HEALTHCARE DELIVERY IN THE US I TESTS FALL SEMESTER 2014

Chapter 12
1. The Institute of Medicine
Select one:
a. serves as the nation's advisor to improve health
b. regulates drugs
c. is the nation's largest medical school
d. regulates medicine

2. Prevention and lifestyle behavior changes to promote health

are not major foci of the medical model.
Select one:
True
False

3. Underutilization of health care services is not a problem in the

U.S.
Select one:
True
False

4. Medical cost inflation is influenced by all of the following

factors except:
Select one:

a. Waste and abuse

b. Increase in elderly population
c. Growth of technology
d. Decrease in uninsured

5. In your own words, briefly describe the five dimensions of

access.
The five dimensions of access are availability, accessibility, accommodation,
affordability, and acceptability.
Availability signifies the common ground between service and capacity. Some
issues associated with it are services primary and preventative care to
patients. Accessibility is the link between the locations of providers and
patients. Accessibility should be convenient for all parties involved.
Affordability is the patients ability to pay. The costs for health care should be
affordable to all. Accommodation is the organization of resources provided.
Acceptability is the similarity between the patients attitude about the
provider, and vice versa.
Shi, L. (2015). Deliviering Health Care in America: A Systems Approach.
Burlington, MA: Jones and Bartlett.
Feedback
a. Availability refers to the fit between service capacity and individuals
requirements. For example: Are primary and preventive services available to
patients? Are enabling services such as transportation, language, and social
services provided? Are there sufficient specialists in the health plan to take
care of patients needs? Is access to primary care services provided 24 hours
a day, 7 days a week?
b. Accessibility refers to the fit between the location of a provider and the
location of patients. For example: Are services convenient to patients (can
the provider location be reached by public or private transportation)? Is the
provider site designed so that disabled or elderly patients are not
inconvenienced? Does the provider accept patients regardless of payment
source (for example, Medicare, Medicaid)?

c. Affordability refers to individuals ability to pay. Even individuals with

insurance often have to consider deductibles and copayments prior to
utilization. For example: Are insurance premiums too high? Are deductibles
and copayments reasonable for the services covered under the plan? Are
prescription prices affordable?
d. Accommodation refers to the fit between the manner in which resources
are organized to provide services and individuals ability to take advantage
of the arrangement. For example: Are there opportunities for the patient to
schedule an appointment? Are scheduled office hours compatible with the
work and way of life of most patients? Can most urgent cases be seen within
1 hour? Can most patients with acute but not urgent problems be seen within
1 day? Can most appropriate requests for routine appointments, such as
preventive exams, be met within 1 week? Are walk-in services permitted by
the plan?
e. Acceptability is based on the attitudes of both patients and providers and
refers to the compatibility between patients attitudes about the personal
and practice characteristics of providers, and providers attitudes about the
personal characteristics of the clients. For example: What is the waiting time
for scheduled appointments? Are patients encouraged to ask questions and
review their records? Are patients and providers accepted without regard to
race, religion, or ethnic origin?

6. Approximately what percentage of GDP is spent on health

care?
Select one:
a. 6%
b. 26%
c. 36%
d. 16%

7. The Donabedian Model includes all of the following elements

except:
Select one:

a. Outcomes
b. Process
c. Costs
d. Structure

8. A service is cost-efficient when:

Select one:
a. The patients insurance plan saves money
b. The desired health outcome is achieved
c. The benefit received is greater than the cost incurred to provide the
service
d. None of the answers

9. The U.S. has never imposed price controls on the health care
industry
Select one:
True
False

10.
What is meant by the term health care costs?
Select one:
a. The price of health care

b. How much a nation spends on health care

c. All the answers
d. Cost of producing health care

11.
What is the purpose of clinical practice guidelines?
Select one:
a. To provide a plan to manage a clinical problem based on evidence or
consensus
b. To improve outcomes
c. All the answers
d. To lower costs

12.
What is Gross Domestic Product (GDP)?
Select one:
a. A measure of all the goods and services produced by a nation in a
given year
b. A measure of all the goods and services produced by a nation in a
given year, divided by the amount of money spent by the government
c. A measure of all the goods and services produced by a nation in a
given year, divided by the population
d. A measure of all the goods and services produced by a nation in a
given year, minus the amount of money spent by the government

