S&S Multiple Choice

  1. The following two forces of change are arguably the most dominant?
    a.  Economic and Political
    b.  Social and Demographic
    c. Technological and Informative
    d.  Ecological and Biological
    Economic and Political
  2. True or False:  Universal access to health care cannot be achieved without massive rationing?
  3. True or False: Communication skills are a fundamental component of patient-centered care?
  4. What percent of the elderly have private long-term care insurance?
    a.  25%
    b.  3%
    c.  10%
    d.  40%
  5. The biggest obstacle to cost-efficient delivery of health care in the future and to any attempts by the government to mandate certain types of care or to ration services may well be:
    a.  Financing
    b.  The multi-payer health care system
    c.  Congress
    d.  The public’s attitudes
    The public’s attitudes
  6. True or False:  The United States is unique to other countries by splitting the population into different insurance programs according to age and income?
  7. True or False: According to the Schoen article and study, Norwegian adults are the most negative about affordability?
  8. True or False: In Gawande’a Article “Getting There From Here,” Gawande uses “path-dependence” to explain how other countries’ nationalized health care systems were built on their own histories, not on ideology.
  9. True or False: In Gawande’a Article “Getting There From Here,” Gawande is a proponent of starting from the bottom up with a new health care system.
  10. As outlined in the article "Getting There From Here" by Dr Atul Gawande the United States, Canada, Switzerland and the UK share some common characteristic in terms of health care systems:
    a) all have national systems that guarantee their citizens affordable health care;
    b) all built their health care delivery systems utilizing networks of hospitals built during WWII;
    c) all have developed their health care delivery systems through building on their own past experiences (path-dependence);
    d) all regard the path-dependence of policies when applied to healthcare as evidence of weak leadership.
    All have developed their health care delivery systems through building on their own past experiences (path-dependence)
  11. Which of the following preferences of selected interest groups are incorrectly matched ? 
    a.Federal and state gov : cost containment, access to care, quality of care
    b. Employers: cost containment, workplace health and safety, minimum regulation
    c. Consumers: access to care, quality of care, lower out of pocket costs
    d. Practitioners: Elimination of cost shifting, administrative simplification, regulatory environment
    Practitioners: Elimination of cost shifting, administrative simplification, regulatory environment

    Practitioners care about Income Maintenance, Professional Autonomy, and Malpractice Reform
  12. Which of the following is not an argument for enhacing States' role in health policy making:
    a. americans distrust centralized gov in general and lack faith in fed gov as an administrator in particular
    b.fed gov has grown too large intrusive and paternalistic
    c. fed gov is too impersonal, distant and unresponsive
    d. state and local gov are closer to the people and more familiar with local needs
    e. national standards reduce flexibility and seriously constrain the ability of states to experiment and innovate
    f. Fed gov responds to crises faster and are more willing that States to take on risks and are more likely to implement and enforce programs of their own making.
    Fed gov responds to crises faster and are more willing that States to take on risks and are more likely to implement and enforce programs of their own making.

    Not True!
  13. Preferences of Interest Groups:

    Federal and State Governments
    • Cost containment
    • Access to care
    • Quality of care
  14. Preferences of Interest Groups:

    • Cost containment
    • Workplace health and safety
    • Minimum regulation
  15. Preferences of Interest Groups:

    • Access to care
    • Quality of care
    • Lower out-of-pocket costs
  16. Preferences of Interest Groups:

    • Administrative simplification
    • Elimination of cost shifting
  17. Preferences of Interest Groups:

    • Income maintenance
    • Professional Autonomy
    • Malpractive reform
  18. Preferences of Interest Groups:

    Provider Organizations
    • Profitability
    • Administrative simplification
    • Bad debt reduction
  19. Preferences of Interest Groups:

