Review C425 OA Exam
Which of the following is true in regards to health care today in the United States?
There are more primary care physicians than specialty physicians.
Primary care receives a higher reimbursement in professional fees.
There are more specialty physicians than primary physicians.
Outpatient care is slowly decreasing. - ANSWERSThere are more specialty physicians
than primary physicians.
What triggered the downsizing phase in the U.S. hospital industry during the 1980s?
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid - ANSWERSProspective payment system
Designated Related Groups (DRG) -based reimbursement necessitated hospitals to do
what?
Admit new patients at a faster rate than before
Admit a greater number of Medicare patients than before
Reduce the length of stay for hospitalized patients
Admit a smaller number of Medicare patients than before - ANSWERSReduce the
length of stay for hospitalized patients
In which type of utilization management is a primary care physician's opinion necessary
in referring or not referring a patient to a specialist?
Concurrent
Retrospective
Gatekeeping
Precertification - ANSWERSGatekeeping
What is one aspect in which managed care differs from conventional insurance?
Collection of premiums
Assumption of risk
Responsibility for delivery of services
Payments to providers - ANSWERSResponsibility for delivery of services
What is the purpose of Skilled Nursing Facilities (SNF) certification?
It enables a facility to be operated as a skilled nursing facility.
It is required to legally operate a nursing home.
It enables a facility to serve Medicare clients.
It enables a facility to serve both Medicare and Medicaid clients. - ANSWERSIt enables
a facility to serve Medicare clients.
What is the main goal of long-term care as it relates to a patient's function?
Restore function
, Provide assistance
Promote independence
Adapt to change - ANSWERSPromote independence
The U.S. government plays a limited role in the health delivery system. The
government's role in the arena of health care delivery consists of:
developing private hospital organizations.
regulating public and private programs at the local levels.
being the responsible party for health care delivery through Medicare and Medicaid
programs.
aiding in competition among managed care organizations. - ANSWERSbeing the
responsible party for health care delivery through Medicare and Medicaid programs.
The ideology system that emphasizes the well-being of the community over an
individual is called the:
social justice system.
market justice system.
money market system.
universal health care system. - ANSWERSsocial justice system.
Which of the following are characteristics of the medical care determinants of health?
Health care factors include access to technology but do not include access to
alternative therapies.
Mental health services are excluded from the WHO's primary health care framework.
Whereas some services (preventive and primary care) contribute to general health
status, others are more influential in end-of-life situations (hospice and long-term care).
The medical system is highly coordinated so that throughout the phases of their lives
patients are rarely faced with poor continuity of care. - ANSWERSWhereas some
services (preventive and primary care) contribute to general health status, others are
more influential in end-of-life situations (hospice and long-term care).
Which of the following has been the primary factor that has shielded the U.S. health
care system from a major overhaul?
Beliefs and values
Science and technology
Social factors
Economic forces - ANSWERSBeliefs and values
What is the purpose of a stop-loss provision in a health insurance plan?
It limits total out-of-pocket costs.
It ensures that the provider will not suffer a loss.
It protects the insurance underwriter.
It excludes certain types of risks from coverage. - ANSWERSIt limits total out-of-pocket
costs.
Which of the following describes access to care?
Which of the following is true in regards to health care today in the United States?
There are more primary care physicians than specialty physicians.
Primary care receives a higher reimbursement in professional fees.
There are more specialty physicians than primary physicians.
Outpatient care is slowly decreasing. - ANSWERSThere are more specialty physicians
than primary physicians.
What triggered the downsizing phase in the U.S. hospital industry during the 1980s?
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid - ANSWERSProspective payment system
Designated Related Groups (DRG) -based reimbursement necessitated hospitals to do
what?
Admit new patients at a faster rate than before
Admit a greater number of Medicare patients than before
Reduce the length of stay for hospitalized patients
Admit a smaller number of Medicare patients than before - ANSWERSReduce the
length of stay for hospitalized patients
In which type of utilization management is a primary care physician's opinion necessary
in referring or not referring a patient to a specialist?
Concurrent
Retrospective
Gatekeeping
Precertification - ANSWERSGatekeeping
What is one aspect in which managed care differs from conventional insurance?
Collection of premiums
Assumption of risk
Responsibility for delivery of services
Payments to providers - ANSWERSResponsibility for delivery of services
What is the purpose of Skilled Nursing Facilities (SNF) certification?
It enables a facility to be operated as a skilled nursing facility.
It is required to legally operate a nursing home.
It enables a facility to serve Medicare clients.
It enables a facility to serve both Medicare and Medicaid clients. - ANSWERSIt enables
a facility to serve Medicare clients.
What is the main goal of long-term care as it relates to a patient's function?
Restore function
, Provide assistance
Promote independence
Adapt to change - ANSWERSPromote independence
The U.S. government plays a limited role in the health delivery system. The
government's role in the arena of health care delivery consists of:
developing private hospital organizations.
regulating public and private programs at the local levels.
being the responsible party for health care delivery through Medicare and Medicaid
programs.
aiding in competition among managed care organizations. - ANSWERSbeing the
responsible party for health care delivery through Medicare and Medicaid programs.
The ideology system that emphasizes the well-being of the community over an
individual is called the:
social justice system.
market justice system.
money market system.
universal health care system. - ANSWERSsocial justice system.
Which of the following are characteristics of the medical care determinants of health?
Health care factors include access to technology but do not include access to
alternative therapies.
Mental health services are excluded from the WHO's primary health care framework.
Whereas some services (preventive and primary care) contribute to general health
status, others are more influential in end-of-life situations (hospice and long-term care).
The medical system is highly coordinated so that throughout the phases of their lives
patients are rarely faced with poor continuity of care. - ANSWERSWhereas some
services (preventive and primary care) contribute to general health status, others are
more influential in end-of-life situations (hospice and long-term care).
Which of the following has been the primary factor that has shielded the U.S. health
care system from a major overhaul?
Beliefs and values
Science and technology
Social factors
Economic forces - ANSWERSBeliefs and values
What is the purpose of a stop-loss provision in a health insurance plan?
It limits total out-of-pocket costs.
It ensures that the provider will not suffer a loss.
It protects the insurance underwriter.
It excludes certain types of risks from coverage. - ANSWERSIt limits total out-of-pocket
costs.
Which of the following describes access to care?
