Study Guide -Delivering Healthcare in America: A Systems ApproachLeiyu Shi & Douglas A. Singh
Chapter 1: A Distinctive System of Health Care Delivery
Multiple Choice Questions
1. The primary objectives of a healthcare system include all of the following except:a. Enabling all citizens to receive healthcare servicesb. Delivering healthcare services that are cost-effectivec. Delivering healthcare services using the most current technology, regardless of costd. Delivering healthcare services that meet established standards of quality
2. The U.S. healthcare system can best be described as:a. Expensiveb. Fragmentedc. Market-orientedd. All of the above
3. For most privately insured Americans, health insurance is:a. Employer-basedb. Financed by the governmentc. Privately purchasedd. None of the above
4. Medicare is primarily for people who meet the following eligibility requirement:a. Elderly b. Low-incomec. Childrend. Disabled5. Medicaid is primarily for people who meet the following eligibility requirement:a. Elderlyb. Low-incomec. Childrend. Disabled 6. The role of the government in the U.S. healthcare system is:a. Regulatorb. Major financerc. Medicare and Medicaid reimbursement rate-setterd. All of the above7. Which of the following is a characteristic of a socialized health insurance system?a. Health care is financed through government-mandated contributions by employers and employeesb. Health care is delivered by government-employed providersc. Both a and bd. Neither a nor b
8. Which of the following is an overarching goal of Healthy People 2010?a. Decrease health care costsb. Create a more coordinated health care systemc. Establish a national health insurance programd. Increase quality and years of healthy life
9. Which of the following is a dimension of social health?a. Sociabilityb. Community involvementc. Marital satisfactiond. All of the above
10. Supplier-induced demand is created by:a. Patients b. Providers c. Health insurance companiesd. The government
Chapter 2: Beliefs, Values, and Health
Multiple Choice Questions
1. The elements of the Epidemiology Triangle of disease occurrence include all of the following except:a. Environmentb. Agentc. Societyd. Host
2. Which of the following factors is the leading cause of preventable disease and death in the United States?a. High fat dietb. Heredity c. Smokingd. Unsafe sex
3. Which of the following is not a behavioral risk factor?a. Irresponsible motor vehicle useb. Inadequate physical exercisec. Unsafe neighborhoodsd. Alcohol abuse
4. What is tertiary prevention?a. Early detection and treatment of diseaseb. Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disabilityc. Reduction of the probability that a disease will develop in the futured. None of the above
5. According to the CDC, which factor contributes most to premature death in the U.S. population?a. Lifestyle and behaviorsb. Lack of medical carec. Social and environmental factorsd. Genetic makeup
6. Which of the following can be considered an environmental factor contributing to health status?a. Air qualityb. Access to health carec. Safety of neighborhoodsd. All of the above
7. Healthcare is considered a social good in:a. Market justiceb. Social justicec. Both a and bd. The total number of cases at a specific point in time divided by the population at risk
8. Demand-side rationing is the same thing as:a. Nonprice rationingb. Price rationingc. Both a and bd. Neither a nor b
9. Prevalence is:a. The number of new cases occurring during a specified period divided by the total populationb. The total number of cases at a specific point in time divided by the specified populationc. The number of new cases occurring during a specified period divided by the population at riskd. The total number of cases at a specific point in time divided by the population at risk
10. Holistic health adds which element to the World Health Organization definition of health?a. Physical b. Mentalc. Spirituald. Social

Chapter 3: The Evolution of Health Services in the United States
Multiple Choice Questions
1. Which of the following forces remains relatively stable, and major shifts in this area would be necessary to bring about any fundamental change in the US health care delivery system?a. Economic forcesb. Political changec. Beliefs and valuesd. Social forces
2. In its historical context, which of the following has played a major role in revolutionizing health care delivery?a. Beliefs and valuesb. Science and technologyc. Medical educationd. Economic growth
3. In the preindustrial era, _____ often functioned as surgeons.a. butchersb. tailorsc. clergymend. barbers
4. Hospitals in the United States evolved froma. alms housesb. sick homesc. pest housesd. inns
5. What was the function of a pest house in the preindustrial period?a. To house people who had a contagious disease.b. To provide refuge to those who were threatened by pests.c. To eradicate pests.d. To treat contagious diseases.
6. Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?a. Urbanizationb. Educational reformc. Science and technologyd. Dependencye. licensing
7. Development of the hospital and ______ happened almost hand in hand in a symbiotic relationship between the two.a. dependency of patientsb. growth of scientific knowledgec. professionalization of medical practiced. cohesiveness of the medical profession
8. Why did physicians remain independent of corporate settings even after the medical profession became well recognized?a. Hospitals were unable to pay high enough salaries to physicians.b. Physicians disliked salary arrangements.c. Licensure laws had not yet been passed.d. Physicians who took up practice in a corporate setting were castigated by the medical profession.
9. Since the early 1900s, the burden of disease in developed countries has shifteda. to underdeveloped countriesb. from infectious to chronic diseasec. from chronic to infectious diseased. from the rich to the poor
10. The inception of _____ was used as a trial balloon for the idea of government-sponsored universal health insurance.a. workers’ compensationb. trade unions c. public health d. health care for the veterans
Chapter 4: Health Services Professionals
Multiple Choice Questions
1. A major factor influencing growth in the health care sector of the U.S. economy is:a. The aging of the populationb. Increasing fertility ratesc. Declining death ratesd. All of the above
2. Which type of health care facility employs the most people in the U.S.?a. Physicians’ offices and clinicsb. Hospitalsc. Nursing and personal care facilitiesd. None of the above
3. When patients have multiple health problems, this is called:a. Coaffliction b. Comortalityc. Codependencyd. Comorbidity
4. The basic source of the physician distribution problem in the U.S. is:a. Lack of health care coverage for all b. The need-based modelc. Lack of awareness that there is a problemd. A shortage of MDs
5. The Nurse Reinvestment Act of 2002 provides:a. Grants and scholarships for nursesb. Funding for nurse retention programsc. Funding for further education for nursesd. All of the above
6. Allied health professionals include:a. Osteopathsb. Dentistsc. Physician assistantsd. None of the above
7. Physician maldistribution occurs by:a. Specialtyb. Geography c. Both a and bd. Neither a nor b8. Primary care is:a. Longitudinalb. The portal to the healthcare systemc. Holisticd. All of the above
9. The principle source of graduate medical education is:a. Medicaidb. Medicarec. Private fundsd. State grant funds
10. Which of the following is a major criticism of managed care?a. Quality of care may be sacrificedb. Managed care is inefficientc. Utilization may increased. Managed care will worsen the physician oversupply
Chapter 5: Medical Technology
Multiple Choice Questions
1. At a fundamental level, medical technology deals with a. production of new equipment to provide more advanced health care b. the application of knowledge produced by biomedical researchc. using discoveries made in basic sciences to improve health care d. new drugs and devices
2. Telemedicine technology that allows a specialist located at a distance to directly interview and examine a patient is referred to as a. telehealthb. simultaneous c. analogous d. synchronous
3. The asynchronous form of telemedicine uses_____ technology. a. store-and- forwardb. access-when-needed c. delayed-accessd. forward-and-retrieve
4. The expectations that Americans have about what medical technology can do to cure illness is based on a. the technological imperative b. cultural beliefs and valuesc. a higher rate of technology diffusion in the US compared to other countries d. medical specialization
5. What is the main intent of the Stark laws? a. Require that personal health information be kept confidential b. Require demonstration of cost-efficiency of new technology c. Prohibit self-referral by physicians to facilities in which they have an ownership interestd. Disclosure of potential harm from a procedure or device
6. Supply-side rationing. a. Curtailment in governing funding for medical research b. Managed care c. Curtailment in payments for new technologyd. Central planning
7. Certain allergy medications containing pseudoephedrine are available without prescription, but must be kept behind the pharmacy counter and sold only in limited quantities upon verification of a person’s identity. a. Food and Drugs Act, 1906 b. Food, Drug, and Cosmetic Act, 1938 c. Kefauver-Harris Drug Amendments, 1962 d. Patriot Act 2006
8. The FDA was given the authority to review the effectiveness and safety of a new drug before it could be marketed. a. Food and Drugs Act, 1906 b. Prescription Drug User Fee Act, 1992 c. Kefauver-Harris Drug Amendments, 1962d. Food, Drug, and Cosmetic Act, 1938
9. This made additional resources available to the FDA, and resulted in a shortened approval process for new drugs. a. Kefauver-Harris Drug Amendments, 1962 b. Food and Drug Administration Modernization Act, 1997c. Orphan Drug Act, 1983 d. Prescription Drug User Fee Act, 1992
10. The Safe Medical Devices Act, 1990 requires a. that injuries, illness, or death from any device be reportedb. premarket approval of devices c. safety testing of devices before and after they have been marketed d. that all problems and potential problems be reported to the FDA
