Although the ACA will enact sweeping U.S. health care system reforms, one fundamental element of the system that will remain unchanged is:
D. Financing of health care expenditures through a combination of public and private sources
The current highest personal care expenditure in the U.S. is for:
B. Hospital Care
Despite U.S. health care spending exceeding by far, expenditures of 28 other developed nations, U.S. health outcomes lag far behind. Extensive research has concluded that reasons for high U.S. high expenditures are:
C. Higher U.S. per capita income and much higher U.S. prices for medical care
Major drivers of U.S. health expenditures include:
A. Advancing medical technology, growth in the older population, specialty medicine, labor intensity, and reimbursement system incentives
The basic concept of health insurance is antithetical to the premise on which personal or property insurance was historically defined because:
A. Health insurance is managed by third parties
The establishment of Blue Cross for hospital care and shortly thereafter, Blue Shield for physicians' services signaled a new era in health care delivery and financing. Which of the following was not among their major impacts:
D. Caused for-profit insurers to use "experience" rather than "community" ratings to establish remiums
The 1973 HMO legislation responded to which of the following national concerns:
D. Rapidly increasing Medicare expenditures and concerns about the quality of care
By focusing on insured populations rather than individuals, managed care organizations can project health service use by:
B. Demographic factors such as age, gender, and other factors
The managed care concept called "capitation" refers to:
A. Physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid fee
An aim of managed care is to transfer some measure of financial risk to providers and to a lesser extent, to patients. Transferring financial risk to patients is accomplished by:
D. Requiring co-pays for specified services
Cost-control initiatives undertaken by managed care organizations to improve communications with chronic disease patients in the hope of avoiding unnecessary, costly care are known by the term:
D. Hospitalization diversion
The "Managed care backlash" beginning in the 1900's refers to:
C. Health care providers and consumers protesting managed care's restrictive policies on provider choice, referrals to specialty care and other practices
The most influential managed care quality assurance organization that accredits many different aspects of managed care organizations on a voluntary basis is:
B. The National Committee on Quality Assurance
The Healthcare Effectiveness Data and Information Set (HEDIS) may be best described as:
D. A standardized method for managed care organizations to collect, calculate and report information about their performance to facilitate purchasers' and consumers' comparisons of different insurance plans on a variety of parameters
The Medicare program enacted in 1965 as Title XVIII of the 1935 Social Security Act is characterized as the most sweeping social legislation ever enacted by the federal government because it:
A. Was only the second mandated U.S. health insurance program after worker's compensation and signaled the federal government's entry into the personal healthcare financing arena
Enacted in 1983, the Diagnosis-related Group payment methodology shifted hospital reimbursement from the retrospective to prospective basis. The major purpose of this new payment system was to:
B. Provide financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patients
In retrospect, implementation of the DRG system demonstrated that:
D. NONE OF THESE
-hospitals were not as inefficient as previously thought
-hospitals could profit from instituting more efficient patient care procedures
-longer lengths of hospital stay were necessary to ensure quality care
The Centers fro Medicare & Medicaid Services "Hospital Compare" web-based program the primary purpose of:
D. Providing consumers with objective criteria that allow comparisons of hospital's use of evidence-based practices and patient satisfaction ratings
Enacted in 1965 as Title XIX of the Social Security Act, Medicaid is:
A. A joint federal-state program supporting basic health services for low income individuals and in which federal and state support is shared based on a state's per capita income.
The intent of the Medicaid Child Health Insurance Program (CHIP) was to:
D. Enroll 10 million uninsured children in Medicaid whose family incomes were too high to qualify for Medicaid but too low to purchase private health insurance
Medicaid and CHIP quality initiatives are carried out through partnerships with the respective states' programs using five quality criteria that include which of the following?
A. Prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of services
Under the ACA, most Americans will be required to have health insurance or be penalized with annual tax. In the ACA legislation, this requirement is popularly know as:
C. "Individual mandate"
As defined and required by the ACA, health insurance exchanges (HIEs), intend to:
B. Create a competitive health insurance market by providing web-based, easily understandably comparative information to consumers on plan choices with standardized rules regarding health plan offers and pricing
The ACA's "Bundled Payments for Care Improvement Initiative" intends to address which of the following long-standing concerns about the Medicare program's costs and quality?
C. Fee-for service payment for individual services provided during a beneficiary's illness resulting in fragmented care with minimal coordination across providers and settings that result in rewarding service quantity rather than quality
ACA implementation over the next sic years will confront policy makers with a daunting array of issues; paying for changes in the delivery system may be the least challenging. The most challenging issues are likely to entail:
D. ALL OF THESE
a. Changes from prior philosophies of providers' individually-based care perspectives to perspectives on achieving improved population health status
b. Changes in medical and other professional schools' educational curricula to include emphasis on population health
c. Recognizing that medical technology cannot solve the overarching problems of providing care for increasing numbers of aged and chronically ill Americans
Long-term care is best described as:
C. Services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needs
Which of the following societal factors increases the need for formal long-term care services?
D. ALL OF THESE
a.women working outside the home
b. high divorce rates
c. smaller family size
The US history of institutional long-term care began with:
B. Communal care settings operated by charitable community members and government supported almshouses
The development of formal home care services, such as those provided by the Visiting Nurses Association originated as:
C. A social response to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseases
Long-term care and nursing-home reform legislation of the 1970's occurred as a response to which of the following:
D. A & C
a. widespread media reports and Congressional hearings on nursing home and residential care facility abuses and negligence
c. national recognition of inadequate quality assurance and monitoring systems in the long-term care industry
The enactment of Medicare and Medicaid in 1965 affected the long-term care industry in many ways. Which of the following was not an effect of the Medicare and Medicaid enactment on the long-term care industry?
