Deck 15: Health-Care System and Policy

Question 1

In the 1800s in Canada, where did needy individuals turn for relief?

A) federal government
B) provincial government
C) municipal government
D) public welfare
E) religious organizations or private charities

Answer 1

E

Question 2

During the 1800s in Canada, for the most part, the assumption was that people were responsible for providing for the contingencies of life for themselves and their families. Such family-based welfare is known as

A) public welfare
B) residual welfare
C) social welfare
D) family support
E) caregiver support

Answer 2

B

Question 3

Health care falls under which jurisdiction in Canada?

A) federal, but the provincial government plays a role through funding
B) municipal, but the federal government plays a role through funding
C) municipal
D) provincial
E) federal

Answer 3

D

Question 4

The principle that no one should be disadvantaged in the receiving of health care because they cannot afford it refers to

A) justice in health care
B) equity in health care
C) social assistance
D) social insurance
E) the intergenerational equity debate

Question 5

Which of the following occurred in the 1950s, during the economic upturn after the Depression?

A) hospitals were closed
B) hospital insurance was discontinued
C) physicians became independent entrepreneurs
D) physicians used less expensive therapies
E) physicians became more specialized

Question 6

In 1966, the Medical Care Act was passed in Canada and implemented in 1968. This Act

A) provided national insurance for physician services
B) ensured hospital care for the entire population
C) provided coverage for medial care for those who could not afford it
D) assessed the medical needs of the Canadian population
E) provided universal coverage for all institutional care including acute care hospitals, institutions for the mentally ill, and nursing homes

Question 7

Under the federal government's cost-shared medical insurance program, the provinces had to meet all but which of the following criteria:

A) universal coverage
B) portability of benefits between countries
C) reasonable access to services
D) comprehensive services
E) non-profit administration by a public agency

Question 8

In 1977, the federal government provided dollars for long-term care through

A) the Established Programs Financing Act
B) the Medical Care Act
C) the Extended Health Care Services Legislation
D) the Canada Health Act
E) the Hospital Insurance and Diagnostic Services

Question 9

The Canada Health Act effectively ended which of the following?

A) preventive medicine
B) Extended Health Care Services Program
C) comprehensive services
D) universal coverage
E) extra billing

Question 10

Which of the following is true about Canada's health-care system in the late 1980s?

A) the health-care system had grown and matured
B) the health-care system was still in development
C) Canada was unique in the world for providing universal medicare
D) there was consistency across the provinces on services offered
E) user fees for medical services were banned

Question 11

Canada's health care system is largely

A) patient driven
B) provider driven
C) both patient and provider driven
D) driven by older people
E) economically driven

Question 12

Which of the following was true about Canada's health care system by the late
1980s

A) user fees charged were the same in every province
B) there was consistency across provinces with respect to services offered
C) it had universal medicare for physician and hospital services
D) older people were receiving less services than younger adults
E) utilization of medicare was driven by financial status rather than individual's needs

Question 13

Prior to the introduction of universal medicare, what often determined whether or not lower-income groups, seniors, and women received health services?

A) place of residence
B) economic ability
C) perceived health
D) attitudinal-belief variables
E) technology

Question 14

The Anderson and Newman model has been used extensively in examining the utilization of physician and hospital services. This model consists of three main components which are

A) social determinants, the health services system, and individual determinants
B) predisposing factors, enabling conditions, and need
C) predisposing factors, the health services system, and individual determinants
D) individual determinants, need, and the health services system
E) social determinants, individual determinants, and need

Question 15

Most research on health service utilization has focused on the individual determinants of Anderson and Newman's model. Individual factors include predisposing factors, enabling conditions and need. Which of the following is a need factor according to this model

A) age
B) sex
C) education
D) chronic conditions
E) health beliefs

Question 16

Anderson and Newman developed a model to examine health care utilization. In this model, social structural and attitudinal-belief variables of the individual are usually classified under which category

A) predisposing factors
B) enabling conditions
C) need
D) social determinants
E) the health care system

Question 17

Factors that allow an individual to use healthcare services, such as income or region of the country where one lives, are called

A) need
B) predisposing factors
C) enabling conditions
D) social norms
E) social structural factors

Question 18

The Andersen-Newman model has been criticized because it

A) over-emphasizes underlying decision-making processes
B) does not account for user fees
C) research has not been able to support any of its components
D) over-emphasizes the broader structural context
E) fails to take into account the broader structural context

Question 19

The most frequent predictor of health service utilization is

A) income
B) need
C) health beliefs
D) age
E) sex

Question 20

The major reason usually cited for declines in mortality at the turn of the century is

A) medical intervention
B) improved nutrition
C) improved hygiene
D) increased natural immunity
E) rising standard of living

Question 21

In 1991, a review of the Canadian research since the beginning of Medicare, found that

A) there was major improvement in the disparities in longevity and the prevalence of illness between the rich and the poor
B) there was little improvement, if any, in the disparities in longevity and the prevalence of illness between the rich and the poor
C) there was no improvement in the disparities in longevity and the prevalence of illness between the rich and the poor
D) there was a slight increase in the disparities in longevity and the prevalence of illness between the rich and the poor
E) there was major increase in the disparities in longevity and the prevalence of illness between the rich and the poor

Question 22

An assessment of medical technology in Canada found all but which of the following to be true?