13.
Why should rising health care costs be controlled?
Select one:
a. Both Americans have to forgo other goods and services when more is
spent on health care AND Unless we control costs, total health care
expenditures will far exceed what they would be under free-market
conditions.
b. Americans have to forgo other goods and services when more is spent
on health care.
c. Neither Americans have to forgo other goods and services when more
is spent on health care OR Unless we control costs, total health care
expenditures will far exceed what they would be under free-market
conditions.
d. Unless we control costs, total health care expenditures will far exceed
what they would be under free-market conditions.

14.
Compared to other nations, the U.S. uses a larger share
of its economic resources for health care.
Select one:
True
False

15.
What is the Health Plan Employer Data and Information
Set (HEDIS)?
Select one:
a. A quality report card
b. A cost report card
c. None of the answers

d. A government database on health planS

16.
The service priorities of the US health care system reflect
Americas fascination with dramatic high-tech medicine. As a
result:
Select one:
a. All the answers
b. little of the health care dollar is spent on prevention
c. the US system is the most expensive in the world
d. the US has the worlds most advanced medical capability

Midterm Exam

1. According to the CDC, which factor contributes most to premature

death in the U.S. population?
Select one:
A. Social and environmental factors
B. Genetic makeup

C. Lifestyle and behaviors

D. Lack of medical care

2. A charge master is
Select one:

a. a master of CPT codes.

b. a person who bills everyone.
c. A coder.

d. a system to gather all hospital and other charges.

3. A free market in healthcare requires:

Select one:
a. Adequate information for patients
b. c. Unencumbered interaction of the forces of supply and demand
c. Independent actions between buyers (patients) and sellers (providers)

d. All the answers

4. Approximately how many millions of people are employed in the U.S.

healthcare system?
Select one:
a. 25

b. 10
c. 15
d. 5

5. True or False? Cultural beliefs have very little to do with health.

Select one:

True

False

6. As the health care delivery system developed in the US, it

emphasized specialization over primary care.
Select one:
True

False

7. Development of the hospital and ______ happened almost hand in

hand in a symbiotic relationship between the two.
Select one:
a. cohesiveness of the medical profession
b. growth of scientific knowledge
c. dependency of patients
d. professionalization of medical practice

8. How is average length of stay calculated?

Select one:
a. By cumulating patient days
b. Discharges X inpatient days
c. Inpatient days/capacity

d. Days of care/discharges

9. Which of the following forces remains relatively stable, and major

shifts in this area would be necessary to bring about any
fundamental change in the US health care delivery system?
Select one:
a. Social forces
b. Economic forces

c. Beliefs and values

d. Political change

10.
True or False? The presence of an agent does not ensure that
disease will occur.
Select one:
True
False

11.
Even though hospitals incurred frequent deaths in the early
1900s, their use was on the rise mainly because
Select one:
a. technology was advancing at a rapid pace
b. people had no other choice but use the hospitals

c. most people had poor living conditions in their homes

d. a large number of immigrants were settling in American cities

12.

To be classified as a community hospital, the hospital must be

Select one:
a. a nongovernmental hospital
b. a nonprofit hospital
c. a public hospital

d. a nonfederal hospital

13.

Inpatient care is

Select one:
a. health care delivered in conjunction with an overnight stay in a facility.
b. care delivered in a licensed facility
c. treatment of acute conditions
d. services delivered by a hospital

14.
A not-for-profit hospital is prohibited by law from making a
profit.
Select one:
True

False

15.

Hospitals in the United States evolved from

Select one:
a. inns

b. almshouses
c. sickhomes
d. pesthouses

16.
Which central agency manages the health care delivery system
in the United States?
Select one:
A. Centers for Disease Control and Prevention
B. Department of Commerce

C. None
D. Department of Health and Human Services

17.
Quality of health care is the main distinguishing factor
between a general hospital and a specialty hospital.
Select one:
True

False

18.
When the first public health infrastructure was being
established in the US, it was recommended that ____ be established.
Select one:

a. a federal agency to oversee public health functions

b. state and local health departments
c. sanitary standards
d. a presidential commission

19.

