HSA 3111 Exam #3 Cover chapters (9-11) 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 medicaWe also discuss several other topics like What limits photosynthesis?
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l 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 risk 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 provider1 7. Under which payment method is a fee schedule used? a. prospective payment b. capitation c. discounted fees d. fee for service 8. Discounted fees are a. discounted capitated fees b. used to shift risk from the financiers to the insurers c. used to share maximum risk with providers d. modified form of fee for service 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 11. Fee for service promoted a. price controls b. moral hazard c. provider-induced demand d. both moral hazard and provider-induced demand 12. Closed-panel plan. a. No new physicians can be added to the plan b. New enrollees are not accepted by the plan c. The enrollee cannot switch from one plan to another d. The enrollee is restricted to the providers on the panel 13. Gatekeeping heavily depends on the services of a a. primary care physician b. case manager c. disease consultant d. nurse practitioner2 14. Gatekeeping ______ secondary care services. a. bypasses b. encompasses the delivery of c. requires a referral for d. does not control 15. An experienced health care professional, such as a nurse practitioner, coordinates an individual’s total health care. a. case management b. utilization review c. gatekeeping d. closed-panel utilization 16. Cost-effective management of care for patients who have complex medical conditions. a. Case management b. Gatekeeping c. Utilization management d. Managed care 17. Self-care with professional support. a. Preauthorization b. Prospective utilization review c. Disease management d. Closed-panel utilization 18. Which of the following is not used in pharmaceutical management? a. Drug formularies b. Disease management c. Tiered cost sharing d. Utilization review 19. Prospective utilization review includes a. precertification b. discharge planning c. review of medical records d. efforts to reduce length of stay3 20. Concurrent UR in a hospital will be primarily concerned with the a. disease process b. length of stay c. preauthorizations d. quality management Chapter 10: Long-Term Care True (T) or False (F) 1. T or F: The predominant users of long-term care services are the elderly. 2. T or F: Most elderly needing long-term care reside in nursing homes. 3. T or F: Elderly in the lowest socioeconomic status are at the greatest risk of need for LTC services. 4. T or F: Private pay patients may be admitted to a certified nursing care facility 5. T or F: Most people needing long-term care need it for more than 90 days. 6. T or F: LTC services are tailored to the needs of the individual patient. 7. T or F: Therapeutic services in long-term care are rendered by a physician. 8. T or F: The number of informal caregivers in the United States has been gradually increasing. 9. T or F: Respite care includes only community-based long-term care services. 10. T or F: In recent years, the number of nursing home beds per 1,000 elderly population has declined. 11. T or F: In recent years, skilled nursing facilities have been the fasted growing segment of the institutional continuum. 12. T or F: AIDS is now classified as a chronic condition 13. T or F: Subacute care is designed for patients who remain critically ill during the postacute phase of illness.4 14. T or F: All states require assisted living facilities to be licensed by the state. 15. T or F: Nursing facilities must be certified by the state in which they operate. Chapter 11: Health Services for Special Populations True (T) or False (F) Questions: 1) T or F: The 2010 U.S. Census allowed respondents to choose one or more races when they self-identify. 2) T or F: Black Americans are more likely to be economically disadvantaged than white Americans. 3) T or F: Many Hispanic families who immigrated to the U.S. may not qualify for Medicaid. 4) T or F: Educational attainment varies very little among Asian American subgroups. 5) T or F: The health status of American Indians no longer lags significantly behind other racial/ethnic groups. 6) T or F: Uninsured people are more likely to postpone seeking medical care, compared to insured people. 7) T or F: The United Nations contends that greater gender equality will lead to profound and positive impacts on children’s well-being and development. 8) T or F: More women than men will suffer from major depression in their lifetimes. 9) T or F: The ACA will make everyone insured. 10) T or F: Rural areas are particularly good places for managed care implementation. Multiple Choice Questions 11) 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 19975 c. Kids First Act of 1997 d. Omnibus Reconciliation Act of 1997 12) A disease is considered chronic if it is observed for at least how long? a. 1 month or longer b. 3 months or longer c. 6 months or longer d. 1 year or longer 13) What does “MUA” stand for? a. Metropolitan Utilization Area b. Medically Underserved Area c. Metropolitan Underserved Area d. Medical Utilization Area 14) Children under age 18 comprise approximately what percentage of the homeless population? a. 10% b. 20% c. 40% d. 60% 15) What is the major health challenges of the migrant population? a. Heart disease b. Cancer c. Infectious disease d. HIV/AIDS6