out of pocket when using health services? a. Bronze b. Silver c. Gold d. Platinum
D. PLATINUM
All forms of reimbursement create the same treatment incentives and disincentives.
FALSE
Cost-sharing and cost shifting refer to the same phenomenon.
FALSE
In health insurance, a deductible is another term for copayment.
FALSE
Individuals with high-deductible health insurance plans uniformly have worse health outcomes than those with low-deductible health insurance plans.
FALSE
Need for health care services is a clearly defined phenomenon.
FALSE
The acronym P4P refers to a form of health care financing termed preferred for payment.
FALSE
The optimal configuration of team members in a patient-centered medical home has been defined and is firmly supported by empirical evidence.
FALSE
The patient protection and affordable care act of 2010 is a form of socialized medicine.
FALSE
The patient protection and affordable care act of 2010 remains intact exactly as passed.
FALSE
The patient protection and affordable care act of 2010 replaced Obamacare.
FALSE
The patient protection and affordable care act of 2010 requires that a person select bronze plan on the exchange to receive a subsidy.
FALSE
An ACO may be defined as a group of providers who agree to be accountable for the cost and quality of the care provided.
TRUE
Another term for patient-centered medical homes is advanced primary care.
TRUE
Bundled payments create a financial incentive to coordinate care across the entire episode of illness or condition management.
TRUE
Hospital global budgets provide hospitals with predictable revenue outlook.
TRUE
In a classic free market, consumers bear the financial consequences of their decision to purchase a product or use a service.
TRUE
In fee for service reimbursement models, providers have little incentive to limit treatment or consider the cost of treatment.
TRUE
Insurance companies are also called third-party payers
TRUE
One way health care markets differ from classic free markets is that in a classic free market, oversupply decreases demand and enhances cost and quality competition.
TRUE
The Affordable Care Act attempts to incentivize some care by removing the cost share for the service.
TRUE
The affordable care act defined potential members of the community health team
TRUE
The patient protection and affordable care act of 2010 required Medicaid expansion which was deemed unconstitutional by the US supreme court in 2012.
TRUE
The term asymmetry of information means that consumers have less information about health care options than physicians, and physicians can therefore influence demand for health services.
TRUE
The term superutilizer refers to individuals who use a disproportionately high amount of health care.
TRUE
Under fee-for-service reimbursement, nurses are often viewed by management as a labor cost.
TRUE
The patient protection and affordable care act had as a goal enhanced access to health insurance. Which of the following mechanisms were used? Select all that apply. a. Insurance companies can no longer deny health insurance to people with pre-existing health conditions. b. Young adults can remain on their parent's health insurance plan, as long as they are unmarried and dependent on their parent's income tax. c. Insurance companies cannot enforce lifetime caps on reimbursement. d. Gender cannot be used as a rating factor.
A, C, D
Maximum out of pocket limits a. Cap the amount of health care costs as individual or family pays in a single year b. Were put in place with the passage of the affordable care act c. Both a and b d. Neither a nor b
a. Cap the amount of health care costs as individual or family pays in a single year
Small-area variation a. Refers to differing patterns of health care utilization in one region as compared to another, differences that occur even when controlling for differences in the patients b. Refers to different types of hospitals in rural versus urban settings c. Both a and b d. Neither a nor b
a. Refers to differing patterns of health care utilization in one region as compared to another, differences that occur even when controlling for differences in the patients
One of the ways ACOs differ from HMOs is a. Generally, there are no gatekeepers in ACOs b. ACOs do not limit beneficiaries access to health care or choice of providers c. Both a and b d. Neither a nor b
C. BOTH A AND B a. Generally, there are no gatekeepers in ACOs b. ACOs do not limit beneficiaries access to health care or choice of providers
The concept of supplier-induced demand a. Was heralded by the work of Jack Wennberg b. Suggests that the supply of health care providers rather than genuine need for health care services drives at least some use of health services c. Both a and b d. Neither a nor b
C. BOTH A AND B a. Was heralded by the work of Jack Wennberg b. Suggests that the supply of health care providers rather than genuine need for health care services drives at least some use of health services
