Deck 2: The Landscape for Health Communication

Question 1

A DRG is best described as:

A) A drug rehab goal, meant to establish guidelines for using various pharmaceutical therapies
B) A code name for a government agency concerned with improving medical care in the United States
C) A diagnosis-related group, established to set parameters on what health care organizations are reimbursed for treating various conditions
D) The Domiciliary Regulatory Commission that decides which state laws apply to malpractice claims that span state borders

Answer 1

C
Explanation: A diagnosis-related group (DRG) establishes a flat-rate reimbursement for specified hospital procedures (e.g., a certain amount paid for an appendectomy) established in advance rather than based on actual costs incurred by the health provider.

Question 2

One provision of the Affordable Care Act is an individual mandate, which means that:

A) People are required to have their children immunized by age 5.
B) People are given the freedom to have home health care rather than be admitted to hospitals.
C) All citizens, with a few exceptions, must maintain health insurance coverage.
D) People who are age 65 and older must register 2 years in advance to qualify for federally funded health insurance plans.

Answer 2

C
Explanation: An individual mandate requires everyone to have health insurance, usually with subsidies.

Question 3

When patients who do not have insurance pay for their own care, they engage in:

A) capitation
B) fee for service
C) reimbursement
D) the Cooperative Member Model

Answer 3

B
Explanation: Fee-for-service is the practice of paying a care provider for specific care provided, as opposed to a capitated amount paid in advance regardless of services rendered.

Question 4

Which of the following offers the greatest incentive to keep people healthy?

A) A pluralistic health system
B) A multi-payer system
C) A single-payer system
D) Universal coverage

Question 5

As the overall population becomes more diverse and older, how is health care likely to be affected?

A) More people will be able to afford medical treatment.
B) People will be better informed, reducing the need for prevention efforts.
C) Care providers and patients may be very different from each other.
D) The overall health of the population is likely to improve.

Question 6

is based on a commitment to offer health services to everyone who needs them, regardless of age, ability to pay, or any other factor.

A) Free enterprise
B) Universal coverage
C) Communal taxation
D) The U.S. tax system

Question 7

Which of the following is most accurate?

A) The United States system is based on France's model.
B) The United States passed federal individual mandate laws in 1995.
C) The United States is primarily a multi-payer system.
D) The United States is a Six Sigma system.

Question 8

Managed care was created mostly to:

A) Allow physicians to make more money
B) Control health care costs
C) Drive specialists out of business
D) Reduce bureaucracy in health care

Question 9

When patients pay a set fee per year or month to cover all the medical services they will need, this is called:

A) Capitation
B) Fee for service
C) Reimbursement
D) The Cooperative Member Model

Question 10

The difference between an HMO and a PPO is:

A) Patients who are members of a PPO have less opportunity to choose their own caregivers than do members of an HMO.
B) HMOs are affected by managed care, whereas PPOs are not.
C) HMOs are usually managed by physicians, whereas PPOs are usually managed by health care administrators with business backgrounds.
D) Physicians and other caregivers work directly for an HMO, whereas they maintain more autonomy as affiliates of a PPO.

Question 11

All of the following are disadvantages of managed care EXCEPT one. Which one is NOT a disadvantage?

A) Managed care has not focused on prevention as much as many people had hoped it would.
B) Caregivers may be tempted to undertreat patients to save money.
C) Gag rules prevent patients from talking to attorneys about their care.
D) Managed care requires a great deal of paperwork.

Question 12

As a consumer, you subscribe to a health plan with relatively low premiums but a very high catastrophic cap. You are expected to pay for most services out of your own pocket and are rewarded with tax breaks for saving money to pay for your own care. Your plan is best described as:

A) A health maintenance organization
B) Indemnity insurance
C) A preferred provider organization
D) A high-deductible health plan

Question 13

If a hospital cuts costs and is able to provide care for less money than the capitated fees it receives, what happens?

A) The hospital gets to keep the difference as profit.
B) The hospital reimburses the patient, providing an incentive for patients to get well quickly.
C) It is no longer considered capitation.
D) All of these are likely to happen.

Question 14

When your aunt needs the care of specialists in different health care organizations, you think back about the tips in your book for navigating the health care system. Based on that advice, all of the following may be helpful EXCEPT:

A) Have each care provider keep separate notes so there is no overlap of information.
B) Encourage your aunt to develop a strong relationship with her principal care provider.
C) Help you aunt maintain a list of everyone involved with her care.
D) Network with other people who have similar health concerns.

Question 15

When Louise has her tonsils removed, the hospital receives an amount of money established in advanced by the insurance company. Flat reimbursement rates for particular procedures are based on:

A) Post hoc reimbursement
B) A spiraling funding model
C) Diagnosis-related groups
D) All of these are involved

Question 16

A candidate on TV says that she favors "Medicare for all." This is another way of saying that she is in favor of:

A) Higher premiums and lower deductibles
B) Fee for service
C) Preferred provider organizations
D) Universal coverage based on a single-payer model

Question 17

You are discouraged to find that, although you have insurance, you must pay out of pocket the first $5,000 of your health expenses each year before your insurance company begins to defray the costs. Which managed care option has the highest out-of-pocket requirement?

A) Preferred provider plan
B) High deductible health plan
C) HMO
D) Prospective payment plan

Question 18

As administrator of a medical center that is part of an HMO, your annual budget is based mostly on how many people subscribe to the HMO since their contributions will be the same no matter how much care they need. This reflects:

A) Capitation
B) Fee for service
C) Indemnity payments
D) Deductibles

Question 19

The __________ mandated that insurance companies cannot refuse coverage to people with pre-existing conditions or charge them higher rates than other people.

A) Family and Medical Leave Act
B) Health Insurance Portability and Accountability Act (HIPAA) c. U.S. Constitution
C) Affordable Care Act

Question 20

Which of the following is an advantage of a single-payer health system?

A) Higher premiums and lower deductibles
B) Lower taxes
C) There is less complicated paperwork

Question 21

Prevention efforts improve people's overall quality of life, but prevention is usually more expensive than treatment.

Question 22

The United States ranks first in the world in terms of quality health care.

Question 23

The Affordable Care Act guaranteed that children could stay on their parents' health insurance until they are 26.

Question 24

Managed care organizations were created to improve the sanitary conditions at medical centers in developing countries. When it was discovered that costs fell as quality rose, managed care was introduced in the United States.

Question 25

A PPO hires physicians and other care providers, who earn an established salary directly from the PPO.

Question 26

One advantage of managed care is that it offers patients a greater level of privacy than they had previously.

Question 27

Medicare is an example of a single-payer system.

Question 28

One argument in favor of universal coverage is that, without it, untreated diseases may spread to others and escalate costs.

Question 29

Single-payer systems typically rely less on tax dollars than do multi-payer systems.

Question 30

Although Japan spends fewer health care dollars per capita than the United States, people in Japan tend to live longer than people in the U.S.

Question 31

Based on advice in your book, list and describe at least four tips for navigating the health care system.

Question 32

From a consumer's perspective, how do fee-for-service and capitated systems differ? From a care provider's perspective?

Question 33

Do you prefer a single-payer or a multi-payer model? Explain your answer by outlining the relative advantages of the model you propose.