Study guide -delivering healthcare in america: a systems approach

Study Guide -Delivering Healthcare in America: A Systems Approach
Leiyu Shi & Douglas A. Singh

Chapter 1: A Distinctive System of Health Care Delivery

Multiple Choice Questions

1. The primary objectives of a healthcare system include all of the following except:
 a. Enabling all citizens to receive healthcare services
 b. Delivering healthcare services that are cost-effective
 c. Delivering healthcare services using the most current technology, regardless of cost
 d. Delivering healthcare services that meet established standards of quality

2. The U.S. healthcare system can best be described as:
 a. Expensive
 b. Fragmented
 c. Market-oriented
 d. All of the above

3. For most privately insured Americans, health insurance is:
 a. Employer-based
 b. Financed by the government
 c. Privately purchased
 d. None of the above

4. Medicare is primarily for people who meet the following eligibility requirement:
 a. Elderly
 b. Low-income
 c. Children
 d. Disabled
5. Medicaid is primarily for people who meet the following eligibility requirement:
 a. Elderly
 b. Low-income
 c. Children
 d. Disabled
6. The role of the government in the U.S. healthcare system is:
 a. Regulator
 b. Major financer
 c. Medicare and Medicaid reimbursement rate-setter
 d. All of the above
7. Which of the following is a characteristic of a socialized health insurance system?
a. Health care is financed through government-mandated contributions by employers and employees
 b. Health care is delivered by government-employed providers
 c. Both a and b
 d. Neither a nor b

8. Which of the following is an overarching goal of Healthy People 2010?
 a. Decrease health care costs
 b. Create a more coordinated health care system
 c. Establish a national health insurance program
 d. Increase quality and years of healthy life

9. Which of the following is a dimension of social health?
 a. Sociability
 b. Community involvement
 c. Marital satisfaction
 d. All of the above

10. Supplier-induced demand is created by:
 a. Patients
 b. Providers
 c. Health insurance companies
 d. The government

Chapter 2: Beliefs, Values, and Health

Multiple Choice Questions

1. The elements of the Epidemiology Triangle of disease occurrence include all of the following except:
 a. Environment
 b. Agent
 c. Society
d. Host

2. Which of the following factors is the leading cause of preventable disease and death in the United States?
 a. High fat diet
 b. Heredity
 c. Smoking
 d. Unsafe sex

3. Which of the following is not a behavioral risk factor?
 a. Irresponsible motor vehicle use
 b. Inadequate physical exercise
 c. Unsafe neighborhoods
 d. Alcohol abuse

4. What is tertiary prevention?
 a. Early detection and treatment of disease
b. Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disability
 c. Reduction of the probability that a disease will develop in the future
 d. None of the above

5. According to the CDC, which factor contributes most to premature death in the U.S. population?
 a. Lifestyle and behaviors
 b. Lack of medical care
 c. Social and environmental factors
 d. Genetic makeup

6. Which of the following can be considered an environmental factor contributing to health status?
 a. Air quality
 b. Access to health care
 c. Safety of neighborhoods
 d. All of the above

7. Healthcare is considered a social good in:
 a. Market justice
 b. Social justice
 c. Both a and b
d. The total number of cases at a specific point in time divided by the population at risk

8. Demand-side rationing is the same thing as:
 a. Nonprice rationing
 b. Price rationing
 c. Both a and b
 d. Neither a nor b

9. Prevalence is:
a. The number of new cases occurring during a specified period divided by the total population
b. The total number of cases at a specific point in time divided by the specified population
c. The number of new cases occurring during a specified period divided by the population at risk
d. The total number of cases at a specific point in time divided by the population at risk

10. Holistic health adds which element to the World Health Organization definition of health?
 a. Physical
 b. Mental
 c. Spiritual
 d. Social


Chapter 3: The Evolution of Health Services in the United States

Multiple Choice Questions

1. Which of the following forces remains relatively stable, and major shifts in this area would be necessary to bring about any fundamental change in the US health care delivery system?
a. Economic forces
b. Political change
c. Beliefs and values
d. Social forces

2. In its historical context, which of the following has played a major role in revolutionizing health care delivery?
a. Beliefs and values
b. Science and technology
c. Medical education
d. Economic growth

3. In the preindustrial era, _____ often functioned as surgeons.
a. butchers
b. tailors
c. clergymen
d. barbers

4. Hospitals in the United States evolved from
a. alms houses
b. sick homes
c. pest houses
d. inns

5. What was the function of a pest house in the preindustrial period?
a. To house people who had a contagious disease.
b. To provide refuge to those who were threatened by pests.
c. To eradicate pests.
d. To treat contagious diseases.

6. Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?
a. Urbanization
b. Educational reform
c. Science and technology
d. Dependency
e. licensing

7. Development of the hospital and ______ happened almost hand in hand in a symbiotic relationship between the two.
a. dependency of patients
b. growth of scientific knowledge
c. professionalization of medical practice
d. cohesiveness of the medical profession

8. Why did physicians remain independent of corporate settings even after the medical profession became well recognized?
a. Hospitals were unable to pay high enough salaries to physicians.
b. Physicians disliked salary arrangements.
c. Licensure laws had not yet been passed.
d. Physicians who took up practice in a corporate setting were castigated by the medical profession.

9. Since the early 1900s, the burden of disease in developed countries has shifted
a. to underdeveloped countries
b. from infectious to chronic disease
c. from chronic to infectious disease
d. from the rich to the poor

10. The inception of _____ was used as a trial balloon for the idea of government-sponsored universal health insurance.
a. workers’ compensation
b. trade unions 
c. public health 
d. health care for the veterans

Chapter 4: Health Services Professionals

Multiple Choice Questions

1.  A major factor influencing growth in the health care sector of the U.S. economy is:
 a. The aging of the population
 b. Increasing fertility rates
 c. Declining death rates
 d. All of the above

2.  Which type of health care facility employs the most people in the U.S.?
 a. Physicians’ offices and clinics
 b. Hospitals
 c. Nursing and personal care facilities
 d. None of the above

3.  When patients have multiple health problems, this is called:
 a. Coaffliction
 b. Comortality
 c. Codependency
 d. Comorbidity

4.  The basic source of the physician distribution problem in the U.S. is:
 a. Lack of health care coverage for all 
 b. The need-based model
 c. Lack of awareness that there is a problem
 d. A shortage of MDs

5.  The Nurse Reinvestment Act of 2002 provides:
 a. Grants and scholarships for nurses
 b. Funding for nurse retention programs
 c. Funding for further education for nurses
 d. All of the above

6.  Allied health professionals include:
 a. Osteopaths
 b. Dentists
 c. Physician assistants
 d. None of the above

7.  Physician maldistribution occurs by:
 a. Specialty
 b. Geography
 c. Both a and b
 d. Neither a nor b
8.  Primary care is:
 a. Longitudinal
 b. The portal to the healthcare system
 c. Holistic
 d. All of the above

9.  The principle source of graduate medical education is:
 a. Medicaid
 b. Medicare
 c. Private funds
 d. State grant funds

10. Which of the following is a major criticism of managed care?
 a. Quality of care may be sacrificed
 b. Managed care is inefficient
 c. Utilization may increase
 d. Managed care will worsen the physician oversupply

Chapter 5: Medical Technology

Multiple Choice Questions

1. At a fundamental level, medical technology deals with  
a. production of new equipment to provide more advanced health care 
b. the application of knowledge produced by biomedical research
c. using discoveries made in basic sciences to improve health care 
d. new drugs and devices

2. Telemedicine technology that allows a specialist located at a distance to directly interview and examine a patient is referred to as 
a. telehealth
b. simultaneous 
c. analogous 
d. synchronous

3. The asynchronous form of telemedicine uses_____ technology. 
a. store-and- forward
b. access-when-needed 
c. delayed-access
d. forward-and-retrieve

4. The expectations that Americans have about what medical technology can do to cure illness is based on 
a. the technological imperative 
b. cultural beliefs and values
c. a higher rate of technology diffusion in the US compared to other countries 
d. medical specialization

5. What is the main intent of the Stark laws? 
a. Require that personal health information be kept confidential 
b. Require demonstration of cost-efficiency of new technology 
c. Prohibit self-referral by physicians to facilities in which they have an ownership interest
d. Disclosure of potential harm from a procedure or device

