Deck 9: Health Care Systems and Policy

Question 1

The Children's Health Insurance Program was designed to reach children whose parents earned too much to qualify for Medicaid,but not enough to afford private health insurance.

Answer 1

True

Question 2

U.S.per capita health spending exceeds that of other industrialized nations by significant margins.

Answer 2

True

Question 3

Capitation is a predetermined fee paid per enrollee per month to the participating health care provider.

Answer 3

True

Question 4

The CDC is responsible for administering the public insurance in the United States.

Question 5

By 2030,the number of older adults needing nursing home care will more than triple.

Question 6

The cost effectiveness of nutrition services is uncertain.

Question 7

Health disparities persist among different populations,including racial and ethnic minorities.

Question 8

Medical nutrition therapy includes dietary modifications and nutrition counseling,but does not include the more complex methods of nutrition support.

Question 9

In 2010,an estimated 50 million people had no health insurance with the majority being children.

Question 10

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

Question 11

The United States has a national health care program that is universal and uniform for all citizens.

Question 12

The Social Security Act of 1935 included provisions for Medicare and Medicaid.

Question 13

A major contributor to health care expenditures in the U.S.is the administrative cost of the insurance process itself.

Question 14

The philosophy behind HMOs is that it is a more cost-effective way to keep Americans healthy.

Question 15

Medicare and Medicaid are the same program.

Question 16

Older Americans consume a disproportionate amount of medical care.

Question 17

Cost shifting of health care expenses is illegal.

Question 18

An advantage of the traditional fee-for-service insurance is unrestricted access to physicians,tests,hospitals,and treatments.

Question 19

A prospective payment system is one example of cost containment.

Question 20

More Americans are covered by governmental health insurance policies than private policies.

Question 21

Enrolled Medicare medical nutrition therapy (MNT)providers are able to bill Medicare for MNT services provided for all of the following except

A) type 1 diabetes.
B) post-kidney transplants.
C) kidney disease requiring dialysis.
D) type 2 diabetes.

Question 22

The Medicare Modernization Act made coverage for which of the following available to Medicare recipients?

A) Inpatient hospital care
B) MNT for type 2 diabetes
C) Bone mass measurements
D) Cardiovascular disease blood screening

Question 23

The _____ is the HMO model in which the HMO contracts with one or more multi-specialty group practices that contract to provide health care services exclusively to its members.

A) group model
B) independent practice association
C) network model
D) staff model

Question 24

In the past,the most notable gaps in Medicare coverage have been

A) prescription drug coverage and in-hospital care.
B) skilled nursing care and prescription drug coverage.
C) physician services and durable medical equipment costs.
D) in-hospital care and skilled nursing care.

Question 25

Examples of benefits provided by Medicare include

A) inpatient hospital care.
B) dentures.
C) routine physical exams.
D) long-term institutional care (excluding skilled nursing care).

Question 26

Which type of health insurance is most likely to encourage physicians to provide more medical services to a patient than may be necessary?

A) Fee-for-service plans
B) Preferred provider plans
C) Health maintenance organizations
D) Public health plans

Question 27

In 2010,approximately _____ percent of the U.S.population was uninsured.

A) 8
B) 12
C) 17
D) 20

Question 28

Public policy is now attempting to direct the medical system toward which of the following?

A) Disease prevention
B) Efficient use of resources
C) Health promotion
D) All of these

Question 29

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

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

Question 30

HMOs and PPOs are examples of

A) group contracts.
B) managed health care systems.
C) traditional fee-for-service plans.
D) consumer-directed health plans.

Question 31

Which of the following is not a major contributor to health care expenditures in the United States?

A) The administrative cost of the insurance process
B) Screening for diabetes
C) Rising professional liability costs
D) Cost of malpractice lawsuits

Question 32

The uninsured most often include

A) the elderly.
B) self-employed business men and women.
C) those with end-stage renal disease.
D) the disabled.

Question 33

In the United States,we _____ disease rather than _____ disease.

A) prevent, treat
B) treat, prevent
C) prolong, cure
D) None of these pairs are correct.

Question 34

In order to be eligible for Medicare benefits,a person must be

A) living on an income below the poverty line.
B) retired.
C) eligible for Social Security disability programs for more than two years.
D) living in a state that has Medicare benefits.

Question 35

An organization that contracts to deliver comprehensive health care to an enrolled group for a prepaid fee is a(n)

A) PPS.
B) HMO.
C) NIH.
D) DRG.

Question 36

A federally run entitlement program through which people age 65 and older receive health insurance is called

A) Medicare.
B) Medicaid.
C) HMO.
D) CHIP.

Question 37

To determine the rating of a particular health care system,one must examine which of the following variables?

A) Access to health care
B) Cost of health care
C) Quality of health care
D) All of these need to be considered.

Question 38

Medicare and Medicaid were created by which legislation?

