Deck 9: Health Care Systems and Policy

Question 1

In 2013, an estimated 80 million people in the U.S. had no health insurance with the majority being older adults.

Answer 1

False

Question 2

Consumer-directed health plans define employer contributions while asking employees to be more responsible for health care decisions and cost-sharing.

Answer 2

True

Question 3

Cost, access, and quality of health care are interrelated; manipulating one has an impact on the others.

Answer 3

True

Question 4

A prospective payment system involves hospitals being paid a fixed sum per case according to a schedule of diagnosis-related groups.

Question 5

An advantage of the traditional fee-for-service insurance is that it encourages physicians to provide more services than may be necessary.

Question 6

The federal government is responsible for the Medicaid program and defines its eligibility, benefits and services, and payment schedules.

Question 7

Use of generic drugs is one method that has been utilized to help contain the costs of health care.

Question 8

Paradoxically, U.S. health care treats preventable illness rather than investing in prevention.

Question 9

Chronic diseases are the leading causes of death in the United States.

Question 10

Traditional fee-for-service plans are provided by the Centers for Medicare and Medicaid Services (CMS).

Question 11

In some HMO programs, the provider receives a capitation payment, usually a specific amount per enrollee per month, to provide a defined group of health care services.

Question 12

Relative weight reflects the cost of caring for a patient in a particular category with a diagnosis-related group (DRG).

Question 13

Over two-thirds of national health care expenditures are from hospital care, physician and clinical services, and prescription drugs.

Question 14

A specific issue that Healthy People 2020will monitor over the next decade is decreasing use of home health services and increasing hospital emergency use.

Question 15

Medicare pays qualified dietitians and nutrition professionals who enroll in the Medicare program as providers, regardless of where they provide medical nutrition therapy (MNT) services.

Question 16

In the United States, there are two general categories of health insurance: private insurance and managed care plans.

Question 17

Government health insurance plans are provided through an employer or a union.

Question 18

As currently used, the term "health care reform" refers to the efforts undertaken to ensure that everyone in the United States has access to affordable, quality health care.

Question 19

A self-insured health plan describes a plan where the risk for medical costs is assumed by the patient, rather than an insurance company.

Question 20

The Children's Health Insurance Program initiative was designed to reach children who are part of working families with incomes too high to qualify for Medicaid but too low to afford private health insurance.

Question 21

The biomedical approach to medicine underestimates and underemphasizes behavioral and lifestyle influences on disease.

Question 22

What best describes how a PPO differs from an HMO?

A)Only PPOs enter into agreements with health care providers
B)A member of a PPO is not required to select a primary care provider
C) A PPO limits coverage to only care from specialists
D) A PPO requires higher deductibles than HMOs

Question 23

Under the Children's Health Insurance Program (CHIP), states may target eligible uninsured children by ____.

A)setting maximum allowable amounts for medical assets
B)offering enrollment at designated times
C) expanding their Medicaid programs
D) increasing parameters for disability diagnoses

Question 24

To be able to receive benefits through a Medicare Advantage Plan (Part C), an individual must have ____.

A)Medicare parts A and B
B)evidence of a disability
C) at least one minor dependent
D) an income that is at or above the federal poverty line

Question 25

Medicare was amended in 2000 to cover nutrition therapy as an outpatient benefit under Part B of the Medicare program.

Question 26

When those without health insurance get sick, they often wind up using ____ when they do need care.

A)primary care providers
B)public health clinics
C) hospital emergency rooms
D) home health services

Question 27

Approximately 48% of Americans receive their health care coverage through ____.

A)Medicaid
B)employer-sponsored insurance
C) Medicare
D) other public insurance

Question 28

Health maintenance organizations are designed to make money by ____.

A)charging fees for each service rendered
B)keeping people healthy
C) limiting coverage to chronic disease and disabilities
D) avoiding public health models of care

Question 29

The cost effectiveness of nutrition services is uncertain.

Question 30

The challenge for the next decade is to change the U.S. approach to health care from a system based on disease prevention and health promotion to one based on treatment of acute conditions.

Question 31

The United States spends less than 5% of all dollars directed toward health care on public health and disease prevention.

Question 32

What best describes a benefit of a point of service (POS) plan?

