HAPP 452 FINAL TEST WITH CORRECT
SOLUTIONS
What is the combined ethos (identity/perspective) of your textbook authors
Bodenheimer and Grumbach? - ANSWER Public and private physicians working as
primary care providers
How would you characterize the goal of the text proffered by Bodenheimer and
Grumbach? - ANSWER To describe to clinicians, public health professionals and others
engaged in the biomedical enterprise how the U.S. health care system functions with
particular emphasis on problems that need fixing.
According to an example in Bodenheimer and Grumbach, a man who contracted
leukemia utilized services that resulted in hospital bills that were on the order of: -
ANSWER $80,000
Why does Bodenheimer and Grumbach Table 2-1 show that government financing
covers 33% of the population at the same time as government pays for 47% of all
national health care expenditures? - ANSWER Because government programs generally
cover sicker populations compared to private programs.
why did individual private health care never grain traction in the U.S.? - ANSWER
Hospital and physicians controlled Blue Cross and Blue Shield and thus set up payment
streams that would promote demand.
Wage controls of World War II encouraged employers to compensate employees with
increasingly generous health care coverage.
Federal tax incentives for employers.
Which of the following historical trends was identified in Chapter 2 of Bodenheimer and
Grumbach: - ANSWER Poor and elderly populations were left behind by private
expansions after World War II, but were greatly relieved by the passage of legislation to
create the Medicare and Medicaid Programs in 1965.
recent (20th and 21st Century) history of health insurance coverage in the U.S. can be
divided thusly: - ANSWER Into three phases: 1. 1930-1970 with large expansion of
employer based coverage; 2. 1980 to 2010 with the reversal of these trends after the
passage of Medicare and Medicaid in 1965; and Post-2010, after the passage of the
Affordable Care Act (Obamacare).
, even if the ACA is fully implemented and maintained, approximately 20 million
Americans will remain uninsured under this law for which of the following reasons: -
ANSWER State government unwillingness to expand their Medicaid programs
,Individuals refusing to comply with the requirement (mandate) to buy health insurance
or to enroll in Medicaid
Undocumented immigrants remaining ineligible for Medicaid coverage
the average premium costs for a single person in the employer-based insurance market
was approximately (hint: pick the overall best answer): - ANSWER $6,024 per year
$502 per month
which of the following demographic groups is at highest risk of being uninsured? -
ANSWER Hispanics earning less than $25,000/year
According to analysis conducted by Kaiser Commission on Medicaid and the Uninsured
and described by Bodenheimer and Grumbach, the rates of persons who went without
needed health care in a given year because of excessive cost was: - ANSWER 4% for
everyone
The work of Baiker et al., 2013, cited in Chapter 3 of Bodenheimer and Grumbach, is
referred to as a "natural experiment" because: - ANSWER A study was done of a policy
intervention that would have happened any ways, i.e., the study was applied to an
intervention that was thus "naturally" occurring.
what proportion of bankruptcies in the U.S. were caused by the inability to pay medical
bills among those with insurance? - ANSWER 62%*75%= 46.5%
True or False: The work of Mayberry and colleagues, 2000- cited in Bodenheimer and
Grumbach, found that patient preferences largely explain why there are racial
variations seen in cardiac surgery outcomes. - ANSWER False
the top 10% of earners in the U.S. earned what proportion of the nation's total income in
the years 1965 and 2012, respectively? - ANSWER 33%, 50.4%
True or False: immigrants have higher mortality rates after adjusting for income level
compared to native born U.S. citizens. (Age adjustments also are presumed.) - ANSWER
False
Per a 2016 publication by the National Health Accounts Team (Martin et al.), CMS Office
of the Actuary, in 2014... - ANSWER Total health care spending in the U.S. was
approximately 3.0 Trillion dollars
Total health care spending was 17.5% of the U.S. GDP
Total U.S. health care spending grew by 5.3% from the previous year
Total U.S. health care spending amounted to $9,523 per person
CMS Office of the Actuary, in 2014, state and local governments in the U.S. spent how
much on health care? - ANSWER $515 billion
, CMS Office of the Actuary, in 2014, the federal government in the U.S. spent how much
on health care? - ANSWER $844 billion
CMS Office of the Actuary the main reason that U.S. health care expenditures went up
between 2014 and 2013 is... - ANSWER Increase Medicaid and individual market
insurance coverage rates
Which of the following are examples of a "fee-for-service" payment to a physician? -
ANSWER Dr. Jones delivers an EKG to Mr. Smith and receives $400 for that procedure.
