Healthcare final 3- finance and workforce

Which of the following is a recognized medical specialty?a. Optometryb. Clinical psychologyc. Cytotechnologyd. Audiologye. Psychiatry e. psychiatry
Which of the following is a recognized allied health professional?a. Allergistb. Anesthesiologistc. Nuclear Medicined. Chiropractice. Pathologist c. nuclear medicine
What setting employs the largest number of health care workers?a. Physician officesb. Home health agenciesc. Nursing homesd. Hospitalse. Group homes d. hospitals
Which of the following statements about workforce planning and development is true?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. demographics are measurable
Which of the following is most often true when describing the influence of workforce resources on health care system outcomes?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. d. all of the above
Which of the following best describes sources of influence on the future health care workforce?a. Mix and size of the current workforceb. Decisions about payment, education policy, and technologyc. Private policy about hiringd. Decisions about technologye. General changes in thinking a. mix and size of the current workforce
Which of the following best describes specialty care when compared to primary care?a. First point of contact for patients using health careb. Gatekeepers in the health care systemc. Focused, intense, episodicd. Major role in coordinating caree. Focus on the whole person c. focused intense, episodic
Which of the following best describes physician supply in the United States?a. There are not enough physiciansb. Too many specialistsc. Not enough rural doctorsd. Supply of doctors is growing but a better distribution is needed by geography and specialtye. Physician supply is too old. b. too many specialists
Which of the following statements about non-physician providers is most often true?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. d. nurse practitioners are going more to meet the demand for primary care than physician assistants
Which of the following statements about health care administrators is most often true?a. Administrators are required to have a degree in administration.b. Administrators must have a degree in business administrationc. 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. d. health care administrators are challenged by powerful interests both inside and outside their system
What two factors are used to calculate health care expenditures for group of employees, members of a health insurance plan, a state or a nation?a. Payment amounts for each type of service, patient use of each type of serviceb. Payment amounts from each payer, patients covered by each payerc. Time and locationd. Historical use of services, and historical prices for some servicese. International comparisons, and comparisons between states a. payment amounts for each type of service, patient use of each type of service
According to authors Shi and Singh, which of the following contributes to increased health care expenditures?a. Control payments to providersb. Control investments in research and developmentc. Expand health insurance coveraged. Designate services as not covered by insurancee. Control the use of health care c. expand health insurance coverage
How are insured most likely to benefit from cost-sharing?a. Pay less for premiumsb. Pay less for visitsc. Pay less for servicesd. Encourages access to caree. None of the above c. pay less for services
Under the Affordable Care Act, which of the following services is least likely to involve cost sharing?a. Pediatric careb. Preventive servicesc. Emergency servicesd. Hospitalizatione. Prescription drugs b. preventative services
Which type of private health insurance is most likely to have the lowest premium?a. High deductible health planb. Individual private health insurancec. Private group health insuranced. Preferred Provider Insurancee. Health Maintenance Organization a. high deductible health plan
Which of the following best describes trends in health insurance from 2008-2013 as features of the Affordable Care Act were being phased into effect?a. Falling premiums and rising deductiblesb. Rising premiums and rising deductiblesc. Stable premiums and Rising deductiblesd. Rising premiums and stable deductiblese. Stable premiums and deductibles b. rising premiums and rising deductibles
Which of the following parts of Medicare include coverage for the broadest scope of health care products and services?a. Part Ab. Part Bc. Part Cd. Part De. Part E b. part b
Which of the following payment types is described as a monthly payment per member for all services needed by the patients in a covered plan?a. Capitation b. Fee for servicesc. Monthly feesd. Discounted fee for servicee. Provider salary a. capitation
Which of the following is a form of prospective payment?a. Fee for serviceb. Medigapc. Cost-plus paymentd. Diagnosis-related groupse. Penalties for readmitting patients with the same diagnosis c. cost-plus payment
an example of an allied health professional nuclear medicine
when comparing psychiatrist to a clinical psychologist, what is important to realize tha psychiatry is a medical speciality
expanding health insurance would also do what increase health expenditures
premiums are something that are received by whom the insurer
Most DOs are ___ and most MDs are ____ generalists specialists
in the US, physicians who are trained in family medicine.general practice, general internal medicine, and general pediatrics are considered primary care physicians aka generalists
a type of physician who has been expanding since the mid 90s hospitalists
there has been a what in the physician labor force increase
___ of the primary workforce are 56 and older and near retirement and less the ______ of medical students are chose primary care one quarter one quarter
maldistribution either a surplus or a shortage of the type of physicians needed to maintain the health status of a given population at an optimum level
