What is the goal of evidence-based medicine?

Fourth Edition, 2008
ISBN-13: 9780763745127, ISBN-l 0:076374512X

HCA 501
Health Care in America
Text: Delivering Health Care in America
Leiyu Shi and Douglas A. Singh
Jones & Bartlett Learning

Multiple Choice Questions (Enter your answers on the enclosed answer sheet)
1. When providers deliver unnecessary services with the objective of protecting themselves against lawsuits, this practice is called
a. defensive medicine
b. supplier-induced demand
c. primary protection
d. legal risk
2. Reimbursement is associated with which of the quad functions?
a. Financing
b. Insurance
c. Delivery
d. Payment
3. Which central agency manages the health care delivery system in the United States?
a. Centers for Disease Control and Prevention
b. Department of Health and Human Services
c. Department of Commerce
4. National health care programs in other countries often use which of the fOllOWing mechanism to control total health care expenditures?
a. Third parties
b. Capitation
c. Global budgets
d. A single-payer system
5. In the United States, who does not generally have access to basic and routine medical services?
a. People who need catastrophic care
b. Those eligible only for public programs
c. The uninsured
d. Those without private health insurance
6 .Which country utilizes socialized health insurance for employees?
a. Germany
b. United States
c. Great Britain
d. Australia
7. All of the following are main elements of the systems framework EXCEPT:
a. system inputs
b. system foundations
c. system structure
d. system processes
8. Deontology asserts:
a. That no one has a duty to do what is right
b. That it is society’s duty to do what is right
c. That it is an individual’s duty to do what is right
d. None of the above
9. Utilitarianism emphasizes:
a. Happiness and welfare for the poor
b. Happiness and welfare for the deserving
c. Happiness and welfare for the rich
d. nappmess ana welfare for the masses
10. Supply-side rationing is also referred to as:
a. Nonprice rationing
b. Price rationing
c. Both a and b
d. None of the above
11. Prevalence is:
a. The total number of cases at a specific point in time divided by the specified population
b. The total number of cases at a wide range in time divided by the specified population
c. The number of new cases occurring during a specified period divided by the total population
d. The number of new cases occurring during a specified period divided by the population at risk
12. The limitations of market justice include:
a. Social problems are not adequately addressed
b. Society is not always protected from the consequences of ill health
c. It leads to inequitable access to health care
d. All of the above
13. Crude rates refer to:
a. A specific age group
b. The total population
c. A specific gender
d. None of the above
14. Holistic health adds which element to the World Health Organization definition of health?
a. Physical
b. Mental
c. Social
d. Spiritual
15. All of the following were factors explaining why the medical profession remained largely an insignificant trade in preindustrial America EXCEPT:
a. Medical practice was in disarray
b. Medical procedures were primitive
c. High demand for prescription drugs
d. Demand was unstable
16.The American system for delivering health care took its current shape during this period:
a. Preindustrial
b. Postindustrial
c. Twentieth century
d. none of the above
17. Today, are the leading cause of illness, disability, and death in the US.
a. typhoid
b. chronic conditions
c. acute illness
d. none of the above
18. This group was primarily responsible for leading the successful drive for workers’ compensation.
a. Internal Revenue Code
b. American Medical Association
c. Blue Cross
d. the American Association of Labor Legislation
19. Capitation is:
a. integration of telecommunications in healthcare
b. umbrella fund for everyone
C. flat rate per worker per month
d. none of the above
20. All of the following are modes of economic interrelationships EXCEPT:
a. use of advanced telecommunictions infrastructures in medicine
b. health professionals remain in the United States
c. consumers travel abroad to receive medical care
d. foreign direct investment in health services enterprises
21. What is an example of health care delivery existing due to social and political needs:
a. Medicaid
b. State Children’s Health Insurance Program
c. Multispecialty centers
d.None of the above.
22. All states require this to be licensed in order to practice. What is a requirement needed to be licensed?
a. graduation from an accredited medical school that awards a Doctor of Medicine
b. score of 85 on board exam
c. enrollment in internship program
d. none of the above
23. What is a main difference between primary care and specialty care?
a. primary care follows specialty care
b. primary care focuses on disease while specialty care focuses on the whole person
c. primary care is longitudinal and specialty care is episodic
d. none of the above
24. What is the principal source offunding for graduate medical education?
a. Medicare
b. Private corporations
c. International companies
d. none of the above.
25. Why are physicians most likely to concentrate in metropolitan and suburban areas?
a. better opportunities for high income
b. greater access to modern facilities and technology
c. cultural diversity
d. All of the above
26. Dental do not have to be licensed.
a. hyqientists
b. pediatrics
c. assistants
d. none of the above
27. This act authorizes a variety of grants and scholarships to keep nurses in the field:
a. American Nursing Association Act
b. Reimbursement Act
c. Nurse Reinvestment Act of 2002
d. None of the above
28. Who is responsible for operational, clinical and financial outcomes of organizations that deliver health services?
a. Health Service Administrators
b. Allied Health Professionals
c. Physical Therapists
d. None of the above
29. 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, 1997
c. Orphan Drug Act, 1983
d. Prescription Drug User Fee Act, 1992
30. What was the purpose of certificate of need (CON) laws?
a. Monitor the diffusion of new technology
b. Control the flow of federal funds for private projects
c. Control new health service programs
d. Control new construction and modernization projects
31. Which area of personal health expenditures has seen the greatest rise in recent years?
a. Long-term care
b. Hospital food
c. Prescription drugs
d. Durable bathroom equipment
32. What is the role of an Institutional Review Board (lRB)?
a. Establish guidelines for the method of conducting research
b. Verify the results of clinical trials
c. Approve and monitor research that involves human subjects
d. All of the above
33. Generally, at the start of medical treatment
a. benefits exceed costs
b. cost-efficiency is minimum
c. costs exceed benefits
d. safety is not a major concern
34 .. Health technology assessment in the US is conducted primarily by
a. various government agencies
b. the NIH
c. the FDA
d. the private sector

