Intro. To Health Services 3 part assignment.

INTRODUCTION TO HEALTH SERVICES

Question 1

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A negative feature of fee-for-service payment mechanisms is:

Select one:

a. They are often not accepted by physicians

b. They often lead to under treatment of medical conditions

c. They encourage requiring patients to undertake more medical procedures than necessary

d. Their payment often entails substantial processing time

Question 2

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The overall trend in recent years is for health care programs to be delivered by smaller, lean companies

Select one:

a. true

b. false

Question 3

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Apart from analyzing objective data, quality of medical care can be interpreted by analyzing customer satisfaction surveys. Yet the interpretation of this data is often difficult because:

Select one:

a. Patients are often incapacitated during the majority of their medical treatment and cannot asses the quality of care they received

b. Patients lack the technical knowledge necessary to evaluate the quality of care they received

c. Patient satisfaction is not correlated to compliance with medical regimens and treatment processes

d. Patients often lie on their satisfaction surveys

Question 4

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Which of the following reimbursement mechanisms for medical services is based on a piece-work approach?

Select one:

a. Capitation

b. Commission

c. Salary

d. Fee-for-service

Question 5

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The passing of the Hill-Burton Legislation really boosted the development of health systems planning in the 1940s. As described by your text, Hill-Burton:

Select one:

a. Promoted hospital development and renovation after World War II by requiring states to produce bed-to-population ratios

b. Reduced the number of hospitals operating in the United States in order to preserve medical resources

c. Reduced taxes on medical research and development in an effort to foster innovation

d. Increased taxes on medical equipment sales in an effort to finance hospital development

Question 6

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With indemnity health insurance arrangements, the bulk of risk is born by:

Select one:

a. The insurance company

b. The health care providers

c. The consumers who hold insurance policies

d. Government, who reimburses the insurance companies for losses they incur

Question 7

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Health care policy clearly articulates what is expected of individuals regarding their own personal care and health habits.

Select one:

a. true

b. false

Question 8

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All but one of the following items are generally treated as exclusions from insurance coverage. Identify the one item.

Select one:

a. Plastic surgery performed for cosmetic reasons

b. Experimental medical procedures and therapies

c. Services not provided by a licensed physician

d. Brain scans for people suffering head injuries

Question 9

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Quality of medical care is uniform in hospitals throughout the country.

Select one:

a. true

b. false

Question 10

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People looking to obtain individual insurance may be denied insurance, owing to "pre-existing conditions" (e.g., a history of cancer or heart disease)

Select one:

a. true

b. false

Question 11

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The term managed care encompasses a number of different incentives and relationships in the health care industry. The fundamental objective of managed care however is:

Select one:

a. To restructure the organization of health services in order to enhance cost containment, maintain quality, and patient care management

b. To place physicians in a position of economic power over their patients

c. To stimulate medical research and development through economic incentives

d. To maximize profits for health care administrators relative to the benefits received by physicians and patients

Question 12

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Quality assurance is essential for the maintenance of product and service quality in the medical industry. In fact, accredited hospitals are required to maintain quality assurance programs. To implement a quality assurance program, hospitals and health service centers must:

Select one:

a. Sign a pledge to maintain the highest quality standards when administering health care services

b. Allow federal auditors to evaluate the current state of a product and service's quality.

c. Collect data from ongoing and reliable sources, such as medical records and claims forms, which can be used as quality indicators

d. Register with the American Medical Association (AMA)

Question 13

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With PPACA/Obamacare, lifetime insurance coverage caps will be banned.

Select one:

a. true

b. false

Question 14

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With PPACA/Obamacare, firms employing 50 or more people will be able to get subsidies if they purchase insurance through an exchange.

Select one:

a. true

b. false

Question 15

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Under managed health care, participating providers (e.g., physicians) negotiate specific a reimbursement mechanism which determines how they will be paid for the services they deliver.

Select one:

a. true

b. false

Question 16

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Quality of care is an important concept for any health care organization. As defined by your text, quality care is:

Select one:

a. An abstract organizational concept that is difficult to measure or observe in reality

b. A benign formality in the health care industry that is mainly used to maintain a positive image in the public's eye

c. An annoying federal mandate that health care professionals and administrators must observe

d. A measure or indicator of the level of performance of the provider in comparison to some set of expectations or standards

Question 17

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Which of these political developments had the greatest amount of historic influence on health care reform in the United States?

Select one:

a. The New Deal

b. The Civil Rights Act of 1964

c. The 1988 Anti-Drug Abuse Act

d. The Hill Burton Act

Question 18

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Managed care systems have emerged in many countries throughout the world. As such, the origin of managed care systems can be attributed to which historical development in the global medical industry?

Select one:

a. The unionization of physicians and other medical professionals

b. The development of prepaid healthcare plans

c. Consumer lobbying efforts to establish price ceilings on health care costs in the United States

d. The need to police economic corruption among physicians and medical officials

Question 19

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A key feature of Medicare prospective payments is:

Select one:

a. Patients need to offset 15% of the fee with copayments

b. Set reimbursement for services is based on a categorization of possible diagnoses, termed the diagnosis-related group (DRG)

c. Service provider receives payments on a fee-for-service basis

d. Payments must be supplemented with either supplemental insurance or Medicaid contributions

Question 20

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Managed care systems often indirectly limit access to consumer health services by increasing clinic waiting times, emphasizing the importance of self-care, and reducing the use of diagnostic procedures and laboratory testing. According to your book, this practice is called:

Select one:

a. Resource maintenance

b. Market policing

c. Rationing

d. Resource allocation

Question 21

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Point-of-service (POS) plans are similar to those offered by planned provider organizations (PPOs), yet they allow for consumers to select non-plan providers when seeking medical care. Those who choose non-plan providers, however, will be expected to:

Select one:

a. Contribute a large percentage of the copayment

b. Excuse themselves from the POS plan after medical services have been received

c. Pay large deductibles on their medical bills before the insurer picks up the bill

d. Pay higher premiums after receiving services.

