Exam 2)MHA 710 Exam 2: Practice Questions & Answers: Updated Solution

The standard cut-off for cost per quality-adjusted life year (QALY) used by most governmental decision makers is set in terms of a multiple of national per capita income. The value of the threshold is usually what percent of national per capita income? (Ans- 100 Government payers that rely on the cost-effectiveness approach in determining what procedures and drugs to cover under the national plan establish the threshold at 100 percent of per capita national income. The rationale is simple. Adding one quality-adjusted life year (QALY) to a person's life will allow that individual to remain a productive member of society, contributing on average an amount equal to per capita income. Suppose you must rely exclusively on cost-effectiveness analysis (CEA) to determine whether a category of people receives an expensive, potentially life-saving, intervention. Which of the following considerations must you keep in mind when making your decision? (Ans- CEA ignores the possibility that certain unidentified individuals in a group may have a greater than normal positive response to the treatment. The CEA approach compares the average cost of a treatment relative to the average response of the treated with its alternatives. The approach may take into consideration the dispersion around those averages, but it does not take into account how individuals may deviate from the average. A super responder can have a much better outcome than the typical patient can. This is the reason it is important to consider other confounding factors that may contribute to differences in response when considering individual resource allocation decisions. When measuring the effectiveness of a treatment, surrogate measures reflect clinical efficacy and include: (Ans- bone-mass density (BMD). Surrogate measures examine the clinical effect of a treatment for a specific medical condition, such as the reduction of high blood pressure and cholesterol levels or improvement in bone mass density. The other options are intermediate outcomes and events that the treatment is designed to delay or avoid completely. Under which of the following circumstances is the principal-agent relationship likely to be most problematic? (Ans- Between surgeons and patients Principal-agent relationships are typically more problematic when the two parties involved in the interaction do not know each other well. Patients and their general practitioners usually have frequent contact with each other. A surgeon's interaction is often a one-time event. There is usually no agency relationship involved in the other examples. According to Grossman (1972), how is the demand for medical care determined? (Ans- It is derived from the demand for health. Grossman's 1972 model emerged from the labor economics literature and treated medical care demand similarly to labor demand. The theory recognizes that the demand for labor is due in large part (derived from) the demand for the final product it produces. Much the same way, the demand for medical care is due to its use as an input in the production of health. In other words, the demand for medical care is derived from the demand for health. Which of the following is least responsible for the reduction in mortality rates in Europe and North America? (Ans- More effective medical interventions Most of the decline in mortality rates in the developed world took place before effective medical interventions were discovered. The concept of quality-adjusted life year (QALY): (Ans- is used extensively to evaluate medical care resource allocation within government-run programs on fixed budgets, especially in Europe. One of the most important applications of QALY analysis is its use in evaluating resource allocation decisions within health care systems. It is also useful in setting priorities within an individual program or health sector, especially when budgets are fixed or spending exceeds targets. Which of the following would likely lead to the greatest improvement in the health status of the population in the United States? (Ans- Improved lifestyles changes