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62 Cards in this Set

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U.S. annual health care expenditures far outstrip those of 7 other developed nations. In relationship with expenditures, U.S. health population status ranking on critical indicators in comparison with those other developed nations is:

c. Dismally lower

a. Remarkably higher


b. About equal


c. Dismally lower


d. None of the above

In the past, patient behaviors within the health care delivery system were formed from the authoritarian positions of better-educated providers who expected patients to be compliant and grateful. Today,health care providers and consumers:

c. encourage more proactive roles for patients’ participation inhealth care decisions with “shared decision-making”

a. show increased appreciation for the reasons why healthprofessionals’ deserve superiority


b. are fully bonded with each other in a joint, consumer-drivenmindset


c. encourage more proactive roles for patients’ participation inhealth care decisions with “shared decision-making”


d. increasingly rely on the legal system to determine boundariesof patient/provider decision-making about treatment options

In the natural history of a disease, the pre-pathogenesis periodrefers to:

a. Behavioral, genetic, environmental and other factors that maycontribute to an individual’s likelihood of contracting a disease

a. Behavioral, genetic, environmental and other factors that maycontribute to an individual’s likelihood of contracting a disease


b. The period after disease diagnosis when a treatment plan isdeveloped


c. The period of post-acute treatment care planning to preventfurther complications


d. Pre-natal assessment of potential fetal disorders

Of the levels of prevention associated with the natural history of disease, primary prevention refers to:

d. health education and specific protection

a. early diagnosis and prompt treatment


b. disability limitation


c. rehabilitation


d. health education and specific protection

Americans spend $9 billion + each year on alternative and complementary therapies. This trend has caused:

c. many private insurers and Medicare and Medicaid to providebenefit coverage for certain treatments

a. the federal government to strictly regulate alternative andcomplementary therapy providers


b. insurers refusing to pay for complementary and alternativetherapy treatments


c. many private insurers and Medicare and Medicaid to providebenefit coverage for certain treatments


d. Government restrictions on Internet marketing of alternativeand complementary therapie

The U.S. healthcare delivery system has numerous stakeholders. In terms of financial power, control of delivery system parameters for the majority of Americans and influence on consumers and providers of health care, which of the following pairs of stakeholders is the most influential:

a. Government and private health insurers

a. Government and private health insurers


b. Consumers and providers


c. Government and consumers


d. Hospitals and health care professionals

The service priorities of the U.S. health care system reflect America’s fascination with dramatic high-tech medicine. As a result:

d. all of the above

a. little of the health care dollar is spent on prevention


b. the US system is the most expensive in the world


c. the US has the world’s most advanced medical capability


d. all of the above

Long term care needs of older, chronically ill Americans pose a particular delivery system challenge because:

b. Neither Medicare nor private insurance support ongoing, non-acute services

a. Most prefer to be cared for in nursing homes


b. Neither Medicare nor private insurance support ongoing, non-acute services


c. Personal long term care insurance is not available in moststates


d. Individuals choosing hospice care are depleting hospitalrevenues for end-of life services

Potential conflicts of interest occur when physicians own or investing businesses (e.g. diagnostic, medical supply companies) to which they can refer patients to generate profits. In response to these physician conflict of interest issues:

a. The ACA includes “Sunshine provisions” require reporting of all financial transactions and transfers of value between pharmaceutical/biologic product manufacturers and physicians,hospitals and other entities reimbursed by the federal government

a. The ACA includes “Sunshine provisions” require reporting ofall financial transactions and transfers of value betweenpharmaceutical/biologic product manufacturers and physicians,hospitals and other entities reimbursed by the federal government


b. The American Medical Association prohibits its members fromowning businesses to which they could refer in order to generateprofits


c. State medical societies outlaw membership by physicians owningprofit-making entities


d. Professional physician societies successfully convincedlegislators to allow physician ownership and/or interests inprofit-making corporations

