b. Clinical psychology
c. Nuclear Medicine
a. Physician offices
b. Home health agencies
c. Nursing homes
e. Group homes
a. Demographics are measurable.
b. Health insurers are unable to predict the cost of health care demand.
c. The demand for health care is unpredictable.
d. Decision makers are unable to anticipate the kind of workforce they will need.
e. Decision makers are unable to plan for epidemics or disasters.
a. The amount and mix of health care workers influences health care access.
b. The amount and mix of health care workers influences health care cost.
c. The amount and mix of health care workers influences health care quality.
d. All of the above.
e. Workforce size and type of workers does not influence system outcomes.
a. Mix and size of the current workforce
b. Decisions about payment, education policy, and technology
c. Private policy about hiring
d. Decisions about technology
e. General changes in thinking
a. First point of contact for patients using health care
b. Gatekeepers in the health care system
c. Focused, intense, episodic
d. Major role in coordinating care
e. Focus on the whole person
a. There are not enough physicians
b. Too many specialists
c. Not enough rural doctors
d. Supply of doctors is growing but a better distribution is needed by geography and specialty
e. Physician supply is too old.
a. Dentists provide better access to children than medical physicians.
b. Pharmacy care is becoming less complex thanks to computers.
c. Physician assistants are doing more to meet the demand for primary care than nurse practitioners.
d. Nurse practitioners are doing more to meet the demand for primary care than physician assistants.
e. Nurse practitioners must have a supervising physician.
a. Administrators are required to have a degree in administration.
b. Administrators must have a degree in business administration
c. Hospital administrators must be licensed by each state.
d. Health care administrators are challenged by powerful interests both inside and outside their system.
e. Health care administrators operate not-for-profit organizations.
a. Payment amounts for each type of service, patient use of each type of service
b. Payment amounts from each payer, patients covered by each payer
c. Time and location
d. Historical use of services, and historical prices for some services
e. International comparisons, and comparisons between states
a. Control payments to providers
b. Control investments in research and development
c. Expand health insurance coverage
d. Designate services as not covered by insurance
e. Control the use of health care
a. Pay less for premiums
b. Pay less for visits
c. Pay less for services
d. Encourages access to care
e. None of the above
a. Pediatric care
b. Preventive services
c. Emergency services
e. Prescription drugs
a. High deductible health plan
b. Individual private health insurance
c. Private group health insurance
d. Preferred Provider Insurance
e. Health Maintenance Organization
a. Falling premiums and rising deductibles
b. Rising premiums and rising deductibles
c. Stable premiums and Rising deductibles
d. Rising premiums and stable deductibles
e. Stable premiums and deductibles
a. Part A
b. Part B
c. Part C
d. Part D
e. Part E
b. Fee for services
c. Monthly fees
d. Discounted fee for service
e. Provider salary
a. Fee for service
c. Cost-plus payment
d. Diagnosis-related groups
e. Penalties for readmitting patients with the same diagnosis
-migrant and community health center programs
area health education centers
a) Support managed care
b) Underwrite medical risk
c) Balance the supply of health care professionals
d) Fund health insurance
a) Payment for services
b) Control of expenditures
c) Health insurance
d) Availability of services
a) inadequate payment to providers
b) health insurance coverage
c) the uninsured status of a segment of the U.S. population
d) managed care enrollment
b) have no effect on
a) Top-down control
d) Demand-side rationing
a) high-risk individuals pay a higher premium than low-risk individuals
b) premiums are based on a group’s utilization of health care services
c) premiums are based on risk rating
d) both high-risk and low-risk people are charged the same premium
a) Pure community rating
b) Adjusted community rating
c) Risk selection
d) Experience rating
a) deductibles and copayments are eliminated
b) premiums rise for every one regardless of risk
c) favorable risk groups pay a lower premium than high-risk groups
d) costs shift from people in poor health to people in good health
a) More comprehensive services can be covered than under an individual plan
b) More people can obtain insurance from a single insurer
c) Risk is spread out among a large number of insured
d) The employer has to deal with only one insurance company
a) self-employed people
b) managed care organizations
d) government policy
a) exempts self-insured plans from certain mandatory benefits
b) mandates that employers provide comprehensive health coverage under their health insurance benefits
c) outlawed discrimination in health insurance and retirement benefits
d) requires that low-income individuals be charged a lower premium than those in high-income categories
a) first-dollar coverage is predominant
b) premiums are based on community rating
c) premiums are based on experience rating
d) people purchase individual private health insurance policies instead of group policies
a) first-dollar coverage
a) in form of a deduction from payroll checks
b) each time the insured receives health care services
c) once a year
d) by the employer to purchase health insurance on behalf of each covered employee
a) Cost sharing lowered health care utilization but there were significant health consequences
b) Cost sharing increased health care utilization
c) Cost sharing did not affect health care utilization
d) Cost sharing lowered health care utilization without any significant health consequences
c) private insurance companies
a) They differ according to cost sharing.