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35. According to the Institute of Medicine, the rise in prescription drug costs is mainly attributed to
a. price inflation
b. increased use of existing drugs
c. research and development costs
d. replacement of older drugs by newer ones
36. What is the main factor that determines the level of demand for health services in the US health care delivery system?
a. finances
b. insurance
e. health services
d. none of the above
37. Which of the following is NOT a fundamental principle that underlies the concept of insurance?
a. Risk is unpredictable for the individual insured.
b. Risk can be predicted with a reasonable degree of accuracy for a group.
c. Insurance provides a mechanism for transferring risk from the group to the individual.
d. Actual losses are shared on some equitable basis by all member of the insured group.
38. Most Americans obtain health insurance coverage through:
a. individual plans
b. employer-sponsored programs
e. self-insurance
d. none of the above.
39. The Medicare program finances medical care for:
a. persons 65 years and older
b. disabled individuals who are entitled to social security benefits
e. people who have end-stage renal disease.
d. All of the above
40. Who is eligible for Medicaid?
a. Children and pregnant women whose family income is at or below 133 percent of the Federal Poverty Level.
b. Families with children
e. The elderly
d. none of the above


41. How does workers’ compensation differ from regular health insurance?
a. it becomes supplemental coverage for eligible employees
b. employers are required by law to bear the full cost of the benefits
c. it is regionally managed
d. none of the above
42. This Act authorized by Congress supports “safety net” hospitals in inner cities and rural ares.
a. Consolidated Omnibus Budget Reconciliation Act of 1985
b. Indian Reconciliation Act of 1989
c. Cost Plus Act of 1992
d. None of the above
43. What is the point of entry into the health services system?
a. specialization
b. primary care
c. coordination of care
d. essential care
44. Which factor has NOT contributed to the increase in outpatient care?
a. reimbursement
b. technological
c. family
d. social
45. are the backbone of ambulatory care and constitute the majority of primary care.
a. home health care
b. hospice services
c. physicians as office-based practitioners
d. alternative medicine
46. Hospice services include:
a. pain management
b. psycholsocial support
c. spiritual support
d. all of the above

