(Test Bank) Jonas and Kovners Health Care Delivery in the United States

Knickman, 12

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12th Edition

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Jonas and Kovners Health Care Delivery in the United States 12th Edition Knickman Test Bank Chapter 1, The Challenge of Health Care Delivery and Health Policy MULTIPLE CHOICE 1. The hope that big data can solve many health -related problems underlies which of the following? *A. Personalized medicine B. A more complex health enterprise C. Better health care management D. Universal health care 2. What percent of all jobs in the United States are in the health sector? A. 8% *B. 11% C. 15% D. 27% 3. Health care in the United States is best described as an enterprise because it blends providers oriented toward altruism with which of the following? A. Government spending B. Minimal regulation *C. A huge health -care industry D. Local regulation 4. What proportion of its economic resources does the United States devote to medical care and the promotion of health? A. About 5% B. Nearly 10% C. About 13% *D. Nearly 20% MULTIPLE RESPONSE 5. Which were among the achievements of health researchers in the nineteenth century? Select all that apply. *A. An understanding of the role of germs in communicating disease B. Development of an efficient way to assess the cost of health care *C. Acknowledgement of the need for clean water and safe sanitation D. Recognition of the need to pay doctors more 6. Which of the following help to pay for health care in the United States? Select all that apply. *A. Taxes *B. Foregone wages *C. Out-of-pocket payments D. Employer bonuses 7. Access to medical care in the United States depends on which of the following? Select all that apply. *A. Race B. Age C. Medical need *D. Geographic location *E. Income level 8. Which of the following are appropriate goals of the public health system? Select all that apply. *A. Promoting healthy behaviors *B. Ensuring safe sanitation and water supplies *C. Protecting the environment D. Alleviating pain and suffering caused by major medical problems *E. Preventing epidemics 9. Which of the following play a role in running the U.S. health care system? Select all that apply. *A. Policy makers *B. Policy advocates *C. Heads of technology companies D. Parents *E. Executives of pharmaceutical businesses 10. Problems in the coordination, transparency, and accountability of medical care arise because of which of the following? Select all that apply. *A. Inadequate information on which patients can base medical choices *B. Providers’ refusal to disclose their prices to patients C. Inequities in patients’ income and educational levels *D. Failure to encourage the use of second opinions MULTIPLE CHOICE 11. Which of the following is not a defining characteristic of the U.S. health care system? A. Dysfunctional methods of payment and financing *B. Dominant role of politicians C. Tension between the free market and government control D. Lack of coordination between the many types of actors and organizations 12. The “health in all” approach to social policy advocates which of the following? *A. Political leadership to guide collective action that encourages pro -health norms and practices B. Univers al health care C. Recognition of the role of social connections in maintaining health D. Safe neighborhoods 13. The relatively new concept of public health is distinguished by which of the following? A. Recognition of the role of health care professionals B. Wider health care access *C. Focus on the lives of patients outside health care organizations D. Disease prevention 14. The evolution of the U.S. health care system has been shaped most strongly by which of the following? A. Coordination between many actors and organizations *B. Economic incentives and opportunities C. An aging population D. The shared goal of restoring health 15. Key social factors that predict an individual’s health include all the following except which? *A. Gender B. Family income C. Availability of educational opportunities D. Social connections 16. The U.S. health care system rewards providers for which of the following? A. Being efficient B. Delivering effective care C. Serving as many people as possible *D. Providing more, and more billable, services 17. Which of the following is a distinguishing feature of many U.S. patients’ experience? *A. Ignorance of the price of a service until after delivery B. Long waits for elective services C. Equal access to health care D. Agreement about whether health care is a good or a right 18. Which stakeholder often plays the role of referee in the U.S. health care system? A. Legislators B. Employers *C. Insurers D. Providers 19. Which stakeholder in the U.S. health care system most likely views health insurance premiums as a cost of doing business? A. Employees *B. Employers C. Insurers D. Public policy makers 20. On which of the following goals do public policy makers most often disagree? A. Slower cost inflation in the health sector B. Continued incorporation of state-of-the-art medical care and prevention strategies C. Elevation of the role of quality in the provision of health care *D. Defini tion of health care access as a universal right SHORT ANSWER 21. Describe two ways in which the payment system in U.S. health care is dysfunctional. Answer: The system rewards providers for delivering more services, and more billable services, than for being efficient and delivering effective care. This makes it economically illogical for providers to be patient -friendly and focus on the delivery of high-value services. The system also lacks transparency for users, w ho seldom know the cost of a service until after the service has been delivered. 22. Individual consumers or patients often seem removed from health care decisions that affect them. Explain why this occurs, and why consumers should instead be at the center of the system. Answer: Individuals seem removed from the U.S. health care system because physicians and providers believe they know best and fail to encourage patients to actively participate in medical decisions that affect them. Individuals also often lack knowledge of the costs of their care. Insurers contribute to the problem by deciding what services are allowed for treatment of specific health conditions. Consumers should be at the center of the system because their needs and wants are the reason the system exists. 