US Health Care Systems

The development that contributed most significantly to the decline of the social mission of voluntary hospitals was the

The Medicaid program has a history of very low reimbursement as compared with Medicare reimbursement; critics site low Medicaid reimbursement as a major reason that primary care doctors have rejected serving the Medicaid population. An ACA provision addresses this issue by:

Integrated health systems or ____________ have been a key provision in the ACA; these systems better coordinate care and improve quality

Which of the following is synonymous with an EHR?

U.S. annual health care expenditures far outstrip those of 7 other developed nations. In relationship with expenditures, U.S. health population status ranking on critical indicators in comparison with those other developed nations is:

The U.S. healthcare delivery system has numerous stakeholders. In terms of financial power, control of delivery system parameters for the majority of Americans, and influence on consumers and providers of health care, which of the following pairs of stakeholders is the most influential:

Of the levels of prevention associated with the natural history of disease, primary prevention refers to:

The service priorities of the U.S. health care system reflect America's fascination with dramatic high-tech medicine. As a result:

Americans spend $9 billion + each year on alternative and complementary therapies. This trend has caused:

In the past, patient behaviors within the health care delivery system were formed from the authoritarian positions of better-educated providers who expected patients to be compliant and grateful. Today, health care providers and consumers:

Potential conflicts of interest occur when physicians own or invest in businesses (e.g. diagnostic, medical supply companies) to which they can refer patients to generate profits. In response to these physician conflict of interest issues:

In the natural history of a disease, the pre-pathogenesis period refers to:

Long term care needs of older, chronically ill Americans pose a particular delivery system challenge because:

As early as the 19th century some Americans carried "health insurance" through employers, fraternal orders, guilds, trade associations, unions or commercial insurance companies. However unlike health insurance of today, these insurance policies only provided for:

The Oregon Death with Dignity Act was a response to which of the following?

The explosion of science and technology in the 1970s resulted in which of the following?

In its early origins in colonial America, the patient/physician relationship can be best characterized as:

Blue Cross Hospital Insurance, the predominant form of health insurance for decades, was modeled after:

A central provision of the ACA to assure health care coverage for most Americans is:

The major health care advances of the second half of the 20th century were in the area of:

The American Medical Association's initial reaction to Blue Cross hospital insurance plans suggested that the plans:

Two primary issues that concerned many regarding the ACA:

The goals of health information technology:

Policies that call on the government to prescribe and control behavior of a group of individuals in which sanctions are imposed for noncompliance:

A health information exchange architecture that is designed for all institutions to periodically send copies of their clinical data to one central repository.

This level of prevention consists of rehabilitation and maximizing remaining functional capacity when disease has occurred and left residual damage; the most costly, labor-intensive aspect of medical care:

This important Act in 1973 attempted to hold down costs by moving from fee-for-service to promoting health and preventing illness:

This key Act provided financial incentive programs for physicians to buy, install and adopt EHR systems.

To receive incentive payments for demonstrating "meaningful use," providers must meet criteria in three stages of EHR implementation. In what stage must providers meet objectives for "capturing patient data and sharing data in a standardized format with patients and other health care professionals?"

A physician who sends a prescription electronically to the pharmacy is an example of which type of HIT?

The US spends approximately what percentage of its GDP on health care?

The US health care system is unlike any in the world because:

Which of the following presents a key challenge or barrier to HIT implementation?

The explosion of scientific knowledge and technological advancement has led to a shortage of:

As part of the ACA, health insurance companies will be held accountable by ensuring that premium dollars are spent primarily on health care, by generally requiring that at least _____% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and quality improvement.

The use of wireless communication devices to support public health and clinical practice:

Examples of alternative therapy:

One of the first, most influential "plans" for hospital coverage, which generated the Blue Cross hospital insurance:

A major health care concern that has spurred multiple policies in health care:

Which of the following is NOT considered on of the main determinants of health:

HIPAA implementation introduced several new provisions beneficial to individuals. Other than the privacy provision concerning patient data, which other was an important provision?

