HAN 300 final

Question 1

Health policies are used in what capacity?

Answer 1

Both a and b

Question 2

What is the role of states in US health policy?

Answer 2

All of the above

Question 3

Which of the following are elements of the policy cycle

Answer 3

All of the above

Question 4

Which of the following is a health policy challenge faced by state governments?

Answer 4

All of the above

Question 5

There are 3 main payment approaches used under the various managed care arrangements. Under ___, a set monthly fee per enrollee (PMPM rate) is paid to the provider

Answer 5

Capitation

Question 6

If the provider is part of the network, they will be paid a set amount called ____.

Answer 6

Capitation

Question 7

Due to declining occupancy rates, hospital executives have been forced to view ambulatory care as an essential portion of their overall healthcare business rather than a supplemental product line of an inpatient facility. The growth of nonhospital-based ambulatory services has intensified competition for outpatient medical services between hospitals and community-based providers. An example of such competition is a(an)

Answer 7

ambulatory clinic for routine and urgent care

Question 8

patients who are enrolled in the northfolk community HMO health plan receive healthcare from physicians who are employed by this company. this example best illustrates the concept of the ____ model HMO

Answer 8

staff

Question 8

Which of the following is an example of horizontal integration?

Answer 8

a hospital links up with a physicians network to better operate as a full-service managed care organization

Question 8

A patient goes into the hospital on Friday night and is admitted. On monday morning, the events of the past Friday, Saturday, and Sunday, as they relate to the patient, are reviewed. This example best illustrates the concept of

Answer 8

retrospective utilization review

Question 9

Sarah thinks she has bronchitis and is required to pay a $50 copay at each visit. Her friend Smitty is suffering with similar symptoms and has insurance, but no copay. Smitty decides to go to the doctor but Sarah decides she’ll wait to see if it clears up. Smitty’s behavior is an example of

Answer 9

Moral hazard

Question 10

A 22-year-old college athlete went to see his primary care provider for a knee injury he sustained in the last Seawolves game. He was then referred to an orthopedic specialist who recommended an MRI. His HMO requires preauthorization. After submitting the required paperwork, his HMO denied the request. This is an example of:

Answer 10

Utilization control

Seawolfs - UUUU

Question 11

Wendy and her family have been covered through her employer sponsored plan for the past 10 years. Due to recent downsizing in her industry, she has been recently laid off. She has been fortunate enough to have found another job, but the insurance coverage doesn’t begin until after 90 days of service. How will the family deal with this period of no employer-based coverage?

Answer 11

Wendy and her family are covered by COBRA, which enables them to maintain the coverage provided by the previous employer as long as they pay 102% of the premium costs.

Question 12

What is an interest group?

Answer 12

An independent, non-governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers.

Question 13

Which of the following is the best definition of equitable access?

Answer 13

the distribution of health care services according to the patient’s self-perceived need

Question 14

Health expenditures that estimate the amount spent for all health services and supplies and health-related research and construction activities consumed in the United States during a calendar year are called

Answer 14

national health expenditures

Question 15

A facility must have at least __________ beds to be called a hospital

Answer 15

6

Question 16

Dorothy, an 87-year-old female, has diabetes, macular degeneration, and poor hearing. She has hearing aids, but it can be a challenge to get her to wear them. Dorothy has become quite confused since her stay at the nursing facility. She needs extensive assistance with dressing, bathing, toileting, and transfers. Dorothy is not eating well and continues to lose weight. An appointment has been made with a nurse practitioner to coordinate Dorothy’s care. This scenario best illustrates the concept of:

Answer 16

case management

Question 17

When a patient has a surgical procedure, the fee includes the procedure and the pre and post care. These charges are based on:

Answer 17

Bundled services

Question 18

A major method of reimbursement for outpatient services that pays a separate amount for each identifiable and individually distinct unit of service is called:

Answer 18

fee-for-service

Question 19

Home care services for those over 65 years of age are covered by:

Answer 19

Medicare Part A

Question 20

Which major public insurance program was legislated in 1965?

Answer 20

Medicare/Medicaid

Question 21

CHIP was created to provide health insurance to:

Answer 21

children who do not qualify for neither Medicare or Medicaid

Question 22

One of the primary areas of emphasis in hospice care is to manage pain and symptoms. This is referred to as:

Answer 22

Palliation

Question 23

Which of the following scenarios would lead to a decrease in utilization of healthcare services?

Answer 23

Requiring patients to obtain pre-authorization for outpatient surgical procedure.

Question 24

Which of the following scenarios would lead to a increased utilization of healthcare services?