23. Contrast the processes of maintaining health and restoring health, and the systems that deliver each. Answer: The medical care system takes charge of restoring health when people are ill, and often of caring for people if restoring health is not possible. It focuses on limiting the spread of a medical problem, alleviating symptoms of the problem, and helping individuals cope with pain, suffering, and loss of function they may experience. The process of maintaining health requires a vibrant public health and social service system that helps people avoid illness by preventing epidemics, ensuring food and water safety, monitoring the environment, and developing education initiatives to encourage healthy behaviors and discourage unhealthy ones. 24. Describe some of the key defining characteristics of the U.S. health care system. Answer: Key defining characteristics of the U.S. health care system include the importance of org anizations such as hospitals, public health departments, and nursing homes in delivering care; the role of professionals such as physicians, policy makers, and managers in running the system; the emergence of new medical technology, smartphones, big data, and new pharmaceuticals; tension between the free market and government control, which centers on the question whether health care is a “good” or a “right;” and a dysfunctional fee-for-service payment system that rewards providers for providing more billable services rather than for being efficient and delivering effective care. 25. Discuss some of the inequalities in access to medical care and in patients’ outcomes in the United States. Answer: In the United States, medical care and its a ssociated outcomes depend on an individual’s income level, race, and geographical location. Those with lower incomes often receive subpar care, and studies have demonstrated that access and outcomes vary by race, even among Blacks, Latinos, and Whites who have the same income and educational levels. Marked differences in access, quality, and outcomes also exist across different regions of the country, partly because best practices do not spread easily or quickly. ESSAY 26. What are some of the major issues and concerns that face the U.S. health system? Describe at least five and give examples of each. Answer: The chapter notes seven major concerns: • Improving quality. Tens of thousands of Americans die because of medical errors each year, and effective treatment for diseases like asthma and diabetes and for mental health and substance abuse problems is given only about half the time. In addition, the health system is not always customer -friendly and lacks many practices other service sectors routinely use to improve customer experiences. The challenge is transferring into action the knowledge we posses about how to organize care to deliver high-quality services virtually all the time. • Improving access and coverage. Despite passage of the Patient Protection and Affordable Care Act (ACA or Obamacare), millions still have no or inadequate health coverage for acute care. Many states still choose not to adopt some expansions of coverage for low -income residents due to political opposition. And even given insurance, access to care is not guaranteed. Some rural areas experience shortages of doctors an d other providers, and many doctors refuse patients with certain types of insurance such as Medicaid. • Slowing the growth of health care expenditures. Both price and volume of services have steadily increased for 50 years, growing faster than the rest of th e U.S. economy. The challenge is to restructure delivery and payment to focus on high-value care with less waste. Some progress has been made in reducing costs, but it has helped businesses and government payers of care more than individuals buying health insurance in the private marketplace. • Encouraging healthy behavior. Healthy behavior can help people avoid disease and injury or prevent these from getting worse. For millions of Americans, however, leading a healthy life takes lower priority than other goals. Health systems are increasingly tackling the challenge of changing health -related behavior, but effective preventi on programs are needed, along with ways to make social and built environments more encouraging of healthy choices. • Improving the public health system. The governmental public health infrastructure maintains population health and regulates aspects of the he alth care delivery system. State and local health departments monitor residents’ health, provide preventive services, and regulate providers and businesses that affect population health. • Improving the coordination, transparency, and accountability of medical care. Problems of quality, cost, and access are caused by fragmentation and lack of coordination both within and between health care organizations, helped by a lack of integrated and electronic record systems and of cooperative r elationships among providers treating the same patient, such as primary care and specialty physicians and hospitals. Providers refuse to reveal prices, second opinions are not encouraged, and patients often lack clear explanations of treatment options and their pros and cons. • Addressing inequalities in access and outcomes. Medical care and its associated outcomes depend on income level, race, and geographical location. Those with less income often receive subpar care, and access and outcomes vary by race, even among Blacks, Latinos, and Whites with the same incomes and education levels. Marked differences in access, quality, and outcomes also exist across different regions of the country. 27. Describe the key stakeholders in the U.S. health system and the role of each. Answer: • Individual consumers or patients should be at the center of the health system but often seem like bystanders when physicians and other providers assert they know best and fail to engage patients as full partners in their own care. Insurers contribute to the problem by deciding what treatm ent is allowed for specific health conditions. • Providers and other professionals in the health workforce include medical providers, caregivers, and pharmaceutical and medical device companies invested in the social goal of keeping people heal thy. More physicians and other providers are working in large practices, hospitals are merging with other types of medical providers, and a greater number of professionals outside the health system are working to improve health. • Employers are stakeholders because most businesses offer employees private health insurance as part of their compensation packages, adding to the cost of doing business and potentially affecting profitability. Employers want healthy employees but also less responsib ility for health care costs. • Insurers are the intermediaries among payers (employers), providers, and consumers. They can lose money if the payments they make to providers exceed the premiums paid by employers, but they are increasingly leaving it up to employers to bear this risk. Instead they negotiate and set rules with employers and providers about what services are eligible for reimbursement and what payments will be made. • Public policy makers include appointed officials and elected politicians, two groups that often set conflicting agendas, sometimes based on different ideas about ho w the health system should work and the role government should play in it. However, they do agree on the need to slow the rising cost of health care, to adopt state -of-the-art medical care and prevention interventions, and to elevate the importance of qual ity and the patient experