Deck 3: Understanding Healthcare Systems and Practice Contexts

Question 1

The United States is the only industrialized country that does not have health care funded by or provided by the government to all of its citizens.

Answer 1

True

Question 2

Working with other local therapy providers to compare and set prices is a recommended strategy for private business owners and private practitioners.

Answer 2

False

Question 3

Jimmo v. Sebelius is a landmark legal case that established Medicare coverage for services that are medically necessary but may not result in an improvement in the function of the beneficiary.

Answer 3

True

Question 4

The "triple aim" of health care refers to efforts to improve population health, improve health care, and reduce costs.

Question 5

The type of economic system found in the United States, in which there is both individual ownership and individual freedom but also a significant component of the economy is controlled by the government, is best called which of the following?

A) A free market economy
B) A mixed economy
C) A competitive economy
D) A dualistic economy

Question 6

Dualism is best defined as:

A) A term that reflects the fact that most insurances require a copayment or coinsurance to cover part of the payment.
B) A term that reflects the offering of Medicare and Medicaid in combination to some patients with disabilities.
C) A term that reflects the use of Medicare B as a secondary insurance for some forms of inpatient payment.
D) A term that reflects the involvement of both government and private industry in the healthcare system.

Question 7

Which of the following is not a principle of a free-market economy?

A) Supply and demand
B) Competition
C) Resource allocation
D) Free choice

Question 8

Which of the following is a set of healthcare service categories that must be covered by certain insurance plans in the individual and group markets as a result of the ACA?

A) Essential health benefits
B) Essential coverage elements
C) Essential health components
D) Essential medical standards

Question 9

Which of the following is most accurate regarding health care provided by countries that provide universal health care for every citizen?

A) Limits are often placed on who qualifies for various types of care and how long they must wait to receive it.
B) There is typically no waiting time to see specialists or receive specialist care once approved by the primary care physician.
C) Care beyond basic primary care or emergency care is not available to most citizens.
D) Primary care and urgent care are provided immediately but at the expense of specialty care, which is almost never available.

Question 10

Which of the following is a federal health program that pays for health care for people over 65 years of age and some individuals with long-term disabilities?

A) Medicaid
B) Primary care
C) Medicare
D) HMOs/PPOs

Question 11

Which of the following most accurately describes SCHIP?

A) A federal program that provides scholarships and educational relief for health practitioners who commit to working in underserved rural and urban areas for at least 3 years after graduation
B) A state program that provides school-based interventions and programming for children with severe developmental delays who cannot participate in services provided under the IDEA
C) A state program that provides educational scholarships for innovations in programs that provide services to children from low-income families
D) A federal program that gave each state permission to offer health insurance for children who are not already insured to address the growing problem of children without health insurance

Question 12

Essential health benefits (EHBs) could most accurately be described as:

A) Health benefits that have been identified as most critical to achieving the World Health Organization's Goals for Health 2025.
B) Health benefits identified by the American Occupational Therapy Association and the World Federation of Occupational Therapists as most essential to occupational performance.
C) A set of health benefits identified as most critical to support the healthy development of children.
D) A set of healthcare service categories that, beginning in 2014, must be covered by certain plans under the Affordable Care Act (ACA).

Question 13

Which of the following statements best describes the free-market system as it applies to our healthcare system?

A) All principles of the free-market system apply to health care in the same way as they apply to all other products.
B) All principles of the free-market system apply to health care in the same way as they apply to all other products except competition, because competition is limited.
C) All principles of the free-market system apply to health care in the same way as they apply to all other products except supply and demand, because supply and demand are totally under government control.
D) All principles of the free-market system apply to health care, but in complex ways that limit consumers' free choice in various ways.

Question 14

A state-run program that is jointly funded by states and the federal government for people who have limited income or high medical expenses, where eligibility for the limited-income cohort is based on the family income and size in relation to the national poverty level, would best be called which of the following?

A) Medicare
B) Medicaid
C) Workers' compensation
D) Sliding-scale self-pay

Question 15

Which of the following is a legislative act that provides for increased access to services and essential health benefits?

A) Patient Protection and Affordable Care Act
B) Individuals with Disabilities Education Act
C) Health Insurance Portability, Accountability and Education Act
D) Rehabilitation Services Education Act

Question 16

Groups of providers that provide care associated with a defined population of patients across multiple settings while being held responsible for the quality and cost of care delivered to that population would best be called:

A) patient-centered medical homes.
B) post-acute care bundles.
C) home health agencies.
D) accountable care organizations.

Question 17

Which of the following is true about AOTA official documents?

A) They are legal documents representing current law and must be used as written to dictate practice.
B) They are written by volunteer groups including both members of AOTA and nonmember practitioners.
C) They represent a consensus opinion of experts, so they should influence practice and action but are not always the "final word" in decision making.
D) They supersede documents written by legislative bodies or federal agencies.

Question 18

Occupational therapy managers often need to access data, information, and other forms of evidence to guide decision making and the development and implementation of programs. Which of the following is most accurate regarding the process of obtaining and interpreting such evidence in the current environment?

A) Data, information, and other forms of evidence are easily accessible, easy to organize, and easy to interpret due to the abundance of resources available to the modern-day occupational therapy manager.
B) Despite the Internet and online data sources, access to relevant data, information, and other forms of evidence remains elusive; it is often difficult for occupational therapy managers to find the necessary evidence.
C) With the rise of the Internet and the development of many systems for storing and accessing data, information, and other forms of evidence, occupational therapy managers may find an overwhelming amount of evidence and may have to focus on organized and strategic approaches to gathering and interpreting the most appropriate evidence.
D) Not much has changed in the last decade; because it is often impossible to validate the sources of data, information, and other forms of online evidence, occupational therapy managers should stick to formal literature searches using electronic search engines.

Question 19

Which of the following is not true in regard to value-based payment models?

A) Value-based payment initiatives have created opportunities for occupational therapy managers to become key leaders in reformulating hospital policies and practices to respond to the bonuses and penalties that are now embedded in the Medicare payment model.
B) The role of occupational therapy in value-based payment models is limited and requires practitioners to submit non-functional measures that do not demonstrate effectiveness of occupational therapy services.
C) In the acute care setting, evidence exists demonstrating the effectiveness of how hospital-based therapy personnel reduce the risk of hospital-acquired conditions such as falls, decubiti, and blood clots and hospital readmissions.
D) Under value-based payment models, purchasers of health care hold providers accountable for delivering high-quality care in a cost-effective manner.

Question 20

Which is true in regard to occupational therapy licensure laws?

A) All licensure laws are 100% consistent across all states due to NBCOT exam requirements for licensure.
B) Licensure is granted on a national basis, and when licensed you are free to practice in any state or U.S. jurisdiction.
C) As of 2020, all 50 states, the District of Columbia, Puerto Rico, and Guam have licensure laws for the practice of occupational therapy.
D) Certification is another name for licensure, and once you are certified you are also licensed to practice as an occupational therapist or occupational therapy assistant.