the US faces maldistributions in both ___ and ___ geography and speciality
what does HPSA stand for health professional shortage area
what is HPSA designations by the department of human and health services for urban and rural areas, population groups, or medical or other public facilities that have a shortage of providers in primary care, dental care, and mental care
federal programs that have demonstrated the success in increasing the supply of primary care services in rural area -national health service corps-migrant and community health center programs area health education centers
makes scholarship support conditional on a commitment to future service in an undeserved area the national health service corps
designated to provide primary care services to the poor and underserved using federal grants migrant and community health center programs
the largest group of health care professionals the nursing profession
examples of allied health professional technicians, assistants, therapists, and technologists
someone who has received a certificate, associates, bachelors, masters degree, doctoral level prep, or post baccalaure training in a science related to health care and has responsibility for the delivery of health related services allied health professional
What is the central role of health services financing in the United States? a) Support managed care b) Underwrite medical risk c) Balance the supply of health care professionals d) Fund health insurance d. fund health insurance
What is the primary mechanism that enables people to obtain health care services? a) Payment for services b) Control of expenditures c) Health insurance d) Availability of services c. health insurance
The phenomenon called ‘moral hazard’ results directly from 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. health insurance coverage
Liberal reimbursement for a given technology will _____ innovation, diffusion, and utilization of that technology. a) increase b) have no effect on c) decrease d) prevent increase
Controlling total health care expenditures by restricting financing for health insurance. a) Top-down control b) Underwriting c) Underutilization d) Demand-side rationing d. demand side rationing
In national health care systems, total expenditures are controlled mainly through supply-side rationing
Under community rating 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 both high-risk and low-risk people are charged the same premium
Which method of risk assessment is required by the ACA for individual and small-group health insurance? a) Pure community rating b) Adjusted community rating c) Risk selection d) Experience rating d. adjusted community rating
Under 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 c. favorable risk groups pay a lower premium than high-risk groups
What is the main advantage of group insurance? a) More comprehensive services can be covered than under an individual plan b) More people can obtain insurance from a single insurerc) Risk is spread out among a large number of insured d) The employer has to deal with only one insurance company c
Self insurance was spurred by a) self-employed people b) managed care organizations c) employers d) government policy d
The Employee Retirement Income Security Act (ERISA), 1974 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
Cost is shifted from people in poor health to the healthy when 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 b
A health insurance plan pays for medical care only after the insured has first paid $1,000 out of pocket on an annual basis. The $1,000 annual cost is called a) first-dollar coverage b) premium c) coinsurance d) deductible d
A copayment is generally paid 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 b
What was the main conclusion of the Rand Health Insurance Experiment 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 d
Medigap policies are sold by a) HMOs b) Medicarec) private insurance companies c
In general, how do bronze, silver, gold, and platinum health plans differ? 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
To purchase private insurance through an exchange, premium subsidies are made available to people with incomes up to 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
The majority of beneficiaries receiving health care through Medicare are a) elderly b) financially poor c) those suffering from end-stage renal disease d) disabled a
What is the main function of the Medicare Payment Advisory Commission (MedPAC)? 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 b
To finance Medicare Part A, 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 d
Skilled nursing care is covered under _____ of Medicare. a) Part D b) Part C c) Part A d) Part B c
The HI portion of Medicare is financed through a) Premiums from enrollees b) General taxes c) Payroll taxes d) None of the above c
For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed a) 30 days b) 60 days c) 100 days d) None of the above c
For hospitalizations, Medicare beneficiaries must pay a deductible a) each time they are admitted to a hospitalCorrect Response b) once per benefit period c) on discharge from a hospital d) None of the above b
Medicare Part B premiums are a) standard for everyone b) market-based c) income-based d) None of the above c
SMI provides a) prescription drugs b) hospital coverage c) skilled nursing facility coverage d) physician services d
Part C of Medicare specifically covers a) rehabilitation services b) preventive care c) prescription drugs d) None of the above d
Why was Medicare Part C created? 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 b
The SMI Trust Fund is for a) Part A b) Part B c) Parts A and B d) Parts B and D d
The primary criterion to become eligible for Medicaid is a) age b) family emergency c) medical necessity d) financial status d
By law, federal matching funds to the states for Medicaid cannot be less than a) 50% b) 25% c) 80% a 50%
