HAPP 452 FINAL EXAM 2025

What is the combined ethos (identity/perspective) of your textbook authors Bodenheimer and Grumbach? - Correct Answer-Public and private physicians working as primary care providers How would you characterize the goal of the text proffered by Bodenheimer and Grumbach? - Correct 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: - Correct 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? - Correct 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.? - Correct 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: - Correct 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: - Correct Answer-Into three phases: 1. 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: - Correct 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): - Correct Answer-$6,024 per year $502 per month which of the following demographic groups is at highest risk of being uninsured? - Correct 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: - Correct 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: - Correct 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? - Correct 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. - Correct 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? - Correct 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.) - Correct Answer-False Per a 2016 publication by the National Health Accounts Team (Martin et al.), CMS Office of the Actuary, in 2014... - Correct 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? - Correct Answer-$515 billion CMS Office of the Actuary, in 2014, the federal government in the U.S. spent how much on health care? - Correct Answer-$844 billion CMS Office of the Actuary the main reason that U.S. health care expenditures went up between 2014 and 2013 is... - Correct Answer-Increase Medicaid and individual market insurance coverage rates Which of the following are examples of a "fee-for-service" payment to a physician? - Correct 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? - Correct Answer-Global budget Preferred Provider Organizations (PPO) are ones where... - Correct Answer-Patients pay less if they use and in-network doctor. Health Maintenance Organizations (HMO) are... - Correct 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? - Correct 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... - Correct 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... - Correct Answer-carve-out service If an insurance company relies on risk-adjusted capitation to collect its premiums, which of the following statements is true: - Correct 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? - Correct Answer-The British system is simpler with capitation payments to primary care providers and fee-for-service payments for other "carve-out" services. Why does Bodenheimer and Grumbach cite Rodwin, 1993, in their Chapter 4? - Correct Answer-To support the concept that physicians who receive bonus payments for referrals to specialists have a conflict-of-interest (i.e., a higher risk of 'moral hazard') when it comes to making such referrals. The following vignette adapted from Bodenheimer and Grumbach's text is an example of what type of payment system from the perspective of Blue Cross? - Correct Answer-Fee-for-service True or False: 'per diem' or 'episode' based pricing of health care utilization are both examples of 'bundling' more than one service together for the purposes of billing, albeit with different denominator units. - Correct Answer-True Joanne is a 75-year-old women hospitalized with an acute pulmonary edema; she further experiences sustained heart failure despite repeated treatment attempts. After several nights spent in the hospital and nu