PHLT 311 Practice Exam 3
In technology assessment, what role do clinical trials play? a) they are used for experimentation with potentially useful drugs b) they are used for establishing the rights of participants c) they are used for evaluating efficacy and safety d) they are used for determining cost-effectiveness
c) they are used for evaluating efficacy and safety
To purchase private insurance through an exchange, premium subsidies are made available to people with incomes up to a) 200% of federal poverty level b) 300% of federal poverty level c) 138% of federal poverty level d) 400% of federal poverty level
d) 400% of federal poverty level
The FDA was given the authority to review the effectiveness and safety of a new drug before it could be marketed. a) Food and Drug Act, 1906 b) Food, Drug, and Cosmetics Act, 1938 c) Prescription Drug User Fee Act, 1992 d) Kefauver-Harris Drug Amendments, 1962
d) Kefauver-Harris Drug Amendments, 1962
This law was criticized for slowing down the introduction of new drugs a) Food, Drug, and Cosmetic Act, 1936 b) Prescription Drug User Fee Act, 1992 c) Food and Drug Administration Modernization Act, 1997 d) Kefauver-Harris Drug Amendments, 1962
d) Kefauver-Harris Drug Amendments, 1962
The SMI Trust Fund is for a) Part A b) Part B c) Parts A and B d) Parts B and D
d) Parts B and D
Outpatient care accounts for what percent of gross patient revenue for all US hospitals? a) 40% b) 10% c) 60% d) 20%
a) 40%
Generally, at the start of medical treatment a) cost-efficiency is minimum b) benefits exceed costs c) safety is not a major concern d) costs exceed benefits
b) benefits exceed costs
What was the main conclusion of the Rand Health Insurance Experiment? a) cost sharing did not affect health care utilization b) cost sharing lowered health care utilization without any significant health consequences c) cost sharing increased health care utilization d) cost sharing health care utilization but there were significant health consequences
b) cost sharing lowered health care utilization without any significant health consequences
Under the ACA what purpose do the health exchanges serve? a) they allow states to exchange information to establish a benchmark plan b) they facilitate enrollment in Medicaid, CHIP, or a private health plan c) they allow individuals and small businesses to purchase health plans d) they replace the state insurance commissions
c) they allow individuals and small businesses to purchase health plans
A DRG represents a) number of discharges from the hospital b) cumulative days of care c) a group of principal diagnoses d) bundled fees established prospectively
c) a group of principal diagnoses
In general, prospective payment systems establish reimbursement for a) costs incurred in the delivery of services b) resources already used c) bundled services d) services already provided
c) bundled services
What is the main function of the National Institutes of Health? a) provide specialized training for medical specialists b) establish medical subspecialties in US medical schools c) conduct and support biomedical research d) conduct and support research on health care quality, cost, and access
c) conduct and support biomedical research
What was the purpose of certificate of need (CON) laws? a) control the flow of federal funds for private projects b) control new health service programs c) control new construction and modernization projects d) monitor the diffusion of new technology
c) control new construction and modernization projects
Under experience rating a) premiums rise for everyone regardless of risk b) costs shift from people in poor health to people in good health c) favorable risk groups pay a lower premium than high-risk groups d) deductibles and copayments are eliminated
c) favorable risk groups pay a lower premium than high-risk groups
Self insurance was spurred by a) managed care organizations b) self-employed people c) government policy d) employers
c) government policy
The use of fee-for-service reimbursement a) has not been affected by innovative methods b) has been eliminated c) has been greatly reduced d) has been increased
c) has been greatly reduced
Evaluation of the appropriateness of medical technology a) clinical trial b) efficacy c) health technology assessment d) cost-effectiveness
c) health technology assessment
Liberal reimbursement for a given technology will _____ innovation, diffusion, and utilization of that technology. a) have no effect on b) prevent c) increase d) decrease
c) increase
Cost-efficiency evaluates marginal benefits in relation to a) marginal safety b) flat of the curve c) marginal costs d) outcomes
c) marginal costs
An MS-DRG is a refined DRG that includes a) costs incurred in treating a patient b) adjustment for treating patients on Medicaid c) patient severity d) adjustment for readmissions within 30 days of discharge
c) patient severity
The HI portion of Medicare is financed through a) general taxes b) premiums from enrollees c) payroll taxes d) none of the above
c) payroll taxes
In a general sense, what is the primary purpose of insurance? a) underwriting b) predicting risk c) protection against risk d) risk assessment
c) protection against risk
Capitation removes the incentive to a) control costs b) underutilize health care c) provide unnecessary services d) file a reimbursement claim
c) provide unnecessary services
What is the incentive under fee-for-service reimbursement? a) payers have the incentive to reduce reimbursement b) insurers have an incentive to reduce premium costs c) providers have an incentive to deliver nonessential services d) patients have the incentive to consume more services than necessary
c) providers have an incentive to deliver nonessential services
RVUs reflect a) coding of physician services b) the dollar value of services c) resource inputs d) units of services delivered