In its early origins in colonial America, the patient/physician relationship can be best characterized as:

c. Personal, confidential and simple with payments based on patients’ financial capacity

a. Interactive and supportive of patient involvement in treatment decisions


b. Complicated in terms of the ways that patients paid for treatment


c. Personal, confidential and simple with payments based on patients’ financial capacity


d. Strict “contracted” arrangements between physicians andpatients

As early as the 19th century some Americans carried “health insurance” through employers, fraternal orders, guilds, trade associations, unions or commercial insurance companies. However unlike health insurance of today, these insurance policies only provided for:

b. Fixed payments to compensate for lost wages due to injury,sickness or disability

a. Maternity care


b. Fixed payments to compensate for lost wages due to injury,sickness or disability


c. Job-related injuries


d. Infectious diseases acquired in the workplace

Blue Cross Hospital Insurance, the predominant form of health insurance for decades, was modeled after:

a. Baylor University Hospital’s school teachers plan

a. Baylor University Hospital’s school teachers plan


b. trade union “sickness” insurance


c. the industrial policies of Metropolitan and Prudential


d. the American Hospital Association policies

The American Medical Association’s initial reaction to Blue Cross hospital insurance plans suggested that the plans:

b. Were unsound and unethical

a. Would strengthen the quality of hospital care


b. Were unsound and unethical


c. Should be available only to professional workers


d. Would help boost physician income

The most significant social legislation passed by any Congress in the history of the United States was the:

d. Social Security Act of 1935

a. Health Maintenance Organization Act of 1973


b. Hill-Burton Act of 1946


c. Social Security Act amendments creating Medicaid and Medicare


d. Social Security Act of 1935

The major health care advances of the second half of the 20th century were in the area of:

b. vaccines and antibiotics to prevent and control infectiousdiseases, tranquilizers, the birth control pill

a. imaging technology


b. vaccines and antibiotics to prevent and control infectious diseases, tranquilizers, the birth control pill


c. infertility management


d. joint replacement technology

The explosion of science and technology in the 1970's resulted in which of the following?

d. All of the above

a. Encouragement for physicians’ specialization


b. Higher costs of health care


c. Medical school efforts to attract more students to primarycare


d. All of the above

The Oregon Death with Dignity Act was a response to which of the following?

c. public and professional concerns about painful and demeaning terminal medical care

a. legal challenges to hospice care


b. inadequate Medicaid resources to pay for terminal care


c. public and professional concerns about painful and demeaning terminal medical care


d. overcrowded hospital intensive care units

A central provision of the ACA to assure health care coverage for most Americans is:

a. the individual mandate

a. the individual mandate


b. national prevention strategy


c. the independent payment advisory board


d. the small employers’ health insurance option

The Medicaid program has a history of very low reimbursement as compared with Medicare reimbursement; critics site low Medicaid reimbursement as a major reason that primary care doctors have rejected serving the Medicaid population. An ACA provision addresses this issue by:

b. Reimbursing states for primary care physician fees for Medicaid patients at no less than 100% of Medicare payment rates

a. Rewarding primary care physicians with bonuses based onincreased of numbers of Medicaid patients they serve in specifictime periods


b. Reimbursing states for primary care physician fees forMedicaid patients at no less than100% of Medicare payment rates


c. Requiring Medicaid patients to pay higher co-pays anddeductibles for each physician visit


d. Requiring physicians to document their losses from Medicaidpayment in relation to their costs in order to receive increasedreimbursement for services to Medicaid patients