Chapter 6: Health Services Financing
Multiple Choice Questions
1. What is the primary reason that a segment of the U.S. population is uninsured? a. Medicare and Medicaid are the only public insurance programs b. The U.S. has a voluntary system of health insurancec. The poor cannot afford health insurance d. U.S. health insurance is dominated by managed care
2. What is the central role of health services financing in the United States? a. Fund health insuranceb. Underwrite medical risk c. Support managed care d. Balance the supply of health care professionals
3. What is the primary mechanism that enables people to obtain health care services? a. Availability of services b. Health insurancec. Payment for services d. Control of expenditures
4. In national health care systems, total expenditures are controlled mainly through a. cost shifting b. underwriting c. supply-side rationingd. demand-side rationing
5. In a general sense, what is the primary purpose of insurance? a. Predicting risk b. Risk assessment c. Protection against riskd. Underwriting
6. What is the primary function of insurance? a. Pay claims on behalf of the insured b. Underwrite policies c. Provide comprehensive coverage d. Protection against catastrophic risk
7. What is the main advantage of group insurance?a. More people can obtain insurance from a single insurerb. Risk is spread out among a large number of insuredc. More comprehensive services can be covered than under an individual pland. The employer has to deal with only one insurance company
8. The majority of beneficiaries receiving health care through Medicare are a. elderlyb. disabled c. financially poor d. those suffering from end-stage renal disease
9. For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed a. 30 days b. 60 days c. 100 daysd. None of the above
10. The dependents of U.S. military personnel receive health care through a. CHAMPUS b. Military Health Services System c. VHA d. TriCare
Chapter 7: Outpatient and Primary Care Services
Multiple Choice Questions:
1. Typically, tertiary care:a. Is highly specializedb. Does not depend on technologyc. Takes place outside of traditional healthcare facilitiesd. All of the above
2. What is gatekeeping?a. The process by which patients are denied needed careb. The process by which primary care physicians refer patients to specialists c. The concept that specialists use more diagnostic tests than primary care physiciansd. The idea that patients should be allowed to choose their own doctors
3. Which country’s health care system is founded on the principles of gatekeeping?a. UKb. USc. Australiad. China
4. Countries whose health systems are oriented more toward primary care achieve:a. Higher satisfaction with health services among their populationsb. Higher expenditures in the overall delivery of carec. Worse health outcomesd. None of the above
5. The most prominent reason for the decline in the number of procedures performed in hospitals is:a. Most of these procedures were shifted to outpatient settingb. Most of these procedures were deemed outdated c. Most of these procedures were unsafed. Most of these procedures used technology that was too expensive
6. What does “PPS” stand for?a. Preferred Provider Systemb. Primary Physician Systemc. Private Practice Systemd. Prospective Payment System
7. One reason women’s health centers were created is:a. Women have more money than men b. Women seek care more often than menc. Women have shorter life spans than mend. None of the above
8. Hospice services are primarily for people with:a. Chronic illnessesb. Rehabilitative needsc. Terminal illnessesd. None of the above
9. What is palliation?a. Pain and symptom managementb. Psychosocial supportc. A surgical interventiond. Bed rest
10. Community health centers serve primarily: a. High-income neighborhoodsb. Populations with insurance c. Populations which are medically underservedd. Both a and b
Chapter 8: Inpatient Facilities and Services
Multiple choice Questions
1. Inpatient care a. Services delivered by a hospital b. Treatment of acute conditions c. Health care delivered in conjunction with an overnight stay in a facility d. Care delivered in a licensed facility
2. The biggest share of national health spending is used by a. hospitalsb. physicians c. prescription drugs d. nursing home care
3. The first hospitals in the United States served mainly a. the poorb. the wealthy c. those needing surgery d. government officials
4. What is the meaning of “excess capacity” in the health care inpatient sector? a. Hospital consolidation b. Few hospitals c. Large institutions d. Empty beds
5. The Hill-Burton Act was passed to a. make it mandatory for private insurers to cover hospital services b. relieve shortage of hospitalsc. curtail the utilization of hospital beds d. have federal control over community hospitals
6. ALOS is an indicator of a. use of hospital capacity b. frequency of use c. severity of illnessd. access
7. Which ownership type constitutes the largest group of hospitals and hospital beds in the United States? a. Private for-profit b. Federal c. Private nonprofitd. State and local government