c) resource inputs
Benchmarking of Health Technology Assessment (HTA) organizations should be linked with a) cost effectiveness of medical technology b) coordination of HTA efforts across various organizations c) standardization of HTA methods d) evaluation of economic worth
c) standardization of HTA methods
The asynchronous form of telemedicine uses _____ technology. a) delayed access b) forward-and-retrieve c) store-and-forward d) access-when-needed
c) store-and-forward
In national health care systems, total expenditures are controlled mainly through a) demand-side rationing b) cost shifting c) supply-side rationing d) underwriting
c) supply-side rationing
The Safe Medical Devices Act, 1990 requires a) premarket approval of devices b) that all problems and potential problems be reported to the FDA c) that injuries, illness, or death from any device be reported d) safety testing of devices before and after they have been marketed
c) that injuries, illness, or death from any device be reported
Under retrospective reimbursement, a health care organization is paid according to a) fees established by the organization b) the number of patients served c) the costs incurred in operating the institution d) predetermined rates
c) the costs incurred in operating the institution
How are preexisting medical conditions covered under the ACA? a) there is no provisions in the law to cover preexisting conditions b) states are mandated to have risk pools to cover preexisting conditions c) they will continue to be covered under a special federal program d) private insurance plans have to cover them starting 2014
d) private insurance plans have to cover them starting 2014
The amount of reimbursement is determined before the services are delivered. a) cost-plus reimbursement b) retrospective reimbursement c) fee-for-service d) prospective reimbursement
d) prospective reimbursement
At a fundamental level, medical technology deals with a) new drugs, devices, and biologics b) using discoveries made in basic sciences to deliver healthcare c) production of new equipment to provide more advanced healthcare d) the application of scientific knowledge for improving health and creating efficiencies
d) the application of scientific knowledge for improving health and creating efficiencies
Health technology assessment in the US is conducted primarily by a) the NIH b) the FDA c) various government agencies d) the private sector
d) the private sector
What is gatekeeping? a) the idea that patients should be allowed to choose their own doctors b) the concept that specialists use more diagnostic tests than primary care physicians c) the process by which patients are denied needed care d) the process by which primary care physicians refer patients to specialists
d) the process by which primary care physicians refer patients to specialists
What perverse incentive is present in retrospective reimbursement? a) It leads to underutilization of health care services. b) Serving more patients would reduce profits. c) Providers reduce their profits if they increase costs. d) Providers can increase their profits by increasing costs.
d) Providers can increase their profits by increasing costs.
Why was Medicare Part C created? a) To provide services to children up to the age of 19 b) To extend benefits to people with end-stage renal disease c) To add a prescription drug benefit to the Medicare program d) To channel beneficiaries into managed care programs
d) To channel beneficiaries into managed care programs
Which country's health care system is founded on the principle of gatekeeping? a) US b) Australia c) China d) UK
d) UK
To finance Medicare Part A a) enrollees are required to pay a subsidized premium b) only employers are required to pay a payroll tax c) employee wages are taxed up to a certain ceiling that is raised each year d) all income earned by a working person is subject to Medicare tax
d) all income earned by a working person is subject to Medicare tax
Which of the following is a reason for the growth of outpatient services? a) new technology b) managed care c) patient preference d) all of the above
d) all of the above
Which of the following is an example of a secondary care service? a) consultation b) surgery c) rehabilitation d) all of the above
d) all of the above
Which of the following factors helps determine the proportion of primary care personnel to specialists needed for the adequate provision of primary care? a) how rigidly the health care delivery system employs gatekeeping b) the population's rates of utilization of primary care services c) neither a nor b d) both a and b
d) both a and b
Emergency departments, in most cases, are equipped to provide a) primary care services b) secondary care services c) tertiary care services d) both b and c
d) both b and c
Under community rating a) premiums are based on a group's utilization of health care services b) high-risk individuals pay a higher premium than low risk individuals c) premiums are based on risk rating d) both high-risk and low-risk people are charged the same premium
d) both high-risk and low-risk people are charged the same premium
Supply-side rationing a) managed care b) curtailment in payments for new technology c) curtailment in governing funding for medical research d) central planning
d) central planning
Which of the following is not a type of prospective reimbursement methodology? a) case mix b) diagnosis-related groups c) ambulatory patient classification d) cost-plus
d) cost-plus
The expectations that Americans have about what medical technology can do to cure illness is based on a) a higher rate of technology diffusion in the US compared to other countries b) the technological imperative c) medical specialization d) cultural beliefs and values
d) cultural beliefs and values