b) They differ according the benefits offered.
c) They differ according to the length of service with an employer.
d) They differ according to both benefits and cost sharing.
a) 138% of federal poverty level
b) 400% of federal poverty level
c) 200% of federal poverty level
d) 300% of federal poverty level
b) financially poor
c) those suffering from end-stage renal disease
a) To control total Medicare expenditures
b) To advise the US Congress on various issues affecting the Medicare program
c) To establish Medicare policy
d) To determine Medicare reimbursement to various providers
a) enrollees are required to pay a subsidized premium
b) employee wages are taxed up to a certain ceiling that is raised each year
c) only employers are required to pay a payroll tax
d) all income earned by a working person is subject to Medicare tax
a) Part D
b) Part C
c) Part A
d) Part B
a) Premiums from enrollees
b) General taxes
c) Payroll taxes
d) None of the above
a) 30 days
b) 60 days
c) 100 days
d) None of the above
a) each time they are admitted to a hospital
b) once per benefit period
c) on discharge from a hospital
d) None of the above
a) standard for everyone
d) None of the above
a) prescription drugs
b) hospital coverage
c) skilled nursing facility coverage
d) physician services
a) rehabilitation services
b) preventive care
c) prescription drugs
d) None of the above
a) To extend benefits to people with end-stage renal disease
b) To channel beneficiaries into managed care programs
c) To add a prescription drug benefit to the Medicare program
d) To provide services to children up to the age of 19
a) Part A
b) Part B
c) Parts A and B
d) Parts B and D
b) family emergency
c) medical necessity
d) financial status
a) has been eliminated
b) has not been affected by innovative methods
c) has been increased
d) has been greatly reduced
a) Insurers have an incentive to reduce premium costs
b) Payers have the incentive to reduce reimbursement
c) Providers have an incentive to deliver nonessential services
d) Patients have the incentive to consume more services than necessary
a) bundled services
b) costs incurred in the delivery of services
c) services already provided
d) resources already used
a) coding of physician services
b) resource inputs
c) the dollar value of services
d) units of services delivered
a) capitated fees
b) bundled fees
c) prospective fees
d) negotiated discounted fees
a) Bundled fee
c) Retrospective reimbursement
a) underutilize health care.
b) file a reimbursement claim.
c) provide unnecessary services.
d) control costs.
a) predetermined rates.
b) the costs incurred in operating the institution.
c) fees established by the organization.
d) the number of patients served.
a) Serving more patients would reduce profits.
b) It leads to underutilization of health care services.
c) Providers can increase their profits by increasing costs.
d) Providers reduce their profits if they increase costs.
a) Retrospective reimbursement
b) Prospective reimbursement
c) Cost-plus reimbursement
a) Case mix
b) Diagnosis-related groups
d) Ambulatory patient classification
a) number of discharges from the hospital
b) cumulative days of care
c) a group of principal diagnoses
d) bundled fees established prospectively
a) patient severity
b) adjustment for readmissions within 30 days of discharge
c) costs incurred in treating a patient
d) adjustment for treating patients on Medicaid
a) a fixed amount for a particular DRG classification
b) a fixed amount for each day of care
c) a per-diem rate based on the DRG classification
d) an amount based on the use of resources in treating a patient
a) a fixed amount per admission
b) a case-specific rate based on psychiatric DRGs
c) a per-diem rate based on psychiatric DRGs
d) an amount determined by resources used in treating a patient
a) A case-mix index is created.
b) Case mix is determined by the principal diagnosis of each patient.
c) Patients are classified according to case-mix groups.
d) A comprehensive assessment of each patient is done.
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 facilitates the determination of ambulatory payment classifications in outpatient centers.
d) It is a data collection instrument used mainly for clinical research.
a) Health care costs are 18% of the total revenues in the health care industry.
b) Health care consumes 18% of the total economic production.
c) Domestic production of health care products and services has increased by 18%.
d) The growth in total health care expenditures is 18%.
a) Public health activities
b) Net cost of private health insurance
c) Personal health care
d) Structures and equipment
a) high-risk individuals
b) those in poor health
c) those in good health
d) those covered by public insurance