6. Supply-side rationing. 
a. Curtailment in governing funding for medical research 
b. Managed care 
c. Curtailment in payments for new technology
d. Central planning

7. Certain allergy medications containing pseudoephedrine are available without prescription, but must be kept behind the pharmacy counter and sold only in limited quantities upon verification of a person’s identity. 
a. Food and Drugs Act, 1906 
b. Food, Drug, and Cosmetic Act, 1938 
c. Kefauver-Harris Drug Amendments, 1962 
d. Patriot Act 2006

8. The FDA was given the authority to review the effectiveness and safety of a new drug before it could be marketed. 
a. Food and Drugs Act, 1906 
b. Prescription Drug User Fee Act, 1992 
c. Kefauver-Harris Drug Amendments, 1962
d. Food, Drug, and Cosmetic Act, 1938

9. This made additional resources available to the FDA, and resulted in a shortened approval process for new drugs. 
a. Kefauver-Harris Drug Amendments, 1962 
b. Food and Drug Administration Modernization Act, 1997
c. Orphan Drug Act, 1983 
d. Prescription Drug User Fee Act, 1992

10. The Safe Medical Devices Act, 1990 requires  
a. that injuries, illness, or death from any device be reported
b. premarket approval of devices 
c. safety testing of devices before and after they have been marketed 
d. that all problems and potential problems be reported to the FDA

Chapter 6: Health Services Financing

Multiple Choice Questions

1. What is the primary reason that a segment of the U.S. population is uninsured? 
a. Medicare and Medicaid are the only public insurance programs 
b. The U.S. has a voluntary system of health insurance
c. The poor cannot afford health insurance 
d. U.S. health insurance is dominated by managed care

2. What is the central role of health services financing in the United States? 
a. Fund health insurance
b. Underwrite medical risk 
c. Support managed care 
d. Balance the supply of health care professionals

3. What is the primary mechanism that enables people to obtain health care services? 
a. Availability of services 
b. Health insurance
c. Payment for services 
d. Control of expenditures

4. In national health care systems, total expenditures are controlled mainly through 
a. cost shifting 
b. underwriting 
c. supply-side rationing
d. demand-side rationing

5. In a general sense, what is the primary purpose of insurance? 
a. Predicting risk 
b. Risk assessment 
c. Protection against risk
d. Underwriting 

6. What is the primary function of insurance? 
a. Pay claims on behalf of the insured 
b. Underwrite policies 
c. Provide comprehensive coverage 
d. Protection against catastrophic risk

7. What is the main advantage of group insurance?
a. More people can obtain insurance from a single insurer
b. Risk is spread out among a large number of insured
c. More comprehensive services can be covered than under an individual plan
d. The employer has to deal with only one insurance company

8. The majority of beneficiaries receiving health care through Medicare are 
a. elderly
b. disabled 
c. financially poor 
d. those suffering from end-stage renal disease

9. For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed 
a. 30 days 
b. 60 days 
c. 100 days
d. None of the above

10. The dependents of U.S. military personnel receive health care through 
b. Military Health Services System 
c. VHA 
d. TriCare

Chapter 7: Outpatient and Primary Care Services

Multiple Choice Questions:

1.  Typically, tertiary care:
 a. Is highly specialized
 b. Does not depend on technology
 c. Takes place outside of traditional healthcare facilities
 d. All of the above

2.  What is gatekeeping?
 a. The process by which patients are denied needed care
 b. The process by which primary care physicians refer patients to specialists
 c. The concept that specialists use more diagnostic tests than primary care physicians
 d. The idea that patients should be allowed to choose their own doctors

3.  Which country’s health care system is founded on the principles of gatekeeping?
 a. UK
 b. US
 c. Australia
 d. China

4.  Countries whose health systems are oriented more toward primary care achieve:
 a. Higher satisfaction with health services among their populations
 b. Higher expenditures in the overall delivery of care
 c. Worse health outcomes
 d. None of the above

5.  The most prominent reason for the decline in the number of procedures performed in hospitals is:
 a. Most of these procedures were shifted to outpatient setting
 b. Most of these procedures were deemed outdated
 c. Most of these procedures were unsafe
 d. Most of these procedures used technology that was too expensive

6.  What does “PPS” stand for?
 a. Preferred Provider System
 b. Primary Physician System
 c. Private Practice System
 d. Prospective Payment System

7.  One reason women’s health centers were created is:
 a. Women have more money than men
 b. Women seek care more often than men
 c. Women have shorter life spans than men
 d. None of the above

8.  Hospice services are primarily for people with:
 a. Chronic illnesses
 b. Rehabilitative needs
 c. Terminal illnesses
  d. None of the above

9.  What is palliation?
 a. Pain and symptom management
 b. Psychosocial support
 c. A surgical intervention
 d. Bed rest

10.  Community health centers serve primarily: 
 a. High-income neighborhoods
 b. Populations with insurance
 c. Populations which are medically underserved
 d. Both a and b

Chapter 8: Inpatient Facilities and Services

Multiple choice Questions

1. Inpatient care 
a. Services delivered by a hospital 
b. Treatment of acute conditions 
c. Health care delivered in conjunction with an overnight stay in a facility 
d. Care delivered in a licensed facility

2. The biggest share of national health spending is used by 
a. hospitals
b. physicians 
c. prescription drugs 
d. nursing home care

3. The first hospitals in the United States served mainly 
a. the poor
b. the wealthy 
c. those needing surgery 
d. government officials

4. What is the meaning of “excess capacity” in the health care inpatient sector? 
a. Hospital consolidation 
b. Few hospitals 
c. Large institutions 
d. Empty beds

5. The Hill-Burton Act was passed to 
a. make it mandatory for private insurers to cover hospital services 
b. relieve shortage of hospitals
c. curtail the utilization of hospital beds 
d. have federal control over community hospitals

6. ALOS is an indicator of 
a. use of hospital capacity 
b. frequency of use 
c. severity of illness
d. access

7. Which ownership type constitutes the largest group of hospitals and hospital beds in the United States? 
a. Private for-profit 
b. Federal 
c. Private nonprofit
d. State and local government

8. In a hospital classified as short stay, the ALOS is less than
a. 5 days 
b. 10 days 
c. 15 days 
d. 25 days

9. To be classified as a Critical Access Hospital, the number of acute care beds should not exceed 
a. 20 
b. 25
c. 35 
d. 50

10. According to US law, nonprofit organizations  
a. can make only a limited amount of profit 
b. are tax exempt
c. cannot have a governing body 
d. must pay taxes only if they are profitable

Chapter 9: Managed Care and Integrated Organizations

Multiple Choice Questions

1. The managed care phenomenon was welcomed mostly by 
a. employers
b. workers 
c. private insurance 
d. the government

2. With the growth of managed care, the balance of power in the medical marketplace swung toward 
a. providers 
b. the supply side 
c. the demand side
d. more regulation

3. A managed care organization functions like 
a. a provider 
b. an insurer
c. a regulator 
d. a financier

4. What is the purpose of cost sharing with providers? 
a. It makes providers immune to costs 
b. It makes providers cost conscious
c. It rewards providers for quality 
d. It keeps insurance premiums low

5. Capitation is best described as 
a. monthly lump sum payment regardless of utilization
b. monthly lump sum payment regardless of cost 
c. per member per month payment
d. payments capped to a maximum cost for delivering services

6. Under capitation, risk is shifted  
a. from the insured to the employer 
b. from the provider to the MCO 
c. from the employer to the MCO 
d. from the MCO to the provider

7. Under which payment method is a fee schedule used? 
a. prospective payment 
b. capitation 
c. discounted fees
d. fee for service
8. The HMO Act of 1973 required 
a. health care providers to contract with HMOs 
b. managed care organizations to offer HMO alternatives 
c. insurers to switch to managed care 
d. employers to offer an HMO alternative to conventional health insurance

9. In the term, managed care, ‘manage’ refers to  
a. management of utilization
b. management of premiums 
c. management of risk 
d. management of the supply of services

