HMGT 3310 NEW MIDTERM EXAM WITH COMPLETE
SOLUTIONS 100% VERIFIED
earliest drug safety law 1840's - Answer sale of imported products
first national public protection law 1906 - Answer unsanitary conditions in the
meatpacking industry
changed health system 1920 - Answer assurance of quality
first health insurance 1929 - Answer Baylor Hospital, BCBS: plan for unlimited access by
school teachers in return for prepayment in the form of a fixed monthly sum
Blue Cross v. Blue Shield - Answer BC = inpatient services
BS = outpatient services
2 effects of WWII on health insurance - Answer 1. freeze on wages --> leveraged
insurance plans to attract workers in a tight labor market
2. tax regulations compounded the value of insurance (excluded from income tax)
Hill-Burton Act (1946) - Answer federal program to fund hospital construction
Medicare and Medicaid (1965) - Answer Medicare = ages 65+
Medicaid = below the poverty line
introduction of HMOs in 1970s - Answer less expensive alternative to traditional health
insurance through passage of legislation to encourage their adoption in employer
benefit plans
,purpose of HMOs - Answer reduce costs, ration expensive services, avoid duplicative
services
influential power of Medicare on consumers and physicians - Answer pressure heavy
utilizers of hospital service to change their habits; reimbursement to hospitals
Medicare reimbursement mechanism evolution- Answer fee-for-service --> set amounts
determined by each patient's primary diagnosis
What % of GDP is spent on health care? - Answer roughly 20%
4 pillars/levels of regulatory system - Answer 1. federal
2. state
3. private 4. local
state regulation - Answer - departments of health and boards of medicine (oversees
sanitation, conducts inspections, issues licenses, gathers/disseminates data)
- first line of defense in addressing fundamental public health needs and assuring
quality of services
departments of welfare - Answer state-administered Medicaid programs
departments of aging - Answer administers services for the elderly
departments of insurance - Answer oversees financing of care
American Medical Association (AMA) - Answer - promoted and guided the development
of physician licensure laws and accreditation standards for medical schools
Joint Commission on Accreditation of Health Care Organizations (JCAHO) - Answer -
private organization controlled by member hospitals; established a process of
accrediting facilities according to quality standards that were generally more stringent
than those of state licensure
,- public/private partnership
- sends auditors to survey facilities for compliance with quality standards, grants
"accredited" status if passed
- most state hospitals may operate with a license but without accreditation, but JCAHO
approval is needed for reimbursement under Medicare/Medicaid
- accreditation necessary for business
policy debates over JCAHO accreditation - Answer conflict of interest
- how to overcome that? use objective measures of physical features and operational
processes (cleanliness, equipment, room sizes, clinical outcome measurements, etc)
medical errors - Answer - oversight through data management
- facilitate data sharing without threatening hospitals with public disclosures that could
damage reputations
Medical Care Availability and Reduction of Error Act - Answer established by
Pennsylvania to create a mandatory hospital error reporting system
Patient Safety and Quality Improvement Act - Answer federal role in overseeing medical
error reduction; authorized creation of patient safety organizations within hospitals to
examine possible dangers to patients in a confidential manner
Quality Assessment and Performance Improvement Program - Answer mechanisms to
identify and correct quality lapses in the scope of Medicare
National Committee for Quality Assurance - Answer represents large employers and
other major payers for care; accredits managed care plans
American healthcare regulatory system - Answer private-public partnership rather than
direct government oversight
, most significant player of healthcare regulatory system - Answer federal government
largest source of payment for healthcare - Answer federal government
Department of Health and Human Services (DHHS) - Answer majority of federal health
care regulatory activity
federal regulation - Answer - imposes criteria on reimbursement under
Medicare/Medicaid programs
- indirectly coordinates state licensure programs through a centralized data bank of
disciplinary actions
- directly regulates practice in federal health care facilities
private regulation - Answer - place their own standards on professionals whose services
are reimbursable
elements of self-policing - Answer - physician specialty policies which grant certification
status to its members who meet their minimum standards
- associations of allied health professionals that check the quality of care given by their
members
agencies under DHHS umbrella - Answer FDA, CMS, CDC, NIH
heads of regulatory bodies (boards, commissions, agencies, departments, etc) - Answer
officials (secretaries) appointed by the president/governor, usually subject to
confirmation by the Senate or state legislature
constitutional limits on regulating bodies - Answer 4th and 5th amendments (due
process)
Administrative Procedures Act - Answer provides roadmap for administrative decision
making; validity of determination can be appealed, not underlying substance
SOLUTIONS 100% VERIFIED
earliest drug safety law 1840's - Answer sale of imported products
first national public protection law 1906 - Answer unsanitary conditions in the
meatpacking industry
changed health system 1920 - Answer assurance of quality
first health insurance 1929 - Answer Baylor Hospital, BCBS: plan for unlimited access by
school teachers in return for prepayment in the form of a fixed monthly sum
Blue Cross v. Blue Shield - Answer BC = inpatient services
BS = outpatient services
2 effects of WWII on health insurance - Answer 1. freeze on wages --> leveraged
insurance plans to attract workers in a tight labor market
2. tax regulations compounded the value of insurance (excluded from income tax)
Hill-Burton Act (1946) - Answer federal program to fund hospital construction
Medicare and Medicaid (1965) - Answer Medicare = ages 65+
Medicaid = below the poverty line
introduction of HMOs in 1970s - Answer less expensive alternative to traditional health
insurance through passage of legislation to encourage their adoption in employer
benefit plans
,purpose of HMOs - Answer reduce costs, ration expensive services, avoid duplicative
services
influential power of Medicare on consumers and physicians - Answer pressure heavy
utilizers of hospital service to change their habits; reimbursement to hospitals
Medicare reimbursement mechanism evolution- Answer fee-for-service --> set amounts
determined by each patient's primary diagnosis
What % of GDP is spent on health care? - Answer roughly 20%
4 pillars/levels of regulatory system - Answer 1. federal
2. state
3. private 4. local
state regulation - Answer - departments of health and boards of medicine (oversees
sanitation, conducts inspections, issues licenses, gathers/disseminates data)
- first line of defense in addressing fundamental public health needs and assuring
quality of services
departments of welfare - Answer state-administered Medicaid programs
departments of aging - Answer administers services for the elderly
departments of insurance - Answer oversees financing of care
American Medical Association (AMA) - Answer - promoted and guided the development
of physician licensure laws and accreditation standards for medical schools
Joint Commission on Accreditation of Health Care Organizations (JCAHO) - Answer -
private organization controlled by member hospitals; established a process of
accrediting facilities according to quality standards that were generally more stringent
than those of state licensure
,- public/private partnership
- sends auditors to survey facilities for compliance with quality standards, grants
"accredited" status if passed
- most state hospitals may operate with a license but without accreditation, but JCAHO
approval is needed for reimbursement under Medicare/Medicaid
- accreditation necessary for business
policy debates over JCAHO accreditation - Answer conflict of interest
- how to overcome that? use objective measures of physical features and operational
processes (cleanliness, equipment, room sizes, clinical outcome measurements, etc)
medical errors - Answer - oversight through data management
- facilitate data sharing without threatening hospitals with public disclosures that could
damage reputations
Medical Care Availability and Reduction of Error Act - Answer established by
Pennsylvania to create a mandatory hospital error reporting system
Patient Safety and Quality Improvement Act - Answer federal role in overseeing medical
error reduction; authorized creation of patient safety organizations within hospitals to
examine possible dangers to patients in a confidential manner
Quality Assessment and Performance Improvement Program - Answer mechanisms to
identify and correct quality lapses in the scope of Medicare
National Committee for Quality Assurance - Answer represents large employers and
other major payers for care; accredits managed care plans
American healthcare regulatory system - Answer private-public partnership rather than
direct government oversight
, most significant player of healthcare regulatory system - Answer federal government
largest source of payment for healthcare - Answer federal government
Department of Health and Human Services (DHHS) - Answer majority of federal health
care regulatory activity
federal regulation - Answer - imposes criteria on reimbursement under
Medicare/Medicaid programs
- indirectly coordinates state licensure programs through a centralized data bank of
disciplinary actions
- directly regulates practice in federal health care facilities
private regulation - Answer - place their own standards on professionals whose services
are reimbursable
elements of self-policing - Answer - physician specialty policies which grant certification
status to its members who meet their minimum standards
- associations of allied health professionals that check the quality of care given by their
members
agencies under DHHS umbrella - Answer FDA, CMS, CDC, NIH
heads of regulatory bodies (boards, commissions, agencies, departments, etc) - Answer
officials (secretaries) appointed by the president/governor, usually subject to
confirmation by the Senate or state legislature
constitutional limits on regulating bodies - Answer 4th and 5th amendments (due
process)
Administrative Procedures Act - Answer provides roadmap for administrative decision
making; validity of determination can be appealed, not underlying substance