    Technology Producers
    • Tac treatment
    • Regulatory environment
    • Research funding
  20. Information contained in electronic health records is used for all of the following except:
    (a)  More efficient billing to insurers
    (b)  Coordinate care
    (c)  Routinely measure quality
    (d)  Reduce medical errors
    More efficient billing to insurers
  21. True or False: The technological imperative is the desire to have state-of-the-art technology available and to use it, despite its cost or established health benefit?
  22. The Agency for Healthcare Research and Quality (AHRQ), a division of the Department of Health and Human Services, is the lead federal agency charged with supporting research that focuses on all of the following except:
    (a)  Improving the quality of healthcare
    (b)  Reducing health care costs
    (c)  Approving new medications and medical devices
    (d)  Improving access to essential services
    Approving new medications and medical devices
  23. True or False: Technological innovations have been the single most important factor in medical cost inflation over the second half of the 20th century?
  24. Concerns in Health Technology Assessment transcend the traditional questions about safety, effectiveness and economic value and also raise which of the following concerns:
    (a)  Social
    (b)  Ethical
    (c)  Legal
    (d)  All of the above
    All of the above. Social, Ethical and Legal
  25. According to IOM, what are the four main components of a fully developed EHR system?
    • 1) Collection and storage of health information
    • 2) Immediate electronic access
    • 3) Provision of information that enhances quality
    • 4) Support of efficient processes
  26. What is telemedicine ? How do the synchronous and asynchronous forms of tele med differ in their application?
    • Telemedicine employs the use of telecommunications technology for medical diagnosis and patient care.
    • Synchronous - real time, direct contact with patients
    • Asynchronous - time lag, greater flexibility
  27. Physicians trained in all of the following areas of medicine are considered primary care physicians (PCPs) except:
    (a)  Family medicine/general practice
    (b)  General internal medicine
    (c)  General pediatrics
    (d)  General surgery
    General Surgery
  28. True or False:  The principal source of funding for graduate medical education is Medicare?
  29. Speciality maldistribution has become ingrained in the US health care delivery systems for all of the following reasons except:
    (a)  Medical technology
    (b)  Reimbursement methods and remuneration
    (c)  There is more demand for specialists
    (d)  Speciality-oriented medical education
    False: There is more demand for specialists
  30. True or False: Physicians constitute the largest group of health care professionals?
    False, nurses constitute the largest group of health care professionals.
  31. Examples of health care redistributive policies include all of the following except:
    (a)  HMOs
    (b)  Medicaid
    (c)  CHIP
    (d) Expansion of health insurance for the uninsured established under the ACA
    False: HMOs

    Redistributive policies are designed to benefit only certain groups of people.
  32. True or False: In the US, each branch and level of government (e.g., federal, state and local) can influence health policy?
  33. In the past health policy initiatives have focused on all of the following except:
    (a)  Access to care
    (b)  Bioterrorism
    (c)  Cost of care
    (d)  Quality of care
    False: Bioterrorism
  34. What are the major distinctions between primary care and specialty care ?
    • Primary care is first contact care, Specialty Care follows primary care
    • Primary Care Providers are gatekeepers; specialty care requires a referral
    • Primary Care is longitudinal, PCPs follow the course of treatment and coordinate services; Specialty care is episodic.
    • Primary Care is holistic and focuses on the whole body, Specialty Care tends to be limited to episode.
  35. True/ False: MD's are trained in osteopathic medicine which emphasizes musculokeletal system of the body and stress preventative medicine that influences natural resistance.
    False. OD's are trained in osteopathic medicine.

    MDs are trained in allopathic medicine which view treatment as an intervention to produce a counteracting reaction.
  36. Non physician practitioners include which of the following ?
    a. physician assitants
    b. mid level providers
    c. nurse practitioners
    d. all of the above
    All of the above.
  37. Why is there a geographic maldistribution of the physician labor force in the United States ?
    • Urban areas offer greater prospects for:
    • Higher income
    • Professional interaction
    • Access to modern facilities and technology
    • Continuing educations
    • Higher standards of living
    • Social amenities 
  38. True or False: Allocative tools involve the direct provision of income, services or goods to certain groups of individuals or institutions and can be distributive or redistributive policies.