With regards to payment pathways, which of the following hospital payment methods is
analogous to physician compensation based on annual salary support? - ANSWER
Global budget
Preferred Provider Organizations (PPO) are ones where... - ANSWER Patients pay less if
they use and in-network doctor.
Health Maintenance Organizations (HMO) are... - ANSWER Managed care entities that
require a patient to use only certain providers, otherwise the service will not be paid for
by the HMO
in the earliest years of the Medicare program how were physician reimbursements
usually made? - ANSWER Based on UCR (usual, customary, and reasonable) payments,
fee-for-service
Chapter 4, the more aggregated (or bundled) medical services are with regards to
provider payment... - ANSWER The higher the financial risk to the treatment provider
(e.g., doctor) for the covered care.
If a service is paid for via direct payments to the doctor in the context of a plan that
otherwise uses capitation to cover doctor services, it is typically referred to as a... -
ANSWER carve-out service
If an insurance company relies on risk-adjusted capitation to collect its premiums, which
of the following statements is true: - ANSWER The company receives higher prospective
capitation payments for groups of persons with a recent history of greater illness.
What is distinctive about the British system of health care reimbursement versus the
U.S. system per Bodenheimer and Grumbach's chapter 4? - ANSWER The British system
is simpler with capitation payments to primary care providers and fee-for-service
payments for other "carve-out" services.
SOLUTIONS
What is the combined ethos (identity/perspective) of your textbook authors
Bodenheimer and Grumbach? - ANSWER Public and private physicians working as
primary care providers
How would you characterize the goal of the text proffered by Bodenheimer and
Grumbach? - ANSWER To describe to clinicians, public health professionals and others
engaged in the biomedical enterprise how the U.S. health care system functions with
particular emphasis on problems that need fixing.
According to an example in Bodenheimer and Grumbach, a man who contracted
leukemia utilized services that resulted in hospital bills that were on the order of: -
ANSWER $80,000
Why does Bodenheimer and Grumbach Table 2-1 show that government financing
covers 33% of the population at the same time as government pays for 47% of all
national health care expenditures? - ANSWER Because government programs generally
cover sicker populations compared to private programs.
why did individual private health care never grain traction in the U.S.? - ANSWER
Hospital and physicians controlled Blue Cross and Blue Shield and thus set up payment
streams that would promote demand.
Wage controls of World War II encouraged employers to compensate employees with
increasingly generous health care coverage.
Federal tax incentives for employers.
Which of the following historical trends was identified in Chapter 2 of Bodenheimer and
Grumbach: - ANSWER Poor and elderly populations were left behind by private
expansions after World War II, but were greatly relieved by the passage of legislation to
create the Medicare and Medicaid Programs in 1965.
recent (20th and 21st Century) history of health insurance coverage in the U.S. can be
divided thusly: - ANSWER Into three phases: 1. 1930-1970 with large expansion of
employer based coverage; 2. 1980 to 2010 with the reversal of these trends after the
passage of Medicare and Medicaid in 1965; and Post-2010, after the passage of the
Affordable Care Act (Obamacare).