B. Prohibition of for-profit providers' participation in Medicare and Medicaid long-term care reimbursement
The major distinction between skilled-nursing and residential care facilities is that skilled nursing facilities:
B. Provide care primarily for people requiring intensive nursing, rehabilitation, or related services
Which of the following was not a driver of expanded home care services during the 1980's through the 1990's?
B. Audits documenting significant fraud and abuse of Medicare billing
Which of the following best describes the informal long-term care system?
B. Care and assistance provided in the home by family members and friends
The hospice movement is concerned with care for terminally ill patients. Which of the following is not a major goal of hospice care?
A. Decreasing costs of care for the terminally ill by avoiding use of expensive technology
Respite care is best defined as:
A. Services that temporarily relieve informal caregivers through assistance in the home or through institutional placement on a temporary basis
A long-term care innovation, "naturally occurring retirement community," is best defined as:
C. Apartment complexes, neighborhoods, or sections of communities where residents have opted to age-in-place
In colonial American, mental health "treatment" consisted of:
C. Confinement in homes, in jails or in almshouses where patients suffered severely
National awareness of the needs of the mentally ill rose sharply in the aftermath of WWI because:
D. Thousands of soldiers returned from the war suffering from "war neurosis" or "shell shock"
During the 1960's, one factor that enabled mentally ill persons to move from large institutions to community settings was:
A. The development of effective pharmacologic treatments for many disorders
Throughout the 1960's and 1970's, federal and state governments expanded community mental health centers and services based on which untested assumptions?
B. Severe mental illness did not differ qualitatively from lesser forms of mental distress and early intervention could prevent development of major psychiatric disorders
The term, "non-parity," as it applies to insurance coverage for mental health services, is best defined as:
B. Insurers using different and unequal systems to cover mental health from those used for medical care
In the late 1970's and early 1980's, efforts of advocacy groups such as the National Alliance on Mental Illness, the National Institutes of Health and clinical researchers ultimately demonstrated that:
C. Psychiatric disorders are biologically-based illnesses requiring targeted treatments, not unfocused "talk" therapies
World Health Organization ranking of the leading causes of disability in the U.S. and Canada in terms of the total number of years lost to illness, disability or premature death places neuropsychiatric disorders at what level?
D. First
An individual's diagnosis with two or more mental illness diagnoses occurring at the same time is termed:
A. Comorbidity
Many factors are associated with lack of access to mental health care. One reason why only about one-third of those in need of mental health services actually receives them is:
C. Fear of family and social stigmatization
Which of the following is not a reason why access to adequate mental health treatment for children and adolescents is particularly problematic?
C. Parental reluctance to acknowledge mental health problems in their children
Psychiatric and behavioral health problems are treated by an array of providers loosely categorized into four sectors. The sector consisting of social service agencies, school-based counseling services, rehabilitation services, vocational services and criminal justice/prison-based services is known as which of the following?
B. Human services
"Recovery Oriented Systems of Care" (ROSC) refers to a major paradigm shift in the approach to mental health assessment and treatment planning. One essential feature of ROSC's is:
C. Shifting treatment plan emphasis from symptom reduction to a "hope plan" for the individual's future
A significant contribution of the ACA to enhanced mental care will be:
D. Requiring health insurance policies to include coverage for psychiatric and behavioral health treatment and parity with coverage for medical treatment
The Mental Health Parity and Addiction Equity Act implemented in 2010 contains many important features to end insurance benefit inequity between mental health and substance abuse benefits and medical/surgical benefits for group health plan with more than 50 employees. A main feature of this legislation included which of the following?
C. Equal coverage applies to all deductibles, co-payments, coinsurance and out-of-pocket expenses
Coverage "carve outs" are a cost-containment method used by managed care plans for mental health benefits. Under this arrangement, management of mental health benefits is:
C. Monitored by community-based mental health centers
"Public Health" is most broadly defined as:
B. community efforts to cope with health problems arising from people living in groups
As a professional health- oriented discipline, public health is unique in what way?
B. it uses an interdisciplinary approach and methods with emphasis on preventive strategies, links with government and politics and dynamic adaptations to new problems
Ecological models as applied to public health are best described as:
D. Models that take into account the vast number and interdependence of factors or determinants that impact the health status of groups of people
Colonial America's public health practices in the form of almshouses and town-employed physicians were modeled upon:
A. Roman principles of quarantine and water sanitation
Government-supported public hospitals frequently provide the following services that are financially unattractive to other community hospitals:
B. burn care, psychiatric medicine and trauma care
The federal government's principal agency concerned with health protection, promotion and provision of services to vulnerable populations is the department of :
C. Health and Human Services
Overall success in meeting Healthy People 2010 goals for improved health status of Americans is best described as:
A. a disappointment because health disparities have not changed for 80% of health objectives and have increased for an additional 13%
The September 11, 2001 terrorist attacks highlighted which of the following about the U.S. public health system?
A. inadequate numbers of skilled public health professionals such as nurses, epidemiologists and lab workers
Which of the following is not suggested as a possible reason for the sometimes contentious relationship between public health leadership and private medicine?
A. private physicians' identification of public health with government bureaucracy
One reason why public health suffers from a poor public image is:
C. public health's major triumphs such as the virtual eradication of vaccine-preventable childhood diseases have resulted in those diseases' disappearance from the public's awareness and political attraction
The major difference between public health ethics and medical ethics is that while medical ethics have an individual and clinical focus, public health ethics:
B. are concerned with institutions' interactions with communities
The primary purpose of the Prevention and Public Health Fund created by the ACA is to:
C. Eliminate unpredictable federal budget appropriations for public health and prevention programs