The AMA interest group has been vocal about which issue(s) facing physicians:

The majority of financing in the US Health Care system comes from:

A health information exchange architecture that is designed for all institutions to maintain copies of their own data at their site in the format used by the HIE and give other institutions access to their database.

The two objectives of any health care delivery system, according to Shi & Singh:

Policies that benefit only certain groups of people by taking money from one group and using it to benefit another (i.e. Medicaid)

Establishment of the Office of the National Coordinator for Health Information Technology in 2004 was the federal government's first step toward creating:

"Meaningful use" of electronic health records is best described as:

The single most important factor in accelerating health information technology adoption since 2008 has been:

The central provision of the HITECH Act of 2009 was:

A major challenge of creating health information systems using data from many different sources is the feature known as "interoperability." The solution applied to achieving interoperability has been the development of:

In health care, which of the following terms refers to a system that includes several service components with each addressing one or more dimensions of a population's health care needs?

In colonial America, the primary functions of hospitals were to:

Until the mid-1980s, hospitals were reimbursed for whatever they charged on a "retrospective" basis. Now they are paid a certain amount for each patient's care on a predetermined "prospective" basis. The amount they are paid is based on:

In its landmark report on hospital errors, "To Err is Human," the Institute of Medicine emphasized that errors in care most typically originate from which one of the following sources?

Hospital value-based purchasing now required by the ACA for over 3,000 Medicare participating hospitals is a program that may be best described as using:

A major trend is hospital corporate organization over the past few years as hospitals strategically prepared for system reforms has included:

The ultimate responsibility for a hospital's quality of care, including the medical care provided, rests with a hospital's:

A major obligation of doctors when obtaining informed consent for a medical procedure is to:

In addition to providing primary and preventive care, federally qualified community health centers also:

In today's hospitals, outpatient clinics frequently provide:

"Urgent Care" is best described as care:

The predominant services of local public health departments today are:

The primary owners of community-based ambulatory surgical centers are:

Medical societies were first established for the primary purpose of:

In 1905, the American Medical Association, with support from the Carnegie Foundation, commissioned a study of U.S. medical schools in response to decades of concern about the quality of medical education and training. The resulting Flexner Report is considered a benchmark in the history of medical education because it:

Which of the following organizations is responsible for approving the content of post-medical school residency training?

Health care reforms will change the emphasis in medical practice from treating illness in individual patients to maintaining wellness in community populations. This shift poses major challenges to the medical education process because:

The U.S. imbalance between specialty physicians and primary care physicians has its origins in many factors. Which of the following does not contribute to physicians' attraction to specialty medicine over primary care?

Academic Health Centers may be best described as:

In order to provide direct patient care, physicians are required to:

In colonial America, the primary mode of medical education was:

Unlike medicine, dentistry essentially remains a "cottage industry," primarily serving only those with dental insurance or who can afford to pay out-of-pocket. For this reason:

A physician residency training program is best described as:

The widespread use and popularity of complementary and alternative medicine in the U.S. resulted in which of the following developments?

Health care system changes, including advancing technology, will likely result in new, more highly specialized health occupations. Which of the following is not one of the expected effects of this development?:

Each year approximately 6,000 international medical graduates (IMGs) enter the U.S. to practice. IMGs are vitally important to the health care delivery system because they:

The category of allied health professionals, "therapeutic science practitioners" concerned with the treatment and rehabilitation of patients with all types of diseases and injuries include which of the following professions?

At the outset of the nurse practitioner movement, educational requirements were often limited to relatively short certificate programs. Today, it is generally accepted that nurse practitioners should be registered nurses with:

The predominant practice setting in the healthcare industry:

Which of the following is considered a physician?

The first state to restrict medical licenses to graduates of medical school

Which of the following specialist is also considered a generalist?