, even if the ACA is fully implemented and maintained, approximately 20 million
Americans will remain uninsured under this law for which of the following reasons: -
ANSWER State government unwillingness to expand their Medicaid programs
,Individuals refusing to comply with the requirement (mandate) to buy health insurance
or to enroll in Medicaid
Undocumented immigrants remaining ineligible for Medicaid coverage
the average premium costs for a single person in the employer-based insurance market
was approximately (hint: pick the overall best answer): - ANSWER $6,024 per year
$502 per month
which of the following demographic groups is at highest risk of being uninsured? -
ANSWER Hispanics earning less than $25,000/year
According to analysis conducted by Kaiser Commission on Medicaid and the Uninsured
and described by Bodenheimer and Grumbach, the rates of persons who went without
needed health care in a given year because of excessive cost was: - ANSWER 4% for
everyone
The work of Baiker et al., 2013, cited in Chapter 3 of Bodenheimer and Grumbach, is
referred to as a "natural experiment" because: - ANSWER A study was done of a policy
intervention that would have happened any ways, i.e., the study was applied to an
intervention that was thus "naturally" occurring.
what proportion of bankruptcies in the U.S. were caused by the inability to pay medical
bills among those with insurance? - ANSWER 62%*75%= 46.5%
True or False: The work of Mayberry and colleagues, 2000- cited in Bodenheimer and
Grumbach, found that patient preferences largely explain why there are racial
variations seen in cardiac surgery outcomes. - ANSWER False
the top 10% of earners in the U.S. earned what proportion of the nation's total income in
the years 1965 and 2012, respectively? - ANSWER 33%, 50.4%
True or False: immigrants have higher mortality rates after adjusting for income level
compared to native born U.S. citizens. (Age adjustments also are presumed.) - ANSWER
False
Per a 2016 publication by the National Health Accounts Team (Martin et al.), CMS Office
of the Actuary, in 2014... - ANSWER Total health care spending in the U.S. was
approximately 3.0 Trillion dollars
Total health care spending was 17.5% of the U.S. GDP
Total U.S. health care spending grew by 5.3% from the previous year
Total U.S. health care spending amounted to $9,523 per person
CMS Office of the Actuary, in 2014, state and local governments in the U.S. spent how
much on health care? - ANSWER $515 billion
, CMS Office of the Actuary, in 2014, the federal government in the U.S. spent how much
on health care? - ANSWER $844 billion
CMS Office of the Actuary the main reason that U.S. health care expenditures went up
between 2014 and 2013 is... - ANSWER Increase Medicaid and individual market
insurance coverage rates
Which of the following are examples of a "fee-for-service" payment to a physician? -
ANSWER Dr. Jones delivers an EKG to Mr. Smith and receives $400 for that procedure.
With regards to payment pathways, which of the following hospital payment methods is
analogous to physician compensation based on annual salary support? - ANSWER
Global budget
Preferred Provider Organizations (PPO) are ones where... - ANSWER Patients pay less if
they use and in-network doctor.
Health Maintenance Organizations (HMO) are... - ANSWER Managed care entities that
require a patient to use only certain providers, otherwise the service will not be paid for
by the HMO
in the earliest years of the Medicare program how were physician reimbursements
usually made? - ANSWER Based on UCR (usual, customary, and reasonable) payments,
fee-for-service
Chapter 4, the more aggregated (or bundled) medical services are with regards to
provider payment... - ANSWER The higher the financial risk to the treatment provider
(e.g., doctor) for the covered care.
If a service is paid for via direct payments to the doctor in the context of a plan that
otherwise uses capitation to cover doctor services, it is typically referred to as a... -
ANSWER carve-out service
If an insurance company relies on risk-adjusted capitation to collect its premiums, which
of the following statements is true: - ANSWER The company receives higher prospective
capitation payments for groups of persons with a recent history of greater illness.
What is distinctive about the British system of health care reimbursement versus the
U.S. system per Bodenheimer and Grumbach's chapter 4? - ANSWER The British system
is simpler with capitation payments to primary care providers and fee-for-service
payments for other "carve-out" services.