A) technologies are too often accepted for use without evaluation
B) technologies are often put into use before evaluations are complete
C) technologies evaluated and accepted for use, are often used for conditions that were not covered by the evaluations
D) technologies that have been evaluated, accepted and used for their intended purposes are often used too much
E) the most effective and less costly technology is always used

Question 23

International research suggests that _____ percent of medical procedures are inappropriate.

A) between 1 and 5
B) between 5 and 8
C) between 10 and 20
D) between 10 and 25
E) between 15 and 30

Question 24

Research has suggested that throughout the industrialized world, national health insurance

A) treats the ill
B) prevents illness
C) prevents disability
D) prevents disease
E) prevents poverty

Question 25

All clinical conditions for which remedies, physicians and hospitals are the pathogens or the "sickening" agents is called

A) medical illness
B) iatrogenic illness
C) enabling conditions
D) illness behaviour
E) malpractice

Question 26

Negative consequences that result from medicine itself, such as errors when individuals are given the wrong drug, or there is a drug interaction, or when an individual becomes addicted to prescription drugs, provide examples of

A) medical illness
B) inappropriate prescribing
C) enabling conditions
D) illness behaviour
E) iatrogenic illness

Question 27

It is argued that due to the depersonalization of diagnosis and therapy within the complex technological medical environment of the hospital, incompetence becomes

A) system breakdown
B) a lack of specialized equipment
C) random human error
D) scientific detachment
E) malpractice

Question 28

Throughout the 1990s, there were reviews of reports and committees on the vision of a new health-care system for Canada. What conclusion did they reach?

A) emphasize fee-for-service programs
B) centralize provincial systems
C) shift the emphasis to curing illnesses
D) emphasis and dollars should be redistributed from medical and institutional care to a broader sense of community health-care services
E) restrict the definition of health to biomedical aspects

Question 29

Which of the following became the first target for reform within the Canadian health care system

A) hospitals
B) medical schools
C) home care
D) physicians
E) community-based services

Question 30

What makes it difficult for provincial ministries of health to influence actual hospital expenditures?

A) user fees
B) global budgeting
C) the federal/provincial jurisdictional split
D) globalization
E) market model

Question 31

All but which of the following were part of the reform to Canada's health care system?

A) closure of long-term or chronic beds within hospitals
B) closure of entire hospitals
C) moratorium on building long-term care beds
D) major increases to community and home care budgets in all provinces
E) medical schools limited new admissions

Question 32

With the reform of the Canadian health care system, home care

A) is providing more medical support than social care
B) has expanded dramatically
C) is resulting in a redirection of services towards those who are most needy and have the greatest potential for prevention
D) is resulting in minimal post-acute care
E) has been shown to be less cost effective than nursing homes for all individuals

Question 33

The Romanow Report (2002) appears not to have grasped that the greatest need of older adults is for

A) short-term home care
B) acute care
C) long-term chronic home care
D) intervention services
E) palliative care

Question 34

All but which of the following provinces have regionalized health care?

A) Alberta
B) Manitoba
C) Ontario
D) Nova Scotia
E) Saskatchewan

Question 35

Which of the following encompasses health promotion, illness prevention, and curative, supportive, and rehabilitative services?

A) primary care
B) secondary care
C) tertiary care
D) home care
E) elder care

Question 36

All but which of the following are key elements of the vision of health reform in Canada?

A) general practitioners working alone in unconnected single practices
B) the development of multidisciplinary teams
C) patient registration or rostering
D) funding on a population or capitation basis
E) inclusion of core services

Question 37

The rhetoric of health reform is being replaced with that of a

A) globalization model
B) market model
C) primary model
D) preventive model
E) biomedical model

Question 38

All but which of the following statements are true about women and Canada's health care system?

A) the majority of informal care providers are women
B) other than physicians, the majority of health care workers are women
C) the top managerial positions in health care are typically filled by women
D) women are largely concentrated in traditional specialties such as pediatrics or are general practitioners
E) the saliency of women as recipients of care has received little attention

Question 39

Which of the following is true about health reform in Canada

A) Canada's health care system is universal, publicly financed and includes all health services
B) Canadians have accepted a private health care system
C) Canadians have accepted the notion that health care should only be for those who can afford it
D) Canadians have rejected the idea of health care as a market commodity
E) Privatization could lead to increased control by citizens through government and decreased control by business interests of multinationals over the health of Canadians

Question 40

All but which of the following statements define privatization?