The most restrictive form of credentialing that restricts entry into practice and prevents abuse of titles

Systematically developed protocols concerning appropriate health care:

The Hill Burton Act:

Outpatient care is synonymous with:

The primary driver for the increase in ambulatory surgical procedures:

According to the Flexner Report, this school was the "model for medical education":

The ACA will impact the health care industy in which way?

The first medical school:

The "Patient Bill of Rights" was established by the AHA in:

Retail clinics have lessened the ______ problem that is often seen in office-based care.

The healthcare workforce projects _________ new jobs will be created in the industry in the next decade:

Supply of specialists to generalists is:

The Donabedian Model for quality addresses:

A system of reimbursement that changed hospitals' behavior in discharging patients because the patient's diagnosis would determine how much the hospital would be paid:

This act states that patients in emergency care settings must be evaluated and stabilized and cannot be turned away:

Most acute care hospitals in the United States:

Which source did NOT shape the hospital industry in the early-mid 1900's?

The basic concept of health insurance is antithetical to the premise on which personal or property insurance was historically defined because:

The "Managed care backlash" beginning in the 1990s, refers to:

Although the ACA will enact sweeping U.S. health care system reforms, one fundamental element of the system that will remain unchanged is:

The intent of the Medicaid Child Health Insurance Program (CHIP) was to:

The managed care concept called "capitation" refers to:

The Centers for Medicare & Medicaid Services "Hospital Compare" web-based program the primary purpose of:

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:

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?

Major drivers of U.S. health expenditures include:

Enacted in 1965 as Title XIX of the Social Security Act, Medicaid is:

Under the ACA, most Americans will be required to have health insurance or be penalized with an annual tax. In the ACA legislation, this requirement is popularly known as:

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:

The current highest personal care expenditure in the U.S. is for:

The Healthcare Effectiveness Data and Information Set (HEDIS) may be best described as:

Respite care is best defined as:

Which of the following best describes the informal long-term care system?

A long-term care innovation, "naturally occurring retirement community," is best defined as:

The major distinction between skilled-nursing and residential care facilities is that skilled nursing facilities:

Which of the following societal factors increases the need for formal long-term care services?

Long-term care and nursing-home reform legislation of the 1970s occurred as a response to which of the following:

The development of formal home care services, such as those provided by the Visiting Nurses Association originated as:

Long-term care is best described as:

During the 1960s, one factor that enabled mentally ill persons to move from large institutions to community settings was:

The term, "non-parity," as it applies to insurance coverage for mental health services, is best defined as:

National awareness of the needs of the mentally ill rose sharply in the aftermath of WWI because:

"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 ROSCs is:

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?

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:

In colonial American, mental health "treatment" consisted of:

An individual's diagnosis with two or more mental illness diagnoses occurring at the same time is termed:

A significant contribution of the ACA to enhanced mental care will be:

Cost sharing techniques (i.e. deductibles, co-payments and co-insurance) are put in place to limit _______________.

The most popular HMO model:

Approximately one in _____ individuals suffer from a chronic condition.

Which of the following is not included in the top 3 sources of health care financing?

Medicaid funding is provided by _______ government(s).

Which of the following is a major concern for the long term care industry?

Medicare prescription drug coverage fall under which option:

Recent estimates place the number of family caregivers at over ________ million individuals.

According to Ruby Wax and the TED Talk on Mental illness, society needs to lose the _______ associated with mental illness:

Will the uninsured continue to pose a problem to our health care system, after the ACA is fully implemented?

Provides skilled nursing care and related services for people requiring medical, nursing, or rehabilitative help:

Which of the following is NOT an institutional-based setting for long term care?

In 1955, 77% of mental health services were delivered on an in-patient basis. By 1990, the number of mental health services delivered on an in-patient basis ___________.

Costs associated with assisted living facilities are borne largely from __________ resources:

In Hospice, this type of care is given to someone with a diagnosis of terminal illness with a life expectancy of 6 months of less.

Approximately one in _____ individuals suffer from a diagnosable mental disorder every year.

Which of the following varies widely among long term care recipients?

Reimbursement is a barrier to respite care because funding mechanisms view it as meeting a __________ need, not a medical need.