10. Under the fee-for-service system, providers had the incentive to  
a. deliver more services than what would be medically necessary because a greater volume would increase their incomes
b. use less technology because they could increase their incomes by not using costly procedures 
c. indiscriminate cost increases because they could get paid whatever they would charge 
d. increase the level of quality in order to attract more patients

 Chapter 10: Long-Term Care

Multiple Choice Questions

1. Low cognitive functioning places an elderly person at a high risk for 
a. clinical depression 
b. functional decline
c. chronic ailments 
d. acute ailments

2. The elderly do not constitute a homogeneous group; hence 
a. they have more chronic ailments than acute episodes 
b. the LTC system must be integrated with the rest of the health care delivery system 
c. most elderly people live independently 
d. a variety of long-term care services are demanded

3. Which of the following plays a primary role in individualizing long-term care services to the patient’s needs?  
a. Coordination of various services 
b. Physician’s orders 
c. An individual assessment
d. A discharge report from the hospital

4. In the delivery of long-term care, customized interventions are carried out according to 
a. an individual assessment 
b. a plan of care
c. weekly evaluations by the patient’s physician 
d. the philosophy of total care

5. What is the key determinant of the need for long-term care? 
a. A disabling accident 
b. An acute episode 
c. Presence of multiple chronic conditions 
d. Limitations in a person’s ability to perform tasks of daily living

6. What is the goal of long-term care? 
a. Promote functional independence
b. Return a person to independent living 
c. Reverse the decline in activities of daily living 
d. Cope with multiple chronic conditions

7. Which of the following can contribute positively to a person’s quality of life? 
a. Palliation
b. Assessment 
c. Plan of care 
d. Total care

8. Why is the assessment of psychiatric illness particularly difficult in geriatric patients? 
a. Mental illness cannot be ruled out 
b. The elderly often fake mental illness. 
c. Psychiatric illness can be intermittent 
d. Comorbidities can obscure diagnosis

9. Personal care is 
a. Individualized care 
b. Basic assistance with ADLs
c. Services that are nurse-intensive 
d. Long-term care provided by unpaid caregivers

10. Maintenance rather than restoration of functioning is particularly the domain of 
a. custodial care
b. restorative care 
c. skilled nursing care 
d. personal care

Chapter 11: Health Services for Special Populations

Multiple Choice Questions

1.  Which racial/ethnic group is most likely to drink alcohol?
 a. White
 b. Black or African American
 c. Asian or Pacific Islander
 d. Hispanic

2.   Which racial/ethnic group is growing the fastest?
a. White
 b. Black or African American
 c. Asian or Pacific Islander
 d. Hispanic

3.  Which racial/ethnic group is least likely to use mammography?
a. White
 b. Black or African American
 c. Asian or Pacific Islander
 d. Hispanic

4.  Approximately how many Americans are uninsured?
 a. 16 million
 b. 26 million
 c. 46 million
 d. 66 million

5.  Lack of insurance can result in:
a. Decreased utilization of lower cost preventive services
b. Increased need for more expensive, emergency health care
c. The spread of infectious diseases
d. All of the above

6.  Which legislation created the State Children’s Health Insurance Plan (SCHIP)?
 a. Balanced Budget Act of 1997
 b. State Children’s Health Insurance Act of 1997
 c. Kids First Act of 1997
 d. Omnibus Reconciliation Act of 1997

7.  What does “MUA” stand for?
 a. Metropolitan Utilization Area
 b. Medically Underserved Area
 c. Metropolitan Underserved Area
 d. Medical Utilization Area

8.  What is the primary purpose of the National Health Service Corps?
 a. To recruit physicians to provide services in physician shortage areas in the U.S.
 b. To recruit physicians from abroad to work in the United States
 c. To send U.S. physicians to developing countries to provide services to the indigent
 d. To recruit physicians into the military
9.  Among women, which racial/ethnic group has the highest percentage distribution of AIDS?
 a. White, non-Hispanic
 b. Black, non-Hispanic
 c. Hispanic
 d. American Indian

10.  What does the federal Ryan White CARE Act fund?
 a. Care for underserved rural and urban populations
 b. Skin cancer screening programs
 c. School-based health services in predominantly minority neighborhoods
 d. Development of treatment and care options for persons with HIV and AIDS