A) it refers to anything that is not public
B) it refers to the provision of health services as a profit-making business
C) it can aim to empower individuals and communities through increased reliance on families, churches and other non-profit organizations
D) it can refer to laissez-faire capitalism as free markets
E) private includes for-profit and not-for-profit organizations

Question 41

The proportion of private funding for health care in Canada

A) has stayed the same
B) has decreased
C) has increased
D) is non-existent
E) makes up the entire health care system

Question 42

Which of the following became central to the new business approach to health care?

A) hospitals
B) physicians
C) nurses
D) home care workers
E) long-term care homes

Question 43

Which of the following statements is true about the argument that for-profit care cuts costs?

A) for-profit health care is less expensive for governments, and less expensive for consumers
B) for-profit health care is more expensive for governments, and more expensive for consumers
C) for-profit health care costs about the same as not-for-profit health care
D) for-profit health care is more expensive for governments, but less expensive for consumers
E) for-profit health care is less expensive for governments, but more expensive for consumers

Question 44

Our vision of health-care reform argues for expanding the mandate under Canada's medicare system, acknowledging the social determinants of health, and defining health as something broader than medicine. That being said, what do we see happening in health care in Canada?

A) a decrease in the dominance of American-style capitalism
B) a broader definition of medicare
C) less territory for for-profit firms
D) an increased role for private clinics
E) private clinics restricting practice to only specialized or elective services (such as abortions and laser eye surgery)

Question 45

For an aging population, the hollowing out of medicare means

A) that all services are being privatized for older people
B) that older people have bankrupted the universal health system
C) that many of the home care and community support services required by older people, are the ones that are no longer available or are becoming privatized
D) only older people in the Canadian population will be insured
E) that older people will no longer be insured

Question 46

The cost of prescription drugs in Canada

A) has stayed the same
B) has increased
C) has decreased
D) is now covered completely by medicare
E) has not been examined

Question 47

Some Canadian provinces have introduced reference-based pricing (RBP) with respect to drug reimbursement. RBP means that

A) the cheapest of the most effective drugs, with the least side effects, is reimbursed through the provincial drug plan
B) the cheapest drug, regardless of its effectiveness, is reimbursed through the provincial drug plan
C) the most effective drugs, with the least side effects, regardless of cost, will be reimbursed through the provincial drug plan
D) reimbursement of a prescription will be dependent on the reference group requiring the drug
E) reimbursement of a prescription will be dependent on the age and economic status of the individual requiring the drug

Question 48

Approximately what percent of Canada's total public health spending is spent on drug expenditures?

A) 4 percent
B) 7 percent
C) 17 percent
D) 27 percent
E) 37 percent

Question 49

The Saskatchewan Commission on Medicare in 2001 noted that the two biggest challenges of modern health care in Canada are

A) an aging population and privatization
B) an aging population and sustainability
C) an aging population and accountability
D) accountability and sustainability
E) accountability and privatization

Question 50

Evidence now available suggest that the neo-liberal agenda in favour of American-style global capitalism

A) has resulted in the expected economic prosperity
B) has resulted in increased employment in OECD countries
C) has increased social expenditures
D) has undermined working-class rights
E) has decreased salary differentials

Question 51

In the 1950s, hospitals were transformed: they were no longer places where the poor went to die but the arenas of skilled medical specialists who used complex technologies.

Question 52

All provinces and territories had become partners in the federal government's cost-shared medical insurance program by 1972.

Question 53

Where universal medicare exists, income is the driving factor behind its use.

Question 54

Incentives for physicians to work in under-serviced areas have been largely successful.

Question 55

Privatization refers to the provision of health services as a profit-making business.

Question 56

Why does Canada have a split federal-provincial responsibility for health care?

Question 57

What reason has typically been cited for declines in mortality at the turn of the century? Is it supported by evidence? Why or why not?

Question 58

What is meant by iatrogenic illness? What are the implications for medical practice?

Question 59

Discuss discontent towards the health care system with respect to the organization of the delivery of health care.

Question 60

Briefly discuss the characteristics of the new vision of health care in Canada.

Question 61

Briefly discuss the key aspects of a primary care model.

Question 62

The rhetoric of health reform is being replaced with that of a market model. Discuss the evidence pertaining to this statement.

Question 63

What is the difference between privatization and profitization of health care?

Question 64

Explain how globalization affects health care in Canada.

Question 65

Describe some of the issues related to pharmaceuticals in the Canadian health care system.

Question 66

Trace the historical roots of Canadian health care policy.

Question 67

Describe Anderson and Newman's health care utilization model. What factors have received most research attention? What are some of the criticisms and strengths of this model? Give an example of how this model can be used to understand the patterns of health care utilization among older people.

Question 68

Discuss aspects of the discontent over Canada's health care system during the 1980s and 1990s. Include relevant evidence to support the critiques.

Question 69

What changes have occurred during the reform of Canada's health care system? What are the effects of the reform on older people?

Question 70

Data suggest that there has been a reduction, not an expansion, of community-based services, with home care providing more medical support than social care. Discuss this statement. Why has this occurred? What are the implications? How will this impact family members and older people?