U.S. Health Care Systems Final Exam
2024
According to Donabedian, in order to help define and measure quality in healthcare organizations,
you must examine three domains. What are the domains? - ANSWER Structure, Process,
Outcomes
Central health planning is a characteristic of what type of national health care system? -
ANSWER Socialized health (social justice)
DRG-based reimbursement necessitated hospitals to do what? - ANSWER Discharge
patients quicker than before
HMO vs PPO - ANSWER An HMO gives you access to certain doctors and hospitals within its
network. A network is made up of providers that have agreed to lower their rates for plan members
and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you
see a provider within that HMO's network.
How were diagnostic related groups (DRG's) originally supposed to decrease costs? -
ANSWER Creating certain procedures/service codes that hospitals would be reimbursed
accordingly
In the _________, a patients physical, mental, social, and spiritual needs are addressed -
ANSWER Holistic Approach
In the gatekeeping method, who makes referrals to specialists? - ANSWER Primary care
physician
In which type of management utilization is a primary care physicians opinion necessary in referring
or not referring a patient to a specialist? - ANSWER Gatekeeping
Long term care services are characterized as: - ANSWER Individualized
Long term care services often interface with what type of care? - ANSWER Various non-long
term care services
, U.S. Health Care Systems Final Exam
2024
Mental disorders are common psychiatric illnesses affecting which group? - ANSWER Adults
Monitoring a patient's progress prognosis for recovery becomes important in which type of
utilization review? - ANSWER Concurrent
Objectives of community based LTC services? - ANSWER Respite to family members,
supplement informal care, prevent institutionalization
Pre-certification is associated with which type of utilization review? - ANSWER Prospective
Severe ADL limitations often indicate the need for what service? -
ANSWER Institutionalization
T or F: 19th century almshouses provided mainly rehabilitation services - ANSWER False
T or F: A license to operate a long term care facility is issued by the Department of Health and
Human Serviecs - ANSWER False
T or F: All elderly require services that are very similar - ANSWER False
T or F: All Medicaid beneficiaries are required to enroll in managed care plans. -
ANSWER False
T or F: Certain subacute care services can be provided in a patients own home -
ANSWER True
T or F: Compared to general hospitals, speciality hospitals offer services that are clinically superior. -
ANSWER False
T or F: Defensive medicine is a cost reducing strategy - ANSWER False
2024
According to Donabedian, in order to help define and measure quality in healthcare organizations,
you must examine three domains. What are the domains? - ANSWER Structure, Process,
Outcomes
Central health planning is a characteristic of what type of national health care system? -
ANSWER Socialized health (social justice)
DRG-based reimbursement necessitated hospitals to do what? - ANSWER Discharge
patients quicker than before
HMO vs PPO - ANSWER An HMO gives you access to certain doctors and hospitals within its
network. A network is made up of providers that have agreed to lower their rates for plan members
and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you
see a provider within that HMO's network.
How were diagnostic related groups (DRG's) originally supposed to decrease costs? -
ANSWER Creating certain procedures/service codes that hospitals would be reimbursed
accordingly
In the _________, a patients physical, mental, social, and spiritual needs are addressed -
ANSWER Holistic Approach
In the gatekeeping method, who makes referrals to specialists? - ANSWER Primary care
physician
In which type of management utilization is a primary care physicians opinion necessary in referring
or not referring a patient to a specialist? - ANSWER Gatekeeping
Long term care services are characterized as: - ANSWER Individualized
Long term care services often interface with what type of care? - ANSWER Various non-long
term care services
, U.S. Health Care Systems Final Exam
2024
Mental disorders are common psychiatric illnesses affecting which group? - ANSWER Adults
Monitoring a patient's progress prognosis for recovery becomes important in which type of
utilization review? - ANSWER Concurrent
Objectives of community based LTC services? - ANSWER Respite to family members,
supplement informal care, prevent institutionalization
Pre-certification is associated with which type of utilization review? - ANSWER Prospective
Severe ADL limitations often indicate the need for what service? -
ANSWER Institutionalization
T or F: 19th century almshouses provided mainly rehabilitation services - ANSWER False
T or F: A license to operate a long term care facility is issued by the Department of Health and
Human Serviecs - ANSWER False
T or F: All elderly require services that are very similar - ANSWER False
T or F: All Medicaid beneficiaries are required to enroll in managed care plans. -
ANSWER False
T or F: Certain subacute care services can be provided in a patients own home -
ANSWER True
T or F: Compared to general hospitals, speciality hospitals offer services that are clinically superior. -
ANSWER False
T or F: Defensive medicine is a cost reducing strategy - ANSWER False