Chapter 12: Cost, Access and Quality

Multiple Choice Questions

1.  What is Gross Domestic Product (GDP)?
 a. A measure of all the goods and services produced by a nation in a given year
b. A measure of all the goods and services produced by a nation in a given year, divided by the population
c. A measure of all the goods and services produced by a nation in a given year, minus the amount of money spent by the government
d. A measure of all the goods and services produced by a nation in a given year, divided by the amount of money spent by the government

2.  What is a PRO?
 a. Price Rationing Organization
 b. Political Review of Outcomes
 c. Peer Review Organization
 d. President’s Review of Organizations

3.  What is meant by the term “health care costs”?
 a. The price of health care
 b. How much a nation spends on health care
 c. Cost of producing health care
 d. All of the above

4.  Medical cost inflation is influenced by all of the following factors except:
 a. Waste and abuse
 b. Increase in elderly population
 c. Decrease in uninsured
 d. Growth of technology

5.  What are administrative costs?
a. Costs associated with management of the financing, insurance, delivery, and payment functions of health care
b. Costs associated with financing and insurance only
c. Costs associated with delivery and payment functions only
d. None of the above

6.  What is the main reason for the lack of success of health care cost control efforts in the U.S.?
 a. Malpractice lawsuits
 b. Cost shifting by providers
 c. Dislike of the practice by consumers
 d. Growth of technology

7.  Fill in the blank: The distinction between predisposing and enabling conditions can be applied to assess the _______ of a health care system.
 a. cost
 b. equity
 c. efficiency
 d. effectiveness

8.  What is the purpose of clinical practice guidelines?
 a. To provide a plan to manage a clinical problem based on evidence or consensus
 b. To lower costs
 c. To improve outcomes
 d. All of the above

9.  What is the Health Plan Employer Data and Information Set (HEDIS)?
 a. A quality report card
 b. A cost report card
 c. A government database on health plans
 d. None of the above

10.  What are the main activities of risk management?
a. Proactive efforts to prevent adverse events related to clinical care and facilities operations
b. Retrospective studies of adverse events
c. Both a and b
d. Neither a nor b

Chapter 13: Health Policy

Multiple Choice Questions:

1.  Which major public insurance program was legislated in 1965?
 a. Medicare
 b. Medicaid
 c. Both a and b
 d. Neither a nor b

2.  Health policies are used in what capacity?
 a. Regulation of behaviors
 b. Allocation of income, services, or goods
 c. Both a and b
 d. Neither a nor b

3.  What is incrementalism?
 a. The fact that in the U.S., health care is financed by multiple entities
 b. The fragmented, uncoordinated delivery of health services
c. Small policy changes that reflect a compromise amongst different groups’ demands
 d. None of the above

4.  Which of the following branches of government is a supplier of policy?
 a. Executive
 b. Legislative
 c. Judicial
 d. All of the above

5.  What is an interest group?
 a. A group of lawmakers within Congress with a particular area of interest
 b. A group of appointed judges with a particular political view point
c. An independent, non-governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers
 d. None of the above

6.  What was the main purpose of the Kerr-Mills program (1960)?
 a. Provision of federal grants to state government programs assisting the elderly
 b. Provision of federal grants to state government programs assisting the poor
 c. Provision of federal grants to state government programs assisting children
 d. None of the above

7.  For what is the National Health Planning and Resources Development Act of 1974 noted?
a. The shift from cost containment to improvement of quality as the principal theme in federal health policy
b. The shift from cost containment to improvement of access as the principal theme in federal health policy
c. The shift from improvement of access to cost containment as the principal theme in federal health policy
d. The shift from improvement of quality to cost containment as the principal theme in federal health policy

8.  What does “CON” stand for?
 a. Certificate of Need
 b. Certificate of Nursing
 c. Certificate of Naturopathy
 d. Certificate of Nationality

9.  In what way does research influence policymaking?
 a. Prescription
 b. Documentation
 c. Analysis
 d. All of the above

10.  All of the following were identified by the Institute of Medicine (Crossing the Quality Chasm, 2001) as areas for quality improvement, except:
 a. Timeliness
 b. Safety
 c. Efficacy
 d. Patient-centeredness


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