Chapter 6 & 9

Question 1

What is the primary reason that a segment of the U.S. population is uninsured?

Answer 1

The U.S. has a voluntary system of health insurance

Question 2

What is the central role of health services financing in the United States?

Answer 2

Fund health insurance

Question 3

What is the primary mechanism that enables people to obtain health care services?

Answer 3

Health insurance

Question 4

In national health care systems, total expenditures are controlled mainly through

Answer 4

supply-side rationing

Question 5

In a general sense, what is the primary purpose of insurance?

Answer 5

Protection against risk

Question 6

What is the primary function of insurance?

Answer 6

Protection against catastrophic risk

Question 7

What is the main advantage of group insurance?

Answer 7

Risk is spread out among a large number of insured

Question 8

The majority of beneficiaries receiving health care through Medicare are

Answer 8

elderly

Question 9

For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed

Answer 9

100 days

Question 10

The dependents of U.S. military personnel receive health care through

Answer 10

TriCare

Question 11

The managed care phenomenon was welcomed mostly by

Answer 11

employers

Question 12

With the growth of managed care, the balance of power in the medical marketplace swung toward

Answer 12

the demand side

Question 13

A managed care organization functions like

Answer 13

an inusrer

Question 14

What is the purpose of cost sharing with providers?

Answer 14

It makes providers cost conscious

Question 15

Capitation is best described as

Answer 15

per member per month payment

Question 16

Under capitation, risk is shifted

Answer 16

from the MCO to the provider

Question 17

Under which payment method is a fee schedule used?

Answer 17

discounted fees

Question 18

The HMO Act of 1973 required

Answer 18

employers to offer an HMO alternative to conventional health insurance

Question 19

In the term, managed care, ‘manage’ refers to

Answer 19

management of utilization

Question 20

Under the fee-for-service system, providers had the incentive to

Answer 20

deliver more services than what would be medically necessary because a greater volume would increase their incomes

Question 21

Integrated delivery system

Answer 21

A network of organizations that provides or arranges to provide a coordinated continuum of service to a defined population and is willing to be held clinically and fiscally accountable for outcomes and health stAtus of the population services

Question 22

Healthcare effective as data and information set

Answer 22

The standard for reporting quality information on managed care plans . The standards are developed by national commuter for quality assurance . A private nonprofit organization .