In colonial America, the primary functions of hospitals were to:

b. shelter older adults, the dying, orphans, and vagrants and protect community residents from contagiously sick and mentally ill persons

a. support scientific research


b. shelter older adults, the dying, orphans, and vagrants and protect community residents from contagiously sick and mentally ill persons


c. provide congregate sites for training of nurses


d. provide entrepreneurial enterprises for business-mindedphysicians

The development that contributed most significantly to the decline of the social mission of voluntary hospitals was the:

b. enactment of private and public insurance reimbursement for hospital care

a. specialization of clinical practice


b. enactment of private and public insurance reimbursement forhospital care


c. development of high-technology hospital care


d. passage of 1973 HMO legislation

The ultimate responsibility for a hospital’s quality of care,including the medical care provided, rests with a hospital’s:

c. board of directors

a. medical staff organization


b. department of quality management


c. board of directors


d. chief executive officer

A major obligation of doctors when obtaining informed consent for a medical procedure is to:

c. ensure that the patient understands the risks and benefits of the procedure

a. shield the patient from information about possible negativeside effects


b. ensure that family members agree with the patient’s decision


c. ensure that the patient understands the risks and benefits ofthe procedure


d. protect themselves from malpractice claims

Until the mid-1980's, hospitals were reimbursed for whatever they charged on a “retrospective” basis. Now they are paid a certain amount for each patient’s care on a predetermined “prospective” basis. The amount they are paid is based on:

b. diagnosis related groups (DRGs)

a. empirical data


b. diagnosis related groups (DRGs)


c. Costs of resources used


d. prospective patient categories (PPCs)

Through discharge planning, hospitals help assure that safe and appropriate post-hospital accommodations are arranged for each patient.Medicare patients may appeal what they believe to be a premature or inappropriate discharge by petitioning which of the following organizations?

c. quality improvement organization (QIO)

a. hospital board of directors


b. hospital medical staff organization


c. quality improvement organization (QIO)


d. American hospital association

In health care, which of the following terms refers to a system that includes several service components with each addressing one or more dimensions of a population’s health care needs?

a. Vertically integrated

a. Vertically integrated


b. Laterally integrated


c. Parallel structured


d. Horizontally integrated

For many years, the standard for assessing hospital quality of care was peer review using physician audits of selected patient records to judge “the degree of conformity with preset standards.” Which of the following was not a reason for the ineffectiveness of such audits?

b. Hospital administrators influenced how reviewers were selected

a. Reviewers used implicit standards to make qualitativejudgments


b. Hospital administrators influenced how reviewers were selected


c. No rational basis existed for chart selection to permitextrapolation of sample findings to the larger patient population


d. When deficiencies were identified, reviewers were reluctant topass judgment on their colleagues

In its landmark report on hospital errors, “To Err is Human,” the Institute of Medicine emphasized that errors in care most typically originate from which one of the following sources?

d. Deficiencies in the systems of care

a. Distracted, fatigued physicians


b. Inadequate nurse training


c. Medical equipment failures


d. Deficiencies in the systems of care

“Hospitals can no longer live in a four-walls, brick and mortar world.” This statement refers to which encompassing principle of healthcare reform?

c. focus on population health status with community-based care delivered in multiple provider sites

a. Primary doctors will be the system leaders, not specialists


b. Almost every American will have health insurance coverage


c. focus on population health status with community-based care delivered in multiple provider sites


d. measures of hospital quality will become more transparent andavailable to the public

A major trend is hospital corporate organization over the past few years as hospitals strategically prepared for system reforms has included:

a. Mergers and consolidations into larger systems of care

a. Mergers and consolidations into larger systems of care


b. Downsizing of nursing and related support personnel


c. Closures of ambulatory clinics


d. Publicly disclosing fees and charges to improve competitivemarket position

Hospital value-based purchasing now required by the ACA for over 3,000 Medicare participating hospitals is a program that may be best described as using:

c. Incentive payments for achievements and improvements in clinical care and patient satisfaction

a. Hospital fines and penalties for readmissions with the samediagnosis within 30 days of discharge


b. Consolidated Medicare payments based on a complete “episode ofcare” rather than piecemeal payments for individual services


c. Incentive payments for achievements and improvements inclinical care and patient satisfaction


d. Organizations composed of multiple providers which are paidincentives for enabling Medicare patients to avoid hospitalization

Hospitals in the future health care system will:

b. no longer be the axis of health care delivery but retain roles as sites of sophisticated care, professional teaching and clinical research

a. expand as hubs of more technologically sophisticated healthcare systems


b. no longer be the axis of health care delivery but retain coreroles as sites of sophisticated care, professional teaching andclinical research


c. surrender their charitable missions to embrace profit-makingprinciples


d. emphasize competition with community physicians

The technological and clinical advances that allow many surgical procedures to be safely performed on an ambulatory basis had what corollary effect on hospitals?

b. Physicians became competitors with hospitals for the samelines of business

a. New joint-business relationships with physicians rapidlydeveloped


b. Physicians became competitors with hospitals for the same lines of business


c. Hospitals sold their ambulatory services to physician groups


d. Hospital outpatient service volume and revenues increased

The primary organizational mode of medical care in the United States, in terms of volume of services delivered, is:

b. private practice physicians’ offices

a. hospital ambulatory clinics


b. private practice physicians’ offices


c. community-based clinics run by voluntary agencies


d. government-operated health clinics.

Which of the following is not a principle of a patient-centered medical home practice?

d. Appointment systems adhere to strictly enforced, advance scheduling

a. providing for all of a patient’s health care needs orappropriately arranging care with other qualified professionals.


b. The personal physician leads a team of individuals in thepractice who take responsibility for the ongoing care ofpatients.


c. Care is coordinated and integrated across all elements of thedelivery system (subspecialty, hospital, home, nursing home),facilitated by electronic record registries


d. Appointment systems adhere to strictly enforced, advance scheduling

In today’s hospitals, outpatient clinics frequently provide:

d. all of the above

a. care for those without private physicians


b. teaching sites for medical residents


c. primary-care services organized similarly to private physicianoffices


d. all of the above

A significant advance in the provision of hospital emergency department services occurred with the introduction of:

b. board-certified emergency medicine physicians

a. physician assistants


b. board-certified emergency medicine physicians


c. MRI diagnostic equipment


d. electronic health records

“Urgent Care” is best described as care:

a. provided on a walk-in, extended hour basis for acute illnessand injury that is either beyond the scope of or availability ofa primary care practice or retail clinic

a. provided on a walk-in, extended hour basis for acute illnessand injury that is either beyond the scope of or availability ofa primary care practice or retail clinic


b. providing a service alternative to crowded emergencydepartments


c. that does not require the services of a physician


d. for fast treatment of easy-to-diagnose conditions

The predominant services of local public health departments today are:

d. child and adult immunizations

a. specialty services for high-risk pregnant women


b. school-based pediatric medical care


c. chronic disease screening


d. child and adult immunizations

The primary owners of community-based ambulatory surgical centers are:

c. physicians

a. hospital corporations


b. shareholders of publicly-traded companies


c. physicians


d. physician specialty societies

In addition to providing primary and preventive care, federally qualified community health centers also:

c. help patients link with other supportive programs and services such as welfare, Medicaid, the Women, Infants and Children supplemental nutrition program (WIC) and the Child Health Insurance Program.

a. provide leadership for housing renewal in inner-cities.


b. offer a broad array of high-tech, medical specialty services


c. help patients link with other supportive programs and services such as welfare, Medicaid, the Women, Infants and Children supplemental nutrition program (WIC) and the Child Health Insurance Program.


d. advocate politically for health insurance for low-income individuals.

In colonial America, the primary mode of medical education was:

d. A. and C.

a. student apprenticeship with European trained physicians


b. applied folklore using herbal remedies


c. on-the-job experience in one of the few existing hospitals


d. A. and C.

Medical societies were first established for the primary purpose of:

c. improving the quality of medical education and practice

a. overseeing the construction of new medical schools


b. promoting medical school affiliations with hospitals


c. improving the quality of medical education and practice


d. establishing national standards for granting the MD degree

In 1905, the American Medical Association, with support from the Carnegie Foundation, commissioned a study of U.S. medical schools in response to decades of concern about the quality of medical education and training. The resulting Flexner Report is considered a benchmark in the history of medical education because it:

d. B. and C

a. resulted in the closure of all medical schools that did notmeet established quality criteria


b. stimulated licensing legislation and established newrequirements pertaining to training lengths and quality standardsin laboratories and other training facilities


c. resulted in contributions of large sums of charitable dollarsfrom foundations and wealthy individuals


d. B. and C

In 1965, the federal government recognized the contributions of medical-school/teaching-hospital research and training activities in advancing the sophistication and effectiveness of medical care with the passage of:

a. Regional Medical Program legislation

a. Regional Medical Program legislation


b. Medicare and Medicaid legislation


c. Health Systems Agency legislation


d. The Health Professions Education Assistance Act

Academic Health Centers may be best described as:

c. complexes of medical schools and other health professional schools -- such as nursing, pharmacy, dentistry, and allied health -- affiliated with each other and with teaching hospitals and other research and clinical facilities

a. complexes of medical schools and teaching hospitals on the same campus


b. major research facilities that are affiliated with a teaching hospital and a medical school


c. complexes of medical schools and other health professional schools -- such as nursing, pharmacy, dentistry, and allied health -- affiliated with each other and with teaching hospitals and other research and clinical facilities


d. major hospitals that attract complex medical cases that provide valuable teaching experience for medical students

In order to provide direct patient care, physicians are required to:

b. complete a 3-7 year accredited residency program and pass amedical board exam of she state in which they will practice

a. pass a national licensing examination immediately followingmedical school graduation


b. complete a 3-7 year accredited residency program and pass amedical board exam of she state in which they will practice


c. Serve under an appointed mentor in their specialty field for adesignated period of time


d. participate in approved collaborative training programs withallied health professionals

Which of the following organizations is responsible for approving the content of post-medical school residency training?

c. Accreditation Council for Graduate Medical Education

a. American Medical Association


b. Association of Academic Health Centers


c. Accreditation Council for Graduate Medical Education


d. American Board of Medical Specialties

The U.S. imbalance between specialty physicians and primary care physicians has its origins in many factors. Which of the following does not contribute to physicians’ attraction to specialty medicine over primary care?

b. Higher government tuition subsidies for specialty training

a. Academic health center socialization processes that shapeskills, values and attitudes


b. Higher government tuition subsidies for specialty training


c. Significant income differentials between specialists andprimary physicians


d. Easier life-work balance management issues for specialists

Physician employment by hospitals continues on a pathway of steady growth. One reason why physicians are leaving private practice for hospital employment is:

c. increasingly complex health insurance and information technology demands of private practice

a. hospitals offer significantly higher earning potential thanprivate practice


b. the desire to be more involved in teaching medical residents


c. increasingly complex health insurance and informationtechnology demands of private practice


d. a desire for “corporate identity” associated with hospitals

Health care reforms will change the emphasis in medical practice from treating illness in individual patients to maintaining wellness in community populations. This shift poses major challenges to the medical education process because:

d. all of the above

a. medical school education and training has focused on curingillness, not preventing it


b. the health care delivery system is largely operated as a“complaint-response” system


c. community health and preventive medicine has historically beenassigned low priority in medical school curricula


d. all of the above

Health care system changes, including advancing technology, will likely result in new, more highly specialized health occupations. Which of the following is not one of the expected effects of this development?:

d. hospitals’ resistance to employing multi-skilled personnel

a. a reduction of providers’ flexibility to develop moreefficient staffing patterns


b. increased personnel costs


c. increasing challenges of small and rural providers inretaining specialty-trained personnel


d. hospitals’ resistance to employing multi-skilled personnel

States try to protect the public from incompetent care by licensing certain health professions. Certification differs from licensing, in that certification:

a. only recognizes special education or training

a. only recognizes special education or training


b. does not assure continuing competency


c. may not examine the important competencies


d. allows people to engage in activities that would otherwise beillegal

A physician residency training program is best described as:

b. an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medical specialty

a. a program enabling medical school graduates to become familiar with a population’s needs in a specific geographic area


b. an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medicalspecialty


c. specialized training in the business operations of a medicalpractice


d. the first opportunity for medical students to have actualcontact with patients