47. What is a characteristic of a free clinic?
a. services are provided at no charge or nominal charge
b. they are not directly supported by government agencies
c. services are delivered mainly by volunteer trained staff
d. all of the above.
48. are regarded as nontraditional and include a wide range of treatments.
a. complementary medicine
b. alternative medicine (alternative therapies)
c. material medicine
d. none of the above

In the above question… answer should be alternative therapies.. as the same option is not mentioned I have selected Option D.
49. In 2004, what type of office visits were visited the most?
a, physicians in general and family practice
b. physicians in specialty services
c. physicians in internal medicine
d. physicians in gynecology
50. ALOS is an indicator of
a. use of hospital capacity
b. frequency of use
c. severity of illness
d. access
51. What financial benefit does a small rural hospital reap by qualifying for the designation, Critical Access Hospital?
a.lt can receive specific federal grants for serving vulnerable populations
b. It can use its beds for either acute care or long-term care as needed
c. It can increase its profitability by receiving special payments for emergency services
d. It can receive cost-plus reimbursement under Medicare Part A
52. Which principle of ethics requires caregivers to involve the patient in medical decision making?
a. Paternalism
b. Fidelity
c. Beneficence
d. Autonomy
53. What is the main drawback of a living will?
a. It cannot cover all possible situations
b. The patient’s agent may not act in the patient’s best interest
c. The person formulating a living will must have a court appointed guardian
d. It becomes invalid when the patient becomes incompetent
54. To participate in Medicare and Medicaid, a health care facility must be
a. conditioned
b. accredited
c. certified
55. Which entity oversees the licensure of health care facilities?
a. The Joint Commission
b. Federal government
c. State government
d. Local county or city government
56. Institutional theory predicts that
a. for-profit and nonprofit organizations will imitate each other when faced with similar regulatory and legal constraints
b. as an enterprise increases in size, its unit overhead costs would decrease
c. as a hospital increases in size, its economies of scale dissipate
d. in competitive markets, both for-profit and nonprofit organizations would deliver certain essential community benefits
57. Under this method, a primary care physician decides whether or not to refer a patient to a specialist.
a. Preauthorization
b. Prospective utilization review
c. Disease management
d. Closed-panel utilization
58. When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?
a. Surgery
b. Gatekeeping
c. Mental health
d. Primary care
59. Which HMO model is likely to require heavy capital outlays to expand into new markets?
a. Staff model
b. Group model
c. Network model
d.IPA model
60. PPOs were created by __ in response to HMOs’ growing market share.
a. physicians
b. insurance companies
c. hospitals
d. independent contractors
61. Which of these organizations was specifically created to bring management expertise to physician group practices?
a. Virtual organizations
b. Physician-hospital organizations
c. Provider-sponsored organizations
d. Management services organizations
62. Where two organizations cease to exist, and a new corporation is formed:
a. Acquisition
b. Merger
c. Joint venture
d. Alliance
63. Regional health systems are often:
a. horizontally integrated
b. vertically integrated
c. formed into virtual organizations
d. formed into alliances
64. requires that any health care need is recognized, evaluated, and addressed.
a. long-term care
b. health care
c. individual care
d. total care
65. What is the primary goal of long-term care?
a. help patients with increased pain
b. cure deadly diseases
c. preventing institutionalization
d. providing socialization
66. This type of clinical category for long-term care is non-medical care provided to support and requires no active medical treatments.
a. personal care
b. nursing care
c. custodial care
d. subacute care
67. What is the most common cause of of mental retardation in America?
a. Down’s syndrome
b. autism
c. spina bifida
d. epilepsy
68. The prevalence of HIV in the population has:
a. increased
b. decreased
c. stayed the same
d. none of the above
69. Which law created two categories for nursing home certification purposes?
a. Nursing Home Reform Act
b. Medical Advancement Act
c. Nursing Home Alternatives Act
d. None of the above
70. Who is the primary payer for health care services for the elderly?
a. Medicaid
b. Medicare
c. private insurance
d. none of the above
71. What was the sixth leading cause of death for Hispanic males in 2003?
a. heart disease
b. malnutrition
c. diabetes
d. homicide
72. What factor has been found to be associated with the highest injury-related mortality reate among Indian children?
a. cultural
b. prenatal care
c. social
d. poverty
73. Most medically uninsured adults are employed but are not covered because:
a. their employer does not offer health benefits
b. they do not work enough hours to qualify for health benefits
c. they cannot afford the premium
d. all of the above.
74. Education and psychotherapy for children with HIV is an example of:
a. heatlh-related support services
b. population-based community health services
c. personal medical and preventive services
d. none of the above
75. Who is the principal user of the health care system?
b. children
c. elderly
76. What is defined as a”high-impact”area?
a. areas with over 3,000 rural health clinics
b. areas that serve at least 4,000 migrant workers for at least two months per year.
c. areas that serve at least 12,000 community members per year
d. none of the above.
77. Which type of patient is most likely to experience disability and more severe medical illnesses?
a. diabetic
b. cancer
c. depressed
d. elderly
78. All of the following are factors effecting the growth in health spending EXCEPT:
a. uninsured patients
b. hospital services
c. prescription drugs
d. physician services
79. What is partly responsible for the surplus of specialists in the US?
a. greater access to financial aid
b. technology
c. increased population
d. none of the above
80. Defensive medicine leads to:
a. decreased cesarean sections
b. legal risks
C. unnecessary tests and services
d. none of the above
81. What was the most sweeping price-control initiative for Medicare?
a. Economic Stabilization Program
b. Balanced Budget Act
c. Omnibus Budge Reconciliation
d. none of the above
82. What is NOT an implication for access to health and health care delivery?
a. access to medical care is one of the key determinants of health
b. measures of access reflect changes across the board
c. access is increasingly linked to quality of care
d. access is a significant benchmark in assessing effectiveness
83. Which main type of access refers to the type, site, and purpose of health services?
a. potential
b. realized
c. equitable
d. inequitable
84. What do proponents believe regarding clinical practice guidelines?
a. it reduces utilization
b. decreases scientific research
c. it promotes lower costs and better outcomes
d. increases technology
85. When public policy pertains to or influences the pursuit of health they become:
a. health policy
b. population policy
c. prevention policy
d. none of the above
86. A problem associated with government involvement in US Health Is:
a. escalating costs
b. bureaucratic inflexibility
c. excessive regulation
d. all of the above
87. An insurance risk pool:
a. helps people acquire private insurance otherwise unavailable
b. helps insurance companies decrease their costs
c. helps employers obtain insurance for their employees
d. none of the above
88. All BUTwhich of the following presidents is mentioned in the text as contributing major changes in health policies:
a. President Lyndon Johnson
b. President John Kennedy
c. President HarryTruman
d. President Bill Clinton
89. Which branch of government is the most active in policymaking?
a. executive
c. legistlative
d. none of the above