A) Hill-Burton Act of 1946
B) National Health Insurance Act of 1988
C) Social Security Amendments of 1965
D) Social Security Act of 1935

Question 39

Medicaid provides assistance with medical care for all of the following except

A) eligible persons with low incomes.
B) certain pregnant women and children with low incomes.
C) older adults with average middle-class incomes.
D) blind persons.

Question 40

Health maintenance organizations are examples of which type of health insurance plan?

A) Private, prepaid fee-for-service
B) Private, prepaid group provider system
C) Public, prepaid fee-for-service
D) Public, prepaid group contract insurance

Question 41

Which of the following is not true regarding nutrition protocols?

A) They are considered unnecessary for achieving payment for nutrition services.
B) They are detailed guidelines for care that are specific to the disease or condition and type of patient.
C) They serve as frameworks to help practitioners in assessment, development, and evaluation of nutrition interventions.
D) The clearly specify appropriate care and acceptable limits of care for each disease state or condition.

Question 42

Trends in health care cost containment among third-party payers include

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) actively setting reimbursement restrictions and limitations.

Question 43

Care delivered according to a _____ has been linked with _____ for the patient.

A) practice guideline, negative outcomes
B) practice guideline, unpredictable outcomes
C) protocol, positive outcomes
D) protocol, unpredictable outcomes

Question 44

The philosophy that the health care system will do everything possible in terms of curative and treatment services to make people well

A) underlies the wellness model paradigm.
B) will be the health care philosophy of the future.
C) was rejected by Americans in the 1970s.
D) underlies the medical model paradigm.

Question 45

Summarize the demographic characteristics of those without health insurance.

Question 46

Discuss some of the current trends and issues that will shape the future of health care.

Question 47

Describe some of the challenges related to health care reform in the U.S.

Question 48

Which of the following is not characteristic of the prospective payment system?

A) It means knowing the amount of payment in advance.
B) It uses DRGs as a basis for reimbursement.
C) It seeks to change incentives under which care is provided and reimbursed.
D) Its purpose is to change the behavior of patients.

Question 49

Differentiate between traditional systems of health care and managed forms of health care.

Question 50

A prospective payment system uses the _____ system of classifying patients' illnesses according to treatment requirements for the purpose of establishing payment rates.

A) HMO
B) PPO
C) DRG
D) outpatient

Question 51

What are some of the major contributors to health care expenditures in the U.S.?

Question 52

_____ is the largest component of national health care expenditures.

A) Hospital care
B) Physician and clinical services
C) Prescription drugs
D) Long-term care

Question 53

Describe eligibility requirements for and services provided to recipients of Medicare and Medicaid.

Question 54

Community nutritionists can argue for reimbursable nutrition services by highlighting the benefits,which include all of following except that nutrition services

A) are relatively inexpensive benefits.
B) have a preventive component.
C) benefits attract subscribers with chronic diseases.
D) are easily documented.

Question 55

Which of the following is not an effective method for containing the cost of healthcare?

A) Shorter hospital stays
B) Requiring second opinions to reduce unnecessary surgery
C) Increasing copayments and deductibles
D) Participating in traditional fee-for-service insurance plans

Question 56

Choose the type of nutrition intervention that is incorrectly matched with an example of a measurable outcome.

A) Burns - survival rate
B) Prenatal care - length of stay
C) Diabetes - glycated hemoglobin levels
D) Obesity - weight changes

Question 57

Explain the philosophy behind the HMO idea.

Question 58

A study that compares the costs of providing health care against a desirable change in patient health outcomes is called a(n)

A) nutrition intervention study.
B) cost-effectiveness study.
C) improved health initiative study.
D) epidemiological assessment.

Question 59

Who is the "third party" in third-party reimbursement?

A) The insurance company or government
B) The patient
C) The physician
D) The hospital

Question 60

You have been asked to present arguments in favor of reimbursable nutrition services to an HMO benefits coordinator.What benefits of nutrition intervention would you highlight in your discussion?

Question 61

Use the following case scenario to answer short answer items. You have been asked to serve on a Task Force to develop a nutrition care protocol for iron-deficiency anemia.
What might be some of the possible positive outcomes of this protocol?

Question 62

Discuss three cost containment efforts.

Question 63

State the value of using medical nutrition therapy protocols to document client outcomes in various health care settings.

Question 64

Use the following case scenario to answer short answer items. You have been asked to serve on a Task Force to develop a nutrition care protocol for iron-deficiency anemia.
The development of patient care protocols includes three steps; what are they?

Question 65

Explain why health promotion is a major component of health care reform at the national level.

Question 66

Use the following case scenario to answer short answer items. You have been asked to serve on a Task Force to develop a nutrition care protocol for iron-deficiency anemia.
For each step,prepare a brief,but detailed,outline of what might be included.

Question 67

What is the Children's Health Insurance Program (CHIP)?

Question 68

List and describe several current health care cost containment measures.

Question 69

What is a consumer-directed health plan? What are its benefits and limitations?

Question 70

List 3 of the major provisions of the Affordable Care Act of 2010.