As of 2011, the United States spent $________ on health care which equates to _____% of our GDP.

"Public Health" is most broadly defined as:

One reason why public health suffers from a poor public image is:

Colonial America's public health practices in the form of almshouses and town-employed physicians were modeled upon:

Ecological models as applied to public health are best described as:

As a professional health- oriented discipline, public health is unique in what way?

Overall success in meeting Healthy People 2010 goals for improved health status of Americans is best described as:

The primary purpose of the Prevention and Public Health Fund created by the ACA is to:

The major difference between public health ethics and medical ethics is that while medical ethics have an individual and clinical focus, public health ethics:

The federal government's principal agency concerned with health protection, promotion and provision of services to vulnerable populations is the department of :

The September 11, 2001 terrorist attacks highlighted which of the following about the U.S. public health system?

In evaluating the quality of health care, explicit standards differ from implicit standards in that:

Clinical research focuses primarily on:

In contrast to traditional, randomized controlled studies, outcomes research evaluates results of health care processes by:

In conducting experimental studies, ethical issues may arise about:

The Agency for Healthcare Research and Quality (AHRQ) is a federal agency charged with:

Empirical standards for assessing the quality of health care practices rely upon:

Changes in the health care delivery system are resulting two new, emerging roles for physicians. These are:

One challenge to achieving the anticipated contributions of health information technology to the quality and cost-effectiveness of health care is:

The ACA core principle that offers potential to begin closing the gap between public health and medicine is:

As system reforms in primary care continue, the roles of nurse practitioners and physician assistants will likely:

Attempts at health care system reforms of the basic problems of cost, quality and access have consistently demonstrated that which of the following results?

Nurses may be among the best prepared to respond to delivery system reforms because:

Which of the following poses as a "future research challenge" in the health system:

Advances in ________ have made same-day surgery possible for procedures that formerly required hospital admissions.

The core discipline of public health research:

The growth of home health care will be a future trend because:

When considering the determinants of health, the environment and lifestyles (behaviors) significantly impact one's health status more than any other determiant. However, the US spends more money funding which health determinant:

There is a predicted shortage of ________ primary care physicians by the year 2025.

Measuring patient satisfaction is important because:

Which of the following is NOT part of the Healthy People steps toward understanding/combatting public health issues?

_______ kill between 44,000-98,000 people a year.

Which of the following does not constitute a public health issue:

Health information technology by way of electronic medical records that lacks the ability to "communicate" with other systems has an issue with:

Because f the changing composition of the health care delivery system, ___________ are no longer considered the "hub" of the health care system.

An effect of the employer mandate of the ACA:

This Act of 2009 included $1.1 billion over a period of 2 years to expand "comparative effectiveness research" by the AHRQ and the NIH:

In 1912, the US Public Health Service changed its name. What was it known as prior to 1912?

One of the largest and longest running health services research projects ever undertaken that has contributed vast amounts of information on the effects of cost-sharing on the provision and outcomes of services:

Research related to workforce supply and employee turnover would fall under which category of health research:

Because of the projected health care workforce shortage, the ACA proposes to address the gap in the comprehensive workforce planning with a:

Which of the following is NOT a demand that the aging population will place on the healthcare system?

In an effort to enforce greater clinical accountability, _________ will no longer reimburse providers for treatment required after an adverse event (i.e. a "never" event, "serious" event, or "preventable" event).

The systematic application of the best available evidence to the evaluation of options and decisions in clinical practice:

Which of the following is an "arm" of the Department of Health and Human Service?

The Patient Centered Outcomes Research Institute (PCORI):

The Tuskegee Syphilis experiment is an example of a ____________ experiment wrought with ethical issues:

An influential report by Lemuel Shattuck documented:

Which of the following is considered a quality-monitoring activity that allows providers can measure and meet quality standards:

Which level of government is NOT responsible for ensuring public health initiatives:

Which of the following represents a "historic landmark" for our health care system after many failed attempts at reform: