HPHM 4312 Health Insurance &
Managed Care
Midterm Exam Review
(Questions & Solutions)
2025
1
, 1. Multiple Choice
Question:
A state government is proposing a major reform in Medicaid coverage. As
a Healthcare Management professional, you are asked to assess the
impact of this reform. Which policy objective is most likely to be
prioritized by lawmakers in this context?
- A. Increasing provider reimbursements solely
- B. Enhancing access to care for low‑income populations
- C. Decreasing administrative costs without changing eligibility
- D. Expanding elective services without revising eligibility criteria
Correct ANS:
B. Enhancing access to care for low‑income populations
Rationale:
Medicaid reform typically aims to increase access to care for vulnerable
groups. Improving eligibility and coverage for low‑income residents is
central to achieving better population health and reducing disparities.
---
2. Fill-in-the-Blank
Question:
The framework used to assess the external environment—including
Political, Economic, Social, Technological, Environmental, and Legal
factors—is known as __________ analysis.
Correct ANS:
PESTEL
Rationale:
PESTEL analysis is a strategic tool used to identify and monitor external
factors that may impact the organization’s performance. In healthcare
2
, management, it helps anticipate market shifts and regulatory changes.
---
3. True/False
Question:
True or False: Managed care plans emphasize preventive care and
coordinated service delivery to control costs and improve quality
outcomes.
Correct ANS:
True
Rationale:
Managed care is designed to reduce unnecessary expenditures by
encouraging preventive measures and coordinated care, ultimately
aiming to improve patient outcomes while controlling costs.
---
4. Multiple Response
Question:
Which of the following are essential components in the formulation of a
health systems policy? (Select all that apply)
- A. Reimbursement models and payment systems
- B. Regulatory and legislative frameworks
- C. Quality improvement and patient safety initiatives
- D. Internal IT support only
- E. Strategic alignment with organizational mission
Correct ANSs:
A, B, C, E
Rationale:
Effective health systems policy relies on comprehensive elements—
3
Managed Care
Midterm Exam Review
(Questions & Solutions)
2025
1
, 1. Multiple Choice
Question:
A state government is proposing a major reform in Medicaid coverage. As
a Healthcare Management professional, you are asked to assess the
impact of this reform. Which policy objective is most likely to be
prioritized by lawmakers in this context?
- A. Increasing provider reimbursements solely
- B. Enhancing access to care for low‑income populations
- C. Decreasing administrative costs without changing eligibility
- D. Expanding elective services without revising eligibility criteria
Correct ANS:
B. Enhancing access to care for low‑income populations
Rationale:
Medicaid reform typically aims to increase access to care for vulnerable
groups. Improving eligibility and coverage for low‑income residents is
central to achieving better population health and reducing disparities.
---
2. Fill-in-the-Blank
Question:
The framework used to assess the external environment—including
Political, Economic, Social, Technological, Environmental, and Legal
factors—is known as __________ analysis.
Correct ANS:
PESTEL
Rationale:
PESTEL analysis is a strategic tool used to identify and monitor external
factors that may impact the organization’s performance. In healthcare
2
, management, it helps anticipate market shifts and regulatory changes.
---
3. True/False
Question:
True or False: Managed care plans emphasize preventive care and
coordinated service delivery to control costs and improve quality
outcomes.
Correct ANS:
True
Rationale:
Managed care is designed to reduce unnecessary expenditures by
encouraging preventive measures and coordinated care, ultimately
aiming to improve patient outcomes while controlling costs.
---
4. Multiple Response
Question:
Which of the following are essential components in the formulation of a
health systems policy? (Select all that apply)
- A. Reimbursement models and payment systems
- B. Regulatory and legislative frameworks
- C. Quality improvement and patient safety initiatives
- D. Internal IT support only
- E. Strategic alignment with organizational mission
Correct ANSs:
A, B, C, E
Rationale:
Effective health systems policy relies on comprehensive elements—
3