ALOS is an indicator of

Select one:
a. access
b. frequency of use
c. use of hospital capacity

d. severity of illness

20.
A multiple payer system is more cumbersome than a single
payer system for all of the following reasons except:
Select one:
a. Government programs require extensive documentation proving services
were provided before paying providers
b. Payments are not standardized across health plans
c. There are numerous health plans, which is difficult for providers to handle
d. Some healthcare services are covered for people in the north, but not in the
south

21.
In the US, public health and private practice of medicine
developed separately because
Select one:
a. the practice of public health was not based on scientific methods.
b. a public health infrastructure was lacking.
c. Americans favored private delivery of medical care over public health
d. physicians were skeptical of the government taking control of medical
practice.

22.
Until the mid-1980s, hospitals were reimbursed for their
expenses for the prior year on a retrospective basis. Now they are
paid a certain amount for each patients care on a prospective
basis. The amount they are paid is based on:
Select one:
a. prospective patient categories (PPCs)
b. empirical data
c. Costs of resources used

d. diagnosis related groups (DRGs)

23.
Which of these hospitals types is not likely to serve the
general public?
Select one:
a. Community hospitals

b. Federal hospitals
c. County and city hospitals

d. Proprietary hospitals

24.
By definition, a public hospital is one that is open to the
general public.
Select one:
True

False

25.
True or False? Under the medical model, health is defined as a
complete state of physical, mental, and social well-being, and not
just the absence of disease or infirmity.
Select one:
True
False

26.

To be called a hospital, a facility must have at least ____ beds.

Select one:
a. 18
b. 12
c. 3

d. 6

27.
In the United States, who does not generally have access to
basic and routine medical services?
Select one:

a. Those eligible only for public programs.

b. People who need catastrophic care.

c. The uninsured
d. Those without private health insurance
28.

The Hill-Burton Act was passed to

Select one:
a. have federal control over community hospitals

b. curtail the utilization of hospital beds

c. relieve shortage of hospitals
d. make it mandatory for private insurers to cover hospital services

29.
When a profession's services are generally accepted and are
legitimized, they impart _____ to the profession
Select one:
a. specialization
b. cohesiveness

c. cultural authority
d. organized strength

30.
Select one:

Which of the following is not a behavioral risk factor?

A. Unsafe neighborhoods
B. Irresponsible motor vehicle use
C. Alcohol abuse
D. Inadequate physical exercise

31.

Why is accurate billing important?

Accurate billing is important because it saves time, money, and effort. If billing is
not performed correctly, the hospital or clinic could lose out on insurance payment,
as well as a loss of reimbursement.

32.

The U.S. healthcare system can best be described as:

Select one:
a. Market-oriented
b. Expensive
c. Fragmented

d. All the answers

33.

The wellness model is built on which of the following:

Select one:
A. Intervention
B. Adequate public health and social services
C. Understanding risk factors

D. All of the answers

34.
Describe the power triangle and the three main power players.
What impact does the power struggle have on health care delivery?
The three main power players in the power triangle are the physician, hospitals, and
insurance. All three play a part in the patients care, but dont always have the same
exact interests. Ultimately causing stress inside the system. The physician does not
always work for the hospital, therefore they are at odds with eachother.

35.
Which of the following cannot be classified as a community
hospital?
Select one:
a. Proprietary hospital
b. Children's hospital
c. Specialty hospital

d. Long-stay hospital

36.

The Flexner Report, published in 1910, reported on

Select one:
a. standards for medical licensure in the US and Canada

b. standards of training in medical schools

c. rates of death in US hospitals
d. the state of medical specialization

37.
Select one:

What is the meaning of the term 'Access'?

A. All citizens have health insurance coverage

B. Ability to get health care when needed

C. Availability of services
D. Employer-based health insurance

38.

Healthcare is considered a social good in:

Select one:
A. Market justice

B. Social justice
C. Both A and B
D. Neither A nor B

39.
Moral hazard has to do with insured patients demand for
health care services.
Select one:
True
False

40.
True or False? A chronic condition is relatively severe, episodic,
and often treatable.
Select one:
True

False

Exam 2