A)Plan members can get medical care from both in- and out-of-network providers.
B)Plan members receive a tax-advantaged health reimbursement arrangement.
C) Plan members can use specialty services without requiring a referral.
D) Plan members are always enrolled in a health savings account.

Question 33

Which type of health insurance is available as either traditional plans or group contract insurance?

A)private insurance
B)preferred provider plans
C) health maintenance organizations
D) public health plans

Question 34

Benefits provided by Medicare Part A include ____.

A)inpatient hospital care
B)diagnostic x-rays
C) ambulance services
D) medical nutrition therapy services

Question 35

Public policy is now attempting to direct the medical system toward ____.

A)disease prevention
B)illness treatment
C) chronic disease management
D) complementary and alternative therapies

Question 36

The International Classification of Diseases was written to guide decision making in areas of moral conflict and to outline the obligations of the practitioner to self, client, society, and the profession.

Question 37

An individual who is ____ would be eligible for Medicare benefits.

A)living on an income below the poverty line
B)retired from fulltime employment
C) eligible for Social Security disability programs for 24 months
D) living in a state that has health insurance benefits

Question 38

The Affordable Care Act (ACA) includes regulations on private market health plans that allow employers to insure participants based on current health status.

Question 39

​What best describes an overarching goal of the health agenda Healthy People 2020?

A)​supporting financial incentives for chronic disease treatment
B)​creating physical environments that promote good health for all
C) ​assigning a treatment role to the health care model
D) ​increasing per capita spending on managing functional health impairments

Question 40

Enrolled Medicare MNT providers are able to bill Medicare for MNT services provided to Medicare beneficiaries with ____ using specified codes.

A)rheumatoid arthritis
B)type 1 diabetes
C) gastro esophageal reflux
D) dementia

Question 41

To determine the rating of a particular health care system, one must examine three crucial variables: cost, quality, and ____.

A)property
B)access
C) budgets
D) injuries

Question 42

By 2030, approximately ____ percent of the population will be over 65 years of age.

A)13
B)17
C) 21
D) 26

Question 43

Which element is a component of the Affordable Care Act to reform health care?

A)Medicaid eligibility is available for people who live at up to 55% of the national poverty level.
B)Pre-existing conditions have been eliminated from care considerations.
C) Young adults can be covered by their parents' insurance until they reach age 18.
D) Individuals and small businesses can buy health insurance through insurance exchanges.

Question 44

For the past several decades, the dominant health model has been the ____.

A)prevention model
B)activity model
C) wellness model
D) medical model

Question 45

The two most notable gaps in Medicare coverage have been ____.

A)rehabilitation services and in-hospital care
B)skilled nursing care and prescription drug coverage
C) primary care physician services and durable medical equipment costs
D) home health care and palliative or hospice care

Question 46

The uninsured most often include____.

A)older adults
B)self-employed business men and women
C) those with end-stage renal disease
D) pregnant women

Question 47

The Medicare Modernization Act provides what benefit as part of optional coverage for Medicare recipients?

A)inpatient hospital care
B)psychiatric and mental health services
C) long-term institutional care
D) cardiovascular disease blood screening

Question 48

In 2013, approximately ____ percent of the U.S. population was uninsured.

A)8
B)13
C) 17
D) 20

Question 49

What best describes how medical nutrition therapy can reduce health costs?

A)It reduces out-of-pocket costs for acute illnesses.
B)It improves patient outcomes and reduces recovery times.
C) It has unlimited financial holdings on health coverage.
D) It is easier to implement when compared to most medical treatments.

Question 50

The largest component of national health care expenditures is ____.

A)hospital care
B)physician and clinical services
C) prescription drug coverage
D) long-term care

Question 51

A consequence of the prospective payment system is _____.

A)the elimination of palliative care services
B)a restriction for dietitians to provide inpatient services
C) an increased focus on outpatient as opposed to inpatient care
D) the replacement of allied health services with nursing care

Question 52

A health insurance contract that is made with an employer or other entity and covers several people by reference to their relationship to the entity is known as a ____.

A)group contract
B)managed care system
C) point-of-service plan
D) exclusive provider contract

Question 53

What best describes one of the challenges to health care reform?

A)making health care accessible only to those with disabilities
B)understanding why some individuals are qualified for health care coverage
C) gaining access to federal funds for health expenditures
D) providing nursing home care to those who need it

Question 54

What trend characterizes the cost-containment efforts of third-party payers to control their own costs?