Controlling total health care expenditures by restricting financing for health insurance a) underwriting b) underutilization c) top-down control d) demand-side rationing
d) demand-side rationing
What is the central role of health services financing in the US? a) underwrite medical risk b) balance the supply of health care professionals c) support managed care d) fund health insurance
d) fund health insurance
At the flat of the curve a) marginal costs are the highest b) additional medical treatment is harmful c) maximum cost-efficiency is achieved d) marginal benefits are zero
d) marginal benefits are zero
Part C of Medicare specifically covers a) rehabilitation services b) preventive care c) prescription drugs d) none of the above
d) none of the above
For hospitalizations, Medicare beneficiaries must pay a deductible a) none of the above b) on discharge from a hospital c) each time they are admitted to a hospital d) once per benefit period
d) once per benefit period
SMI provides a) prescription drugs b) skilled nursing facility coverage c) hospital coverage d) physician services
d) physician services
How is community-oriented primary care (COPC) different from primary care? a) COPC adds a population-based approach to identifying and addressing community health problems b) COPC adheres more strongly to the biomedical model c) COPC does not believe in the link between primary and secondary prevention d) all of the above
a) COPC adds a population-based approach to identifying and addressing community health problems
Skilled nursing care is covered under _____ of Medicare a) Part A b) Part B c) Part C d) Part D
a) Part A
How is case mix determined for an inpatient facility? a) a comprehensive assessment of each patient is done b) a case-mix index is created c) patients are classified according to case-mix groups d) case-mix is deterred by the principal diagnosis of each patient
a) a comprehensive assessment of each patient is done
Cost is shifted from people in poor health to the healthy when a) premiums are based on community rating b) people purchase individual private health insurance policies instead of group policies c) premiums are based on experience rating d) first-dollar coverage is predominate
a) premiums are based on community rating
Which of the following is a typical setting for ambulatory care services? a) sports medicine clinics b) dialysis centers c) all of the above d) physicians' offices
a) sports medicine clinics
Adverse selection makes health insurance less affordable for a) those in good health b) high-risk individuals c) those covered by public insurance d) those in poor health
a) those in good health
According to a US Supreme Court decision, individual states can decide whether or not to expand their Medicaid programs to comply with the ACA. a) true b) false
a) true
Health insurance plans are prohibited from having lifetime dollar limits on medical benefits a) true b) false
a) true
It is illegal for an insurance company to sell a Medigap plan to someone who is covered by Medicaid a) true b) false
a) true
Research shows that prospectively set bundled payment methods are effective in reducing health care spending without significantly affected quality of care a) true b) false
a) true
State governments are required to partially finance the Medicaid program a) true b) false
a) true
Under community rating, people are charged the same premium regardless of health risk a) true b) false
a) true
Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US a) true b) false
a) true
Public (government) share of the total health care spending in the US is approximately a) 25% b) 45% c) 35 % d) 55%
b) 45%
This made additional resources available to the FDA, and resulted in a shortened approval process for new drugs a) Orphan Act, 1983 b) Prescription Drug User Fee Act, 1992 c) Food and Drug Administration Modernization Act, 1997 d) Kefauver-Harris Drug Amendments, 1962
b) Prescription Drug User Fee Act, 1992
The insurance arm of military health care is called a) VISN b) TRICARE c) VHA d) CHAMPUS
b) TRICARE
Under the DRG method of reimbursement, a psychiatric hospital is paid a) a case-specific rate based on psychiatric DRGs b) a per-diem rate based on psychiatric DRGs c) an amount determined by resources used in treating a patient d) a fixed amount per admission
b) a per-diem rate based on psychiatric DRGs
Which method of risk assessment is required by ACA for individual and small group health insurance? a) experience rating b) adjusted community rating c) pure community rating d) risk selection
b) adjusted community rating
The Employee Retirement Income Security Act (ERISA), 1974 a) outlawed discrimination in health insurance and retirement benefits b) exempts self-insured plans from certain mandatory benefits c) mandates that employers provide comprehensive health coverage under their health insurance benefits d) requires that low-income individuals be charged a lower premium than those in high-income categories
b) exempts self-insured plans from certain mandatory benefits
Health insurance plans are allowed to have annual dollar limited on a person's medical benefits. a) true b) false
b) false
Long-term care services for the elderly are covered under Medicare a) true b) false
b) false
Part D of Medicare does not require the payment of a premium a) true b) false
b) false
The proliferation of health care delivery through managed care created a decreased demand for primary care physicians a) true b) false
b) false
The term e-health applies only to the electronic delivery of health care by qualified health care professionals. a) true b) false
b) false
____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of services a) bundled-fee b) fee-for-service c) prospective d) cost-plus
b) fee-for-service