Answer 24

Reimbursement of CT scans as a screening tool for lung cancer in patients over 50-year-old with history of smoking.

Question 25

Which of the following is located in the hospital but is considered an outpatient service?

Answer 25

Emergency Department

Question 26

All primary care is ambulatory, but _______________ ambulatory services represent primary care.

Answer 26

not all

Question 27

Hospital governance has traditionally followed a tripartite structure. The three major sources of authority in hospital governance are the Board of Trustees, the Chief Executive Officer (CEO), and the _______________.

Answer 27

Medical Director (CMO)

Question 28

The _______________ under Diagnosis Related Group is used by Medicare to determine acute-care hospital inpatient reimbursement.

Answer 28

prospective payment system (PPS)

Question 29

_______________ of healthcare facilities is carried out by the state governments, and each state sets its own standards. These standards place heavy emphasis on hospitals’ physical plants, fire safety, heating, space allocations, and sanitation. Minimum standards are also established for equipment and personnel.

Answer 29

Licensure

Question 30

Cost sharing by consumers is a form of:

Answer 30

demand-side incentive

Question 31

Payments need to be made to the providers and the facilities this is also called _______________ in the quad function.

Answer 31

delivery

Question 32

Consumers today want the freedom to choose their health care providers. This type of health plan offers the greatest latitude in choice, but does so at a higher premium/cost to an employee or employer:

Answer 32

Preferred provider organization

Question 33

What contradictory incentive is present in retrospective reimbursement?

Answer 33

Providers reduce their profits if they increase costs

Question 34

There were six main factors shown to increase significant growth of hospitals in the United States. Which of the following was one of the six factors?

Answer 34

Advances in medical education.

Question 35

Health insurance provided a vehicle enabling people to pay for hospital services. Insurance also contributed to the increased demand for health services. Historically, insurance plans provided generous coverage for inpatient care. Consequently, there were few restrictions for patients and physicians to opt for more expensive hospital services. Even more important was the method of reimbursement for inpatient care. This type of reimbursement was

Answer 35

Retrospective

Question 36

There are noted differences between private nonprofit and for-profit hospitals. A Nonprofit hospital would be _____________________________________________ whereas a for-profit hospitals financial returns to the owners or stockholders is an important objective.

Answer 36

Operated primarily for the benefit of the community

Question 37

The government played a significant role in the expansion of hospitals. First, the _______________ provided grants to states for the construction of new hospital beds. Secondly, the creation of _______________ had a significant impact on the increase in the number of hospital beds and their utilization as government-funded health insurance became available to a large number of elderly and poor Americans.

Answer 37

Hill-Burton Act; Medicare and Medicaid

Question 38

Examples of processes that improve quality include all of the following except:

Answer 38

practicing defensive medicine.

Question 39

All of the following contribute to escalating costs except:

Answer 39

a competitive marketplace

Question 40

A patient was harmed after a stay in the ICU. A root cause analysis was performed and it was determined that it was the result of a lack of supervision caused by a shortage of nurses on the unit. Which of the Agency on Healthcare Research and Quality’s (AHRQ) definitions of an “adverse event” best fit this scenario?

Answer 40

systemic factors

think: ROOT cause - sySTEMic factors

Question 41

Under a discounted fee-for-service arrangement in a managed care organization:

Answer 41

a provider and a payer negotiate the provider’s fees

Question 42

A patient goes for exploratory laparotomy and is billed $8,000. Their indemnity plan pays $6,000. What happens when the actual expense of health care services exceeds the predetermined indemnity amount?

Answer 42

The insured pays the difference

Question 43

Which of the following is NOT a dimension of access to care?

Answer 43

Utilization

Question 44

In a gatekeeping system, patients do not visit specialists without a referral from their primary care physicians. On the surface, gatekeeping may appear to be a controlling mechanism for denying needed care. In most cases, however, the interposition of primary care protects patients from unnecessary procedures and over treatment. This is because specialists are much greater users of tests and procedures, and such interventions carry a definite risk of iatrogenic complications. Gatekeeping must emphasize the coordinating role of primary care to ensure

Answer 44

comprehensiveness and continuity of care.

Question 45

Cost and access concerns have received most of the attention over the past decades, while quality has been largely ignored. The primary reason for the lack of attention paid to quality has been:

Answer 45

quality is difficult to define and measure, and different measurement tools often yield conflicting data.

Question 46

When looking at trends for health insurance costs, which of the following statements is accurate?

Answer 46

employee’s contributions to their premiums have increased

its a trend to get spotify premium

Question 47

Which of the following DOES NOT qualify as a definition of accessibility as related to access?

Answer 47

whether the plan has enough specialists to care for patients’ needs.