WGU C425 OA Review Exam Questions and Answers Latest Updated 2023/2024 Rated A+

WGU C425 OA Review Exam Questions and Answers Latest Updated 2023/2024 Rated A+ . 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. - ANSWER-There 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 - ANSWER-Prospective 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 - ANSWER-Reduce 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 - ANSWER-Gatekeeping 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 - ANSWER-Responsibility 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. - ANSWER-It 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 - ANSWER-Promote 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. - ANSWER-being 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. - ANSWER-social 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. - ANSWER-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). 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 - ANSWER-Beliefs 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. - ANSWER-It limits total out-of-pocket costs. Which of the following describes access to care? It is distinguished from acceptability of services. It is rarely predicted by race or income. It is often predicted by income and occupation. Access for disadvantaged populations was absent from legislative history until the ACA. - ANSWER-It is often predicted by income and occupation. Accountable care organizations are: focused on reducing medical malpractice. designed to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes. known for increasing health expenditures and sometimes reducing quality. designed to improve access to care for children and pregnant women. - ANSWERdesigned to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes. How does health care policy-making operate in the United States?