90. Which group have policies been created to provide access to health care?
a. elderly
b. poor children
c. poor adults
d. all of the above
91. What is the third main concern of health care policy?
a. cost
b. research
c. qualify of care
d. technology
92. The majority of employers currently offer:
a. long-term plan
b. defined benefit plan
c. deductible health plan
d. none of the above

93. The greatest challenge in insurance is:
a. maintaining a balance between healthy and sick enrollees
b. maintaining a balance between young and elder enrollees
c. maintaining a balance between premium and nonpreminum enrollees
d. none of the above
94. What is a disadvantage of managed competition?
a. the medical infrastructure fluctuates
b. increased government bureaucracy
c. it cannot gurantee that everyone would have equal access to care
d. all of the above
95. Infectious diseases and health care must be viewed from a____________perspective.
a. cost
b. cultural
c. global
d. multi-faceted
96. What is a strategy used to deal with nurse shortages?
a. investments in training
b. improvement in work environments
c. opening new schools
d. all of the above
97. What approach will be used in order to improve quality and productivity?
a. collaborative team approach
b. collaboration
c. cross-training
d. all of the above

98. What is the goal of evidence-based medicine?
a. increase the amount of patients
b. increase the availabilty of prescription medicine
c. increase the value of medicine
d. none of the above
99. What type of integration is represented by a chain of nursing homes?
a. Vertical integration
b. Network
c. Horizontal integration
d. Diversification
100. Where a new corporation created by two partnering organizations remains independent:
a. Acquisition
b. Merger
c. Joint venture
d. Alliance

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