Each year approximately 6,000 international medical graduates (IMGs) enter the U.S. to practice. IMGs are vitally important to the health care delivery system because they:

c. they fill a shortfall in the number of residents required by U.S. hospitals

a. receive education superior to that of most U.S. medical students


b. they are willing to work for less compensation than U.S.physicians


c. they fill a shortfall in the number of residents required by U.S. hospitals


d. are more likely to engage in primary care than their U.S.counterparts who prefer specialty medicine.

At the outset of the nurse practitioner movement, educational requirements were often limited to relatively short certificate programs. Today, it is generally accepted that nurse practitioners should be registered nurses with:

c. a master’s degree

a. an associate’s degree


b. a hospital certificate of nursing competency


c. a master’s degree


d. a doctoral degree

Unlike medicine, dentistry essentially remains a “cottage industry,” primarily serving only those with dental insurance or who can afford to pay out-of-pocket. For this reason:

a. Many of the population groups with the greatest need have no access to services

a. Many of the population groups with the greatest need have noaccess to services


b. Most dentists specialize in one of 8 specialty areas


c. The American Dental Association has shown little interest inincreasing minority recruitment to better reflect racial andethnic diversity of the U.S. population


d. Few dental schools offer advanced degrees in dental publichealth

The category of allied health professionals, “therapeutic science practitioners” concerned with the treatment and rehabilitation of patients with all types of diseases and injuries include which of the following professions?

c. Physical and occupational therapists, speech language pathologists

a. Laboratory technologists and technicians


b. Social workers and rehabilitation counselors


c. Physical and occupational therapists, speech languagepathologists


d. Alternative therapists

Complementary medicine differs from alternative medicine in that complementary medicine:

a. is used together with conventional medical treatment while alternative medicine is used in place of conventional medical treatment

a. is used together with conventional medical treatment whilealternative medicine is used in place of conventional medicaltreatment


b. is limited to treatment by certified providers


c. uses only organic substances in treatment


d. is licensed by the Food and Drug Administration

The widespread use and popularity of complementary and alternative medicine in the U.S. resulted in which of the following developments?

a. The National Institutes of Health creating the National Centerfor Complementary and Alternative Medicine (NCCAM)

a. The National Institutes of Health creating the National Centerfor Complementary and Alternative Medicine (NCCAM)


b. Most states’ licensure of complementary and alternative therapists


c. Schools of Pharmacy developing specialty training in herbal medicine


d. New medical residency training opportunities in natural healing

The ACA addressed numerous long-standing health workforce issues.Most importantly, it established the National Health Care Workforce Commission with the overall mandate to:

d. Evaluate and make recommendations in areas such as training and support for workers at all levels, efficient work forced employment, professional compensation and coordination among different types of providers

a. Ensure private, philanthropic tuition support for minorityapplicants to professional schools


b. Increase the number of International Medical Graduates fordeployment in rural and inner-city underserved geographic areas


c. Require states to take more regulatory control of all healthprofessions and develop new schools of public health


d. Evaluate and make recommendations in areas such as trainingand support for workers at all levels, efficient workforcedeployment, professional compensation and coordination amongdifferent types of providers

Major obstacles to ensuring an efficient and rational health workforce in the future include:

c. Separate and often conflicting interests of governments,educational institutions, professional organizations, insurers and providers

a. An inadequate number of educational institutions toaccommodate qualified students


b. An influx of foreign-trained graduates that exceeds demand


c. Separate and often conflicting interests of governments,educational institutions, professional organizations, insurersand providers


d. Declining need for health care professionals in severalcategories of practice