The insurance arm of military health care is called a) VHA b) TRICARE c) VISN d) CHAMPUS b
To receive payment for services delivered, providers must file a ____ with third-party payers. a) charge b) fee-schedule c) claim d) bill c
The use of fee-for-service reimbursement a) has been eliminated b) has not been affected by innovative methods c) has been increased d) has been greatly reduced d
_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of services. a) Prospective b) Cost-plus c) Bundled-fee d) Fee-for-service d
What is the incentive under fee-for-service reimbursement? 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 c. providers have an incentive to deliver nonessential services
In general, prospective payment systems establish reimbursement for a) bundled services b) costs incurred in the delivery of services c) services already provided d) resources already used a. bundled services
RVUs reflect a) coding of physician services b) resource inputs c) the dollar value of services d) units of services delivered b. resource inputs
Preferred providers are paid a) capitated fees b) bundled fees c) prospective fees d) negotiated discounted fees d. negotiated discounted fees
When a fixed monthly fee per enrollee is paid to a provider, it is called a) Bundled fee b) Capitation c) Retrospective reimbursement d) Charge b. capitation
Capitation removes the incentive to a) underutilize health care. b) file a reimbursement claim. c) provide unnecessary services. d) control costs. c. provide necessary services
Under retrospective reimbursement, a health care organization is paid according to a) predetermined rates.b) the costs incurred in operating the institution. c) fees established by the organization. d) the number of patients served. b. the costs incurred in operating the institution
What perverse incentive is present in retrospective reimbursement? 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. c. providers can increase their profits by increasing costs
The amount of reimbursement is determined before the services are delivered. a) Retrospective reimbursement b) Prospective reimbursement c) Cost-plus reimbursement d) Fee-for-service b. perspective reimbursement
Which of the following is not a type of prospective reimbursement methodology? a) Case mix b) Diagnosis-related groups c) Cost-plus d) Ambulatory patient classification c. cost-plus
A DRG represents a) number of discharges from the hospital b) cumulative days of care c) a group of principal diagnoses d) bundled fees established prospectively c. a group of principal diagnoses
An MS-DRG is a refined DRG that includes 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. patient severity
Under the DRG method of reimbursement, an acute care hospital is paid 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.
Under the DRG method of reimbursement, a psychiatric hospital is paid 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 c.
How is case mix determined for an inpatient facility? 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. d.
What is the Minimum Data Set (MDS)? 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. b
If national health expenditures amount to 18% of the GDP, what does this mean? 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%. b
The largest share of national health expenditures is attributed to: a) Public health activities b) Net cost of private health insurancec) Personal health care d) Structures and equipment c
Public (government) share of the total health care spending in the United States is approximately a) 45% b) 35% c) 55% d) 25% a.
Adverse selection makes health insurance less affordable for a) high-risk individuals b) those in poor health c) those in good health d) those covered by public insurance c.
True or False? Medicaid recipients are classified as medically uninsured. false
True or False? Health insurance increases the demand for health care services. true
True or False? Tax policy in the U.S. provides an incentive to obtain employer-paid health insurance. true
True or False? People in older age groups represent a higher risk than those in lower age groups. true
True or False? Under community rating, people are charged the same premium regardless of health risk. true
true or False? Today, the majority of health insurance exists in the form of managed care plans. true
True or False? By law, a health insurance plan must cover work-related injuries. false
True or False? The government plays a significant role in financing health care services in the United States. true
True or False? It is illegal for an insurance company to sell a Medigap plan to someone who is covered by Medicaid true
True or False? Under the ACA, private health insurance will no longer be the main source of coverage. false
True or False? The ACA requires that employers provide health insurance to part-time workers if the employer has 50+ full-time equivalent workers. false
True or False? Health insurance plans are prohibited from having lifetime dollar limits on medical benefits. true
True or False? Health insurance plans are allowed to have annual dollar limits on a person’s medical benefits. false
True or False? Under the Medicare program, eligibility criteria and benefits are consistent throughout the US. true
True or False? Part D of Medicare does not require the payment of a premium. false
True or False? Long-term care services for the elderly are covered under Medicare. false
True or False? Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US. false
True or False? State governments are required to partially finance the Medicaid program. true
True or False? According to a US Supreme Court decision, individual states can decide whether or not to expand their Medicaid programs to comply with the ACA. true
True or False? Research shows that prospectively set bundled payment methods are effective in reducing health care spending without significantly affecting quality of care. true

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