A)avoiding corporate management of health care costs of employees
B)moving away from managed care to fee-for-service models
C) moving toward cost shifting in order to avoid self-insured health plans
D) setting reimbursement restrictions and limitations

Question 55

The level of health care activity is expected to grow as a result of various factors, including ____.

A)expanded guidelines for diagnosing chronic health problems
B)increased health disparities between racial and ethnic minorities
C) growth of infant mortality rates
D) continuing advances in medicine

Question 56

When nutrition services are integrated into health care and diet and nutritional status change, what outcome is most likely to occur?

A)Blood pressure in hypertensive patients is lowered.
B)The prevalence of hemophilia is reduced.
C) Instances of premature infant delivery is reduced.
D) Patients report greater satisfaction in their personal relationships.

Question 57

Dietetics practitioners have voluntarily adopted the Code of Ethics to set forth obligations of the dietetics practitioner to the self, clients, society, and _____.

A)the government
B)insurance companies
C) the profession
D) third-party payers

Question 58

Medicaid provides assistance with medical care for ____.

A)Medicare-covered government employees
B)people with end-stage renal disease
C) people eligible for Social Security benefits
D) blind persons

Question 59

What best describes the concept of the prospective payment system?

A)The patient pays a specific portion of his own medical care.
B)Insurers are given discounts to cover the costs of charity care.
C) Insurance plan members pay certain amounts to preferred providers within a network.
D) Hospitals are paid a fixed sum according to diagnosis related groups.

Question 60

Because medicine has its roots in the treatment of acute disease, proposals for changes in medical education have emphasized the need to train physicians to _____.

A)develop wellness plans to prevent acute illnesses
B)diagnose patients with short-term disabilities
C) treat patients with chronic diseases
D) make diagnoses that will provide the most reimbursements

Question 61

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

Question 62

​Match the HMO model with its correct description. Options will only be used once.
a.​Group model
b.Independent practice association
c.​Network model
d.​Staff model
​HMO owns and operates its own facility, is equipped for laboratory, pharmacy, and X-ray services, and hires its own physicians and other health care providers.

Question 63

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
a.Medicaid
b.Medicare
​Financed by taxes from federal, state, and local sources

Question 64

​Match the HMO model with its correct description. Options will only be used once.
a.​Group model
b.Independent practice association
c.​Network model
d.​Staff model
​HMO contracts with one or more multispecialty group practices that contract to provide health care services to its members.

Question 65

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

Question 66

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
a.Medicaid
b.Medicare
​Consists of Part A and Part B

Question 67

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

Question 68

​Match the HMO model with its correct description. Options will only be used once.
a.​Group model
b.Independent practice association
c.​Network model
d.​Staff model
​The HMO model is decentralized.

Question 69

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​Payment made by a third party

Question 70

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​A prepaid plan that both finances and delivers health care

Question 71

​Match the HMO model with its correct description. Options will only be used once.
a.​Group model
b.Independent practice association
c.​Network model
d.​Staff model
​HMO contracts with multiple group practices, hospitals, and other providers to provide services to its members, but in a non-exclusive arrangement.

Question 72

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​A predetermined fee paid per enrollee per month to the participating health care provider

Question 73

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

Question 74

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
a.Medicaid
b.Medicare
​Social Security Administration handles enrollment

Question 75

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​Portion of the charge for medical services that the patient must pay

Question 76

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
a.Medicaid
b.Medicare
​Federal-state partnership assistance program

Question 77

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
a.Medicaid
b.Medicare
​Assists individuals with end-stage renal disease

Question 78

Match the description in the left column with one of the two programs in the right column. The same letter may be used more than once.
a.Medicaid
b.Medicare
​Serves certain pregnant women and infants with family incomes below 133% of the poverty level

Question 79

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​Health insurance contract that is made with an employer and covers a group of employees

Question 80

​Match the definition in the left column with its correct term in the right column. Options will only be used once.
a.​capitation
b.coinsurance
c.copayment
d.deductible
e.​group contract
f.​HMO
g.​managed-care system
h.​PPO
i.​prospective payment system
j.​reimbursement
​A payment system under which hospitals are paid a fixed sum per case