US Health Care Systems (Quizzes/ Exams Answers)2022

US Health Care Systems (Quizzes/ Exams Answers)2022The development that contributed most significantly to the decline of the social mission of voluntary hospitals was the Enactment of private and public insurance reimbursement for hospital care 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: Reimbursing states for primary care physician fees for Medicaid patients at no less than100% of Medicare payment rates Integrated health systems or ____________ have been a key provision in the ACA; these systems better coordinate care and improve quality Accountable Care Organizations Which of the following is synonymous with an EHR? None of the above 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: Dismally lower 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: Government and private health insurers Of the levels of prevention associated with the natural history of disease, primary prevention refers to: health education and specific protection The service priorities of the U.S. health care system reflect America's fascination with dramatic high-tech medicine. As a result: all of the above Americans spend $9 billion + each year on alternative and complementary therapies. This trend has caused: many private insurers and Medicare and Medicaid to provide benefit coverage for certain treatments 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: encourage more proactive roles for patients' participation in health care decisions with "shared decision-making" 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: The ACA includes "Sunshine provisions" require reporting of all financial transactions and transfers of value between pharmaceutical/biologic product manufacturers and physicians, hospitals and other entities reimbursed by the federal government In the natural history of a disease, the pre-pathogenesis period refers to: Behavioral, genetic, environmental and other factors that may contribute to an individual's likelihood of contracting a disease 00:02 01:08 Long term care needs of older, chronically ill Americans pose a particular delivery system challenge because: Neither Medicare nor private insurance support ongoing, non-acute services 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: Fixed payments to compensate for lost wages due to injury, sickness or disability The Oregon Death with Dignity Act was a response to which of the following? public and professional concerns about painful and demeaning terminal medical care The explosion of science and technology in the 1970s resulted in which of the following? All of the above In its early origins in colonial America, the patient/physician relationship can be best characterized as: Personal, confidential and simple with payments based on patients' financial capacity Blue Cross Hospital Insurance, the predominant form of health insurance for decades, was modeled after: Baylor University Hospital's school teachers plan A central provision of the ACA to assure health care coverage for most Americans is: the individual mandate The major health care advances of the second half of the 20th century were in the area of: vaccines and antibiotics to prevent and control infectious diseases, tranquilizers, the birth control pill The American Medical Association's initial reaction to Blue Cross hospital insurance plans suggested that the plans: Were unsound and unethical Two primary issues that concerned many regarding the ACA: individual mandate & Medicaid expansion The goals of health information technology: Both A (improve health care quality) and B (reduce health care costs) Policies that call on the government to prescribe and control behavior of a group of individuals in which sanctions are imposed for noncompliance: Regulatory A health information exchange architecture that is designed for all institutions to periodically send copies of their clinical data to one central repository. Monolithic Model 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: Tertiary prevention This important Act in 1973 attempted to hold down costs by moving from fee-for-service to promoting health and preventing illness: HMO Act of 1973 This key Act provided financial incentive programs for physicians to buy, install and adopt EHR systems. HITECH Act 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?" Stage 1 A physician who sends a prescription electronically to the pharmacy is an example of which type of HIT? CPOE The US spends approximately what percentage of its GDP on health care? 17% The US health care system is unlike any in the world because: Both A (it is fragmented) & B (it is $2.7 trillion industry) Which of the following presents a key challenge or barrier to HIT implementation? All of the above The explosion of scientific knowledge and technological advancement has led to a shortage of: primary care providers 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. 85% The use of wireless communication devices to support public health and clinical practice: M-health Examples of alternative therapy: all of the above One of the first, most influential "plans" for hospital coverage, which generated the Blue Cross hospital insurance: Baylor University Hospital plan A major health care concern that has spurred multiple policies in health care: all of the above Which of the following is NOT considered on of the main determinants of health: occupation HIPAA implementation introduced several new provisions beneficial to individuals. Other than the privacy provision concerning patient data, which other was an important provision? Elimination of preexisting periods for individuals moving from job-to-job The AMA interest group has been vocal about which issue(s) facing physicians: all of the above The majority of financing in the US Health Care system comes from: private sources 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. Federated Model The two objectives of any health care delivery system, according to Shi & Singh: enable all citizens access to care AND cost effective, quality care Policies that benefit only certain groups of people by taking money from one group and using it to benefit another (i.e. Medicaid) Redistributive Establishment of the Office of the National Coordinator for Health Information Technology in 2004 was the federal government's first step toward creating: a nationwide health network "Meaningful use" of electronic health records is best described as: efficient applications of electronic health records under internal criteria established within physician practices and hospitals. The single most important factor in accelerating health information technology adoption since 2008 has been: financial incentive programs that reward "meaningful use" The central provision of the HITECH Act of 2009 was: $ 20.8 billion allocation through the Medicare and Medicaid programs to incentivize physicians and health care organizations to adopt electronic health records 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: health information exchanges (HIEs) 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? Vertically integrated In colonial America, the primary functions of hospitals were to: shelter older adults, the dying, orphans, and vagrants and protect community residents from contagiously sick and mentally ill persons 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: diagnosis related groups (DRGs) 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? Deficiencies in the systems of care 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: Incentive payments for achievements and improvements in clinical care and