8. In a hospital classified as short stay, the ALOS is less thana. 5 days b. 10 days c. 15 days d. 25 days
9. To be classified as a Critical Access Hospital, the number of acute care beds should not exceed a. 20 b. 25c. 35 d. 50
10. According to US law, nonprofit organizations a. can make only a limited amount of profit b. are tax exemptc. cannot have a governing body d. must pay taxes only if they are profitable
Chapter 9: Managed Care and Integrated Organizations
Multiple Choice Questions
1. The managed care phenomenon was welcomed mostly by a. employersb. workers c. private insurance d. the government
2. With the growth of managed care, the balance of power in the medical marketplace swung toward a. providers b. the supply side c. the demand sided. more regulation
3. A managed care organization functions like a. a provider b. an insurerc. a regulator d. a financier
4. What is the purpose of cost sharing with providers? a. It makes providers immune to costs b. It makes providers cost consciousc. It rewards providers for quality d. It keeps insurance premiums low
5. Capitation is best described as a. monthly lump sum payment regardless of utilizationb. monthly lump sum payment regardless of cost c. per member per month paymentd. 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 provider
7. Under which payment method is a fee schedule used? a. prospective payment b. capitation c. discounted feesd. fee for service8. The HMO Act of 1973 required a. health care providers to contract with HMOs b. managed care organizations to offer HMO alternatives c. insurers to switch to managed care d. employers to offer an HMO alternative to conventional health insurance
9. In the term, managed care, ‘manage’ refers to a. management of utilizationb. 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 incomesb. 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
Chapter 10: Long-Term Care
Multiple Choice Questions
1. Low cognitive functioning places an elderly person at a high risk for a. clinical depression b. functional declinec. chronic ailments d. acute ailments
2. The elderly do not constitute a homogeneous group; hence a. they have more chronic ailments than acute episodes b. the LTC system must be integrated with the rest of the health care delivery system c. most elderly people live independently d. a variety of long-term care services are demanded
3. Which of the following plays a primary role in individualizing long-term care services to the patient’s needs? a. Coordination of various services b. Physician’s orders c. An individual assessmentd. A discharge report from the hospital
4. In the delivery of long-term care, customized interventions are carried out according to a. an individual assessment b. a plan of carec. weekly evaluations by the patient’s physician d. the philosophy of total care
5. What is the key determinant of the need for long-term care? a. A disabling accident b. An acute episode c. Presence of multiple chronic conditions d. Limitations in a person’s ability to perform tasks of daily living
6. What is the goal of long-term care? a. Promote functional independenceb. Return a person to independent living c. Reverse the decline in activities of daily living d. Cope with multiple chronic conditions
7. Which of the following can contribute positively to a person’s quality of life? a. Palliationb. Assessment c. Plan of care d. Total care
8. Why is the assessment of psychiatric illness particularly difficult in geriatric patients? a. Mental illness cannot be ruled out b. The elderly often fake mental illness. c. Psychiatric illness can be intermittent d. Comorbidities can obscure diagnosis
9. Personal care is a. Individualized care b. Basic assistance with ADLsc. Services that are nurse-intensive d. Long-term care provided by unpaid caregivers
10. Maintenance rather than restoration of functioning is particularly the domain of a. custodial careb. restorative care c. skilled nursing care d. personal care
Chapter 11: Health Services for Special Populations
Multiple Choice Questions
1. Which racial/ethnic group is most likely to drink alcohol?a. Whiteb. Black or African Americanc. Asian or Pacific Islander d. Hispanic
2. Which racial/ethnic group is growing the fastest?a. Whiteb. Black or African Americanc. Asian or Pacific Islander d. Hispanic
3. Which racial/ethnic group is least likely to use mammography?a. Whiteb. Black or African Americanc. Asian or Pacific Islander d. Hispanic
4. Approximately how many Americans are uninsured?a. 16 millionb. 26 million c. 46 milliond. 66 million
5. Lack of insurance can result in: a. Decreased utilization of lower cost preventive servicesb. Increased need for more expensive, emergency health carec. The spread of infectious diseasesd. All of the above
6. Which legislation created the State Children’s Health Insurance Plan (SCHIP)?a. Balanced Budget Act of 1997b. State Children’s Health Insurance Act of 1997c. Kids First Act of 1997d. Omnibus Reconciliation Act of 1997
7. What does “MUA” stand for?a. Metropolitan Utilization Areab. Medically Underserved Areac. Metropolitan Underserved Aread. Medical Utilization Area
8. What is the primary purpose of the National Health Service Corps?a. To recruit physicians to provide services in physician shortage areas in the U.S.b. To recruit physicians from abroad to work in the United Statesc. To send U.S. physicians to developing countries to provide services to the indigentd. To recruit physicians into the military9. Among women, which racial/ethnic group has the highest percentage distribution of AIDS?a. White, non-Hispanicb. Black, non-Hispanicc. Hispanicd. American Indian
10. What does the federal Ryan White CARE Act fund?a. Care for underserved rural and urban populations b. Skin cancer screening programsc. School-based health services in predominantly minority neighborhoodsd. Development of treatment and care options for persons with HIV and AIDS

Chapter 12: Cost, Access and Quality
Multiple Choice Questions
1. What is Gross Domestic Product (GDP)?a. A measure of all the goods and services produced by a nation in a given yearb. A measure of all the goods and services produced by a nation in a given year, divided by the populationc. A measure of all the goods and services produced by a nation in a given year, minus the amount of money spent by the governmentd. A measure of all the goods and services produced by a nation in a given year, divided by the amount of money spent by the government
2. What is a PRO?a. Price Rationing Organizationb. Political Review of Outcomes c. Peer Review Organizationd. President’s Review of Organizations
3. What is meant by the term “health care costs”?a. The price of health careb. How much a nation spends on health carec. Cost of producing health cared. All of the above
4. Medical cost inflation is influenced by all of the following factors except:a. Waste and abuseb. Increase in elderly populationc. Decrease in uninsuredd. Growth of technology
5. What are administrative costs?a. Costs associated with management of the financing, insurance, delivery, and payment functions of health careb. Costs associated with financing and insurance onlyc. Costs associated with delivery and payment functions onlyd. None of the above
6. What is the main reason for the lack of success of health care cost control efforts in the U.S.?a. Malpractice lawsuitsb. Cost shifting by providersc. Dislike of the practice by consumersd. Growth of technology
7. Fill in the blank: The distinction between predisposing and enabling conditions can be applied to assess the _______ of a health care system.a. costb. equityc. efficiencyd. effectiveness
8. What is the purpose of clinical practice guidelines?a. To provide a plan to manage a clinical problem based on evidence or consensusb. To lower costsc. To improve outcomesd. All of the above
9. What is the Health Plan Employer Data and Information Set (HEDIS)?a. A quality report card b. A cost report cardc. A government database on health plansd. None of the above
10. What are the main activities of risk management?a. Proactive efforts to prevent adverse events related to clinical care and facilities operationsb. Retrospective studies of adverse eventsc. Both a and bd. Neither a nor b
Chapter 13: Health Policy
Multiple Choice Questions:
1. Which major public insurance program was legislated in 1965?a. Medicareb. Medicaidc. Both a and bd. Neither a nor b
2. Health policies are used in what capacity?a. Regulation of behaviorsb. Allocation of income, services, or goodsc. Both a and bd. Neither a nor b
3. What is incrementalism?a. The fact that in the U.S., health care is financed by multiple entitiesb. The fragmented, uncoordinated delivery of health services c. Small policy changes that reflect a compromise amongst different groups’ demandsd. None of the above
4. Which of the following branches of government is a supplier of policy?a. Executiveb. Legislativec. Judiciald. All of the above
5. What is an interest group?a. A group of lawmakers within Congress with a particular area of interestb. A group of appointed judges with a particular political view pointc. An independent, non-governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers d. None of the above
6. What was the main purpose of the Kerr-Mills program (1960)?a. Provision of federal grants to state government programs assisting the elderlyb. Provision of federal grants to state government programs assisting the poorc. Provision of federal grants to state government programs assisting childrend. None of the above
7. For what is the National Health Planning and Resources Development Act of 1974 noted? a. The shift from cost containment to improvement of quality as the principal theme in federal health policyb. The shift from cost containment to improvement of access as the principal theme in federal health policyc. The shift from improvement of access to cost containment as the principal theme in federal health policyd. The shift from improvement of quality to cost containment as the principal theme in federal health policy
8. What does “CON” stand for?a. Certificate of Needb. Certificate of Nursingc. Certificate of Naturopathyd. Certificate of Nationality
9. In what way does research influence policymaking?a. Prescriptionb. Documentationc. Analysisd. All of the above
10. All of the following were identified by the Institute of Medicine (Crossing the Quality Chasm, 2001) as areas for quality improvement, except:a. Timelinessb. Safetyc. Efficacyd. Patient-centeredness

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