Medicare Part B premiums are a) standard for everyone b) income-based c) none of the above d) market-based
b) income-based
What is the likely impact of the ACA on primary care? a) decrease b) increase c) unknown d) stay the same
b) increase
What is the Minimum Data Set (MDS)? a) it facilitates the determination of case-mix groups in rehabilitation hospitals b) it is a patient assessment instrument for skilled nursing facilities c) it is a data collection instrument used mainly for clinical research d) it facilitates the determination of ambulatory payment classifications in outpatient centers
b) it is a patient assessment instrument for skilled nursing facilities
Preferred providers are paid a) capitated fees b) negotiated discounted fees c) bundled fees d) prospective fees
b) negotiated discounted fees
The point at which marginal benefits equal marginal costs. a) flat of the curve b) optimum point c) equal intensity d) minimum cost-efficiency
b) optimum point
The largest share of national health expenditures is attributed to a) structures and equipment b) personal health care c) public health activities d) net cost of private health insurance
b) personal health care
Medigap policies are sold by a) Medicare b) private insurance companies c) HMOs
b) private insurance companies
What is the main intent of the Stark laws? a) disclosure of potential harm from a procedure or device b) prohibit self-referral by physicians to facilities in which they have an ownership interest c) require that personal health information be kept confidential d) require demonstration of cost-efficiency of new technology
b) prohibit self-referral by physicians to facilities in which they have an ownership interest
The 'doughnut hole' in Medicare prescription drug coverage a) applies after a beneficiary has fully met the deductible b) provides no benefits until the beneficiary qualifies for the catastrophic level c) is designed to suspend benefits if monthly premiums are not paid d) suspends the payment of monthly premiums
b) provides no benefits until the beneficiary qualifies for the catastrophic level
Telemedicine technology that allows a specialist located at a distance to directly interview and examine a patient is referred to as a) telehealth b) synchronous c) simultaneous d) analogous
b) synchronous
In general, how do bronze, silver, gold, and platinum health plans differ? a) they differ according to both benefits and cost sharing b) they differ according to cost sharing c) they differ according to the benefits offered d) they differ according to the length of service with an employer
b) they differ according to cost sharing
For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed a) 30 days b) 60 days c) 100 days d) None of the above
c) 100 days
The most stringent requirements of premarket approval regarding safety and effectiveness apply to _____ devices a) Class I b) Class II c) Class III d) Class IV
c) Class III
If national health expenditures amount to 18% of the GDP, what does this mean? a) The growth in total health care expenditures is 18%. b) Domestic production of health care products and services has increased by 18%. c) Health care consumes 18% of the total economic production. d) Health care costs are 18% of the total revenues in the health care industry.
c) Health care consumes 18% of the total economic production.
This law provided incentives for pharmaceutical firms to develop new drugs for health problems that affected a relatively small number of people a) Kefauver-Harris Drug Amendments, 1962 b) Prescription Drug User Fee Act, 1992 c) Orphan Drug Act, 1983 d) Food and Drug Administration Modernization Act, 1997
c) Orphan Drug Act, 1983
Certain allergy medications containing pseudoephedrine are available without prescription, but must be kept behind the pharmacy counter and sold only in limited quantities upon verification of a person's identity. a) Kefauver-Harris Drug Amendments, 1962 b) Food, Drug, and Cosmetic Act, 1938 c) Patriot Act 2006 d) Food and Drugs Act, 1906
c) Patriot Act 2006
What does "PPS" stand for? a) Preferred Provider System b) Private Practice System c) Prospective Payment System d) Primary Physician System
c) Prospective Payment System
Under the DRG method of reimbursement, an acute care hospital is paid a) a per-diem rate based on the DRG classification b) an amount based on the use of resources in treating a patient c) a fixed amount for a particular DRG classification d) a fixed amount for each day of care
c) a fixed amount for a particular DRG classification
What is the main application of quality-adjusted life years? a) they are used as indicators of the economic worth of technology b) they are used to evaluate the ethical dimension of technology c) they are used to determine how long on average a person is likely to live if a given technology is indicated for a health condition d) they are used as a measure of health benefits
d) they are used as a measure of health benefits
What is the main function of the Medicare Payment Advisory Commission (MedPAC)? a) to determine Medicare reimbursement to various providers b) to establish Medicare policy c) to control total Medicare expenditures d) to advise the US Congress on various issues affecting the Medicare program
d) to advise the US Congress on various issues affecting the Medicare program
Which of the following has the greatest impact on system-wide health care costs? a) training costs associated with new technology b) purchase price of new technology c) increased hospitalizations due to overuse of technology d) utilization of technology once it becomes available
d) utilization of technology once it becomes available
Private health insurance is also referred to as a) public insurance b) employee health insurance c) mandatory health insurance d) voluntary health insurance
d) voluntary health insurance