patient satisfaction A major trend is hospital corporate organization over the past few years as hospitals strategically prepared for system reforms has included: Mergers and consolidations into larger systems of care The ultimate responsibility for a hospital's quality of care, including the medical care provided, rests with a hospital's: board of directors A major obligation of doctors when obtaining informed consent for a medical procedure is to: ensure that the patient understands the risks and benefits of the procedure In addition to providing primary and preventive care, federally qualified community health centers also: help patients link with other supportive programs and services such as welfare, Medicaid, the Women, Infants and Children supplemental nutrition program (WIC) and the Child Health Insurance Program. In today's hospitals, outpatient clinics frequently provide: all of the above "Urgent Care" is best described as care: provided on a walk-in, extended hour basis for acute illness and injury that is either beyond the scope of or availability of a primary care practice or retail clinic The predominant services of local public health departments today are: child and adult immunizations The primary owners of community-based ambulatory surgical centers are: physicians Medical societies were first established for the primary purpose of: improving the quality of medical education and practice 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: B. and C. Which of the following organizations is responsible for approving the content of post-medical school residency training? Accreditation Council for Graduate Medical Education 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: all of the above 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? Higher government tuition subsidies for specialty training Academic Health Centers may be best described as: complexes of medical schools and other health professional schools -- such as nursing, pharmacy, dentistry, and allied health -- affiliated with each other and with teaching hospitals and other research and clinical facilities In order to provide direct patient care, physicians are required to: complete a 3-7 year accredited residency program and pass a medical board exam of she state in which they will practice In colonial America, the primary mode of medical education was: A. and C. 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: Many of the population groups with the greatest need have no access to services A physician residency training program is best described as: an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medical specialty The widespread use and popularity of complementary and alternative medicine in the U.S. resulted in which of the following developments? The National Institutes of Health creating the National Center for Complementary and Alternative Medicine (NCCAM) 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?: hospitals' resistance to employing multi-skilled personnel 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: they fill a shortfall in the number of residents required by U.S. hospitals 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? Physical and occupational therapists, speech language pathologists 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: a master's degree The predominant practice setting in the healthcare industry: Hospitals Which of the following is considered a physician? Opthamologist The first state to restrict medical licenses to graduates of medical school Georgia Which of the following specialist is also considered a generalist? Pediatrician The most restrictive form of credentialing that restricts entry into practice and prevents abuse of titles Licensure Systematically developed protocols concerning appropriate health care: Clinical Practice Guidelines The Hill Burton Act: Expanded hospitals to over 4,600 within 20 years of its passage Outpatient care is synonymous with: Ambulatory Care The primary driver for the increase in ambulatory surgical procedures: Both A and B According to the Flexner Report, this school was the "model for medical education": Johns Hopkins The ACA will impact the health care industy in which way? All of the above The first medical school: College of Philadelphia The "Patient Bill of Rights" was established by the AHA in: 1972 Retail clinics have lessened the ______ problem that is often seen in office-based care. access The healthcare workforce projects _________ new jobs will be created in the industry in the next decade: 5.6 million Supply of specialists to generalists is: 67:33 The Donabedian Model for quality addresses: All of the above 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: Diagnosis-Related Group This act states that patients in emergency care settings must be evaluated and stabilized and cannot be turned away: Emergency Medical Treatment and Active Labor Act Most acute care hospitals in the United States: Not-for-profit Which source did NOT shape the hospital industry in the early-mid 1900's? None of the above The basic concept of health insurance is antithetical to the premise on which personal or property insurance was historically defined because: other forms of insurance were intended to cover individuals against the low risk of unlikely events such as premature deaths or accidents while health insurance provides coverage for unlikely events in addition to routine and discretionary services The "Managed care backlash" beginning in the 1990s, refers to: health care providers and consumers protesting managed care's restrictive policies on provider choice, referrals to specialty care and other practices Although the ACA will enact sweeping U.S. health care system reforms, one fundamental element of the system that will remain unchanged is: financing of health care expenditures through a combination of public and private sources The intent of the Medicaid Child Health Insurance Program (CHIP) was to: 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 The managed care concept called "capitation" refers to: physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid fee The Centers for Medicare & Medicaid Services "Hospital Compare" web-based program the primary purpose of: providing consumers with objective criteria that allow comparisons of hospitals' use of evidence-based practices and patient satisfaction ratings 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: disease management 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? prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of services Major drivers of U.S. health expenditures include: advancing medical technology, growth in the older population, specialty medicine, labor intensity, and reimbursement system incentives Enacted in 1965 as Title XIX of the Social Security Act, Medicaid is: 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. 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: "individual mandate" 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: provide financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patients The current highest personal care expenditure in the U.S. is for: hospital care The Healthcare Effectiveness Data and Information Set (HEDIS) may be best described as: 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 Respite care is best defined as: services that temporarily relieve informal caregivers through assistance in the home or through institutional placement on a temporary basis Which of the following best describes the informal long-term care system? care and assistance provided in the home by family members and friends