Question 22

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The Health Plan Employer and Data Information Set (HEDIS) is often used to evaluate care quality offered by managed health care plans.

Select one:

a. true

b. false

Question 23

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Section 1122 of the Social Security Act Amendments is directly related to Certificate of Need legislation, as it requires that:

Select one:

a. Medicare patients pay a large deductible on medical services if they fail to prove sufficient need

b. Medicare fund recipients comply with state Certificate of Need laws

c. States prove that they are worthy of federal funding for medical programs

d. More stringent measures of need be applied to Medicare fund recipients

Question 24

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Which of the following reimbursement mechanism for medical services is based on a flat rate approach?

Select one:

a. Capitation

b. Commission

c. Salary

d. Fee-for-service

Question 25

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With indemnity health insurance arrangements, insurers:

Select one:

a. Establish contractual arrangements with both consumers and providers

b. Establish contractual arrangements only with consumers

c. Establish contractual arrangements only with providers

d. Offer health care services under the auspices of their own health care professionals

Question 26

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Quality assessment is essential when ensuring that a medical product or service is of the highest quality. As such, quality assessment is best understood as:

Select one:

a. The application of federal legislation which mandates minimum standards of health care product or service quality

b. The process of measuring the quality of care provided in a health care setting

c. A subjective judgment of the quality of a medical service or product by consumers

d. An intricate corporate process which involves employee voting to determine a product's quality

Question 27

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With insurance plans that have large deductibles:

Select one:

a. Premiums can be reduced dramatically

b. Premiums are reduced modestly

c. Premium are increased dramatically

d. Premiums are increased modestly

Question 28

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What does the National Committee for Quality Assurance (NCQA) provide to managed care programs?

Select one:

a. Expert help with managed care program development

b. A platform for the voluntary accreditation of health plans

c. Regulations that all managed care programs must adhere to

d. Referrals to physicians of the highest professional caliber

Question 29

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What are the two primary financial mechanisms used in managed care systems?

Select one:

a. Invoices and receipts

b. Premiums and Interest

c. Securities and loans

d. Copayments and deductibles

Question 30

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According to your text, the generation and introduction of new health care policies are often the result of:

Select one:

a. The imposition of technocratic knowledge

b. Compromises between political officials

c. The realization of optimal economic efficiency in the health care market

d. Staged protests by social movements seeking new, inclusive forms of health care policy

Question 31

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Many states have enacted Certificate of Need legislation as an attempt to impose rationality on the U.S health care system. This legislation requires that:

Select one:

a. Medicaid and Medicare patients prove they are worthy of federal health services

b. Medical organizations receive regulatory approval before expanding major medical centers and health care facilities

c. Physicians prove that a particular drug is needed by a particular population

d. Medical equipment developers prove a product is needed before they begin developing it

Question 32

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Medicaid programs are delivered uniformly in all 50 states of the United States.

Select one:

a. true

b. false

Question 33

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PPACA/Obamacare requires insurers to offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions.

Select one:

a. true

b. false

Question 34

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A negative feature of capitation payment mechanisms is:

Select one:

a. They are often not accepted by physicians

b. They often lead to under treatment of medical conditions

c. They encourage requiring patients to undertake more medical procedures than necessary

d. Their payment often entails substantial processing time

Question 35

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Preferred provider organizations (PPOs) are relatively new forms of managed care. Preferred provider organizations are:

Select one:

a. Physician organized groups that provide discounted medical treatment to underprivileged or disadvantaged groups of people

b. Organizations of physicians and other health care professionals who charge a standard, hourly fee for services

c. Organizations created by insurance providers which offer medical coverage with doctors inside and outside of the organization's guidelines

d. Created by insurance companies via networking with physicians and hospitals in order to provide services in exchange for contractual, discounted, pre-negotiated fees

Question 36

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As described in your book, a key financial objective of managed care is:

Select one:

a. To shift financial risk onto the consumer in order to discourage service utilization

b. To create revenue for the funding of medical research and development

c. To shift the financial risk onto the provider as an incentive toward cost containment and appropriate service utilization

d. To finance policy campaigns that advance the motives of the medical industry

Question 37

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With service health insurance arrangements, insurers:

Select one:

a. Establish contractual arrangements with both consumers and providers

b. Establish contractual arrangements only with consumers

c. Establish contractual arrangements only with providers

d. Offer health care services under the auspices of their own health care professionals

Question 38

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Instead of opting to use the standard Medicare health care package, eligible enrollees can opt to use a Medicare HMO.

Select one:

a. true

b. false

Question 39

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Medicare coverage of which of the following is relatively limited?

Select one:

a. Somatic acute care services

b. Hospital care coverage

c. Physician care coverage

d. Mental health and long-term care

Question 40

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PPACA/Obamacare is a voluntary program: citizens who wish to opt out of the program can do so.

Select one:

a. true

b. false