    • Distribtuive polices spread benefits throughout society.  They include reserach, funding of medical personnel, construction of facilities and the initiation of new institutions.
    • Redistributive policies target benefits to specific groups in order to correct disparities.  They include Medicaid, CHIP, and pieces of the ACA.
  39. Which of the following is not one of three main factors that drive health policy concerns about medical technology
    a) medical technology is an important contributor to rising health costs
    b) medical technology often provides health benefits
    c) advances in medical technology never is cost effective
    d) the utilization of medical technology also provides economic benefits by creating jobs in health care and other sectors of the economy
    False: Advances in medical technology never is cost effective
  40. Which of the following is not one of the three main concerns that dominate the debate about medicare policy?
    a) spending should be restrained to keep the program viable
    b) the program is not adequately focused on the management of chronic conditions
    c) the program does not cover long term nursing home care
    d) Cancer prevention remains an elusive goal in preventative care measure and no good screening tests are jointly agreed upon by guidelines.
    False: Cancer prevention remains an elusive goal in preventative care measure and no good screening tests are jointly agreed upon by guidelines.
  41. Role and influence of research includes all of the following except?
    a) documentation:gathering, cataloging and correlating facts.
    b) making analysis of what does and does not work
    c) prescription
    d) malpractice reform and reducing incentives to protect patient safety.
    False: Malpractice reform and reducing incentives to protect patient safety.
  42. According to S&S , an acceptable helath care system should include all of the following except:
    a) enabling all citizens to receive needed health care services
    b) delivering services that are cost effective
    c) using the most current technology, regardless of cost
    d) having services that meet established standards of care
    False: c) using the most current technology, regardless of cost
  43. Characteristics of US Health Care
    • No central agency, fragmented system
    • Only select groups get coverage: aged, disabled, children, indigent, Veteran, etc.
    • Mostly private insurance
    • Mostly private providers
    • 1/3 of Americans are uninsured
    • High technology usage
  44. Characteristics of Australian Health Care
    • Medicare
    • Financed by income taxes and income based levies
    • 43% still carry private insurance to cover gaps in public coverage
    • Public hospitals provide limited services
    • Medicare reimburses costs of private care
    • Higher OOP than other countries
    • Higher Quality than other countries
    • Middle of the road on access and confidence
  45. Characteristics of German Health Care
    • Regional Sickness Funds
    • Financed by employer & employee income contributions
    • Standard, community-rated coverage plans
    • 88% enroled in public funds
    • 11% prviate (higher income)
    • Sickness funds negotiate contracts with hospitals
    • Hospitals have mandated global budgets
    • Physician spending is capped
    • Standardized care plans for chronics disease
    • Oldest national system in the world (19th century)
    • High confidence in quality
  46. 10 IOM Quality Recommendations
    • Continuous Care from multiple sources/media
    • Customizable Care
    • Patient-centered and source of control
    • Knowledge and information flow freely
    • Evidence-based
    • Safety is a priority
    • Transparency allows for informed decision-making
    • Proactive care - needs are anticipated
    • Waste is decreased
    • Cooperation among clincians
  47. Blum's Model of Health Deteminants
    • Environment
    • Heredity
    • Lifestyle
    • Medical Care
  48. Four basic components of US HC delivery system?
    • 1) Finance - most privately insured patients are sponsored through their employer, as a fringe benefit.  Most companies purchase insurance through an MCO
    • 2) Insurance - MCO specifies how/where an individual can receive care.  Also act as a claims processor and manage the disbursements of funds to providers.
    • 3) Delivery - refers to the provision of HC providers.  Providers refer to any entity that delivers HC services and can either independently bill for those services or is tax supported.
    • 4) Payment - deals with reimbursement for services delivered.  Insurer determines the amount paid for certain services.  Funds for actual disbursement comes from the premiums paid to the MCO.  In government insurance plans, tax revenues are used to pay providers.
  49. Impact of Technology
    • Quality of Care - More effective, less invasive care, safer therapies and preventive remedies, increased longevity and decreased morbidity
    • Quality of Life - Ability to engage in activities they couldn't before, relieve pain and suffering, increased independence and control
    • Cost - Increased
  50. Biggest Dork in MSHA Class of 2014:
    Trick Question: All three tie!
  51. How to improve evidence-based health care
    • 1) Health care leaders must emphasize evidence-based guidelines.
    • 2) Ongoing modeling of multidisciplinary caregiving to determine best practices.
    • 3) Ongoing clinical trials of drugs.
    • 4) Constant revision and updating of guidelines and protocols.
    • 5) Incorporating economic analysis into practice guidelines.
    • 6) Restructuring financial incentives to focus on outcomes rather than volume.
  52. Six main forces that will determine future changes in health care.
    • 1) Social and Demographic Forces
    • 2) Economics Forces
    • 3) Political Forces
    • 4) Technological Forces
    • 5) Informational Forces
    • 6) Ecological Forces
  53. Successful Historical Precedents for PPACA
    1) Oregon Health Plan - Late 80's Medicaid expansion including prioritization and streamlining of covered procedures, Health Insurance Pool for those with pre-existing conditions, and an Employer mandate.

    2) Massachsettss Health Plan - 2006 Individual Mandate, Employer mandate, Subsidized coverage for low-income
  54. Patient Activation
    A person's ability to manage their own health and utilization of care.Challenges include socioeconomic and health status.  Those enrolled in Medicaid are the least active of all insured.
  55. Recommendations for Transforming the Nursing Profession
    • Nurses should practice to the full extent of their education and training.
    • Nurses should achieve higher levels of education and training.
    • Nurses should be full partners in redesigning health care.
    • Improved data and technology should drive assessment of workforce requirements by role, skill mix and demographics.
  56. Training of Primary Care Physicians (to become comprehensivists)
    • Comprehensivists will need to be experts in:
    • 1) Anticipating, preventing and managing complications of common conditions.
    • 2) Managing complex pharmacology.
    • 3) Understanding end-of-life issues.
    • 4) Coordinating care.
    • 5) Leading health care teams.
  57. Future Long-Term Care Challenges
    • 1) Financing - less than 10% of elderly have LTC insurance and midlle class is growing, strain on state and federal budgets.
    • 2) Resources - shift away from insititutional care straining the system.
    • 3) Infrastructure - LTC is more attractive because of new facility design.
    • 4) Workforce - Aging of americans shrinks workforce as number of those who need LTC grows.
    • 5) Regulation - Quality issues and inconsisten applciaiton of regulations must be addressed.
    • 6) IT - technology will enable better tracking of LTC patients as they move between facilities.
  58. What changes will technology bring to the delivery of health care?
    • 1) Rational drug design allows more accurate creation and customization of drugs.
    • 2) Imaging technology allows better identifiaction of disesase and delivery of treatment.
    • 3) Advanced, minimally invasive surgery.
    • 4) Genetic mapping has allowed identifaction of genes which cause disease and may lead to disease.
    • 5) Gene therapy - inserting of genese into targeted cells to correct a defect.
    • 6) Vaccines now used for therapy of noninfectious diseases (HPV/cancer) in addition to prevention. Also more advacned vaccines being developed.
    • 7) Transplantation of organs8) Regenerative medicine.
  59. Globalization and International Cooperation
    Globalization means that infectious disesases are no longer contained to a single geographic area.  Also, large-scale devastation no longer needs to be a addressed by a single country. 

    International cooperation is necessary to prevent and manage the effects of disease pandemics and deliver aid after disasters.
Card Set
S&S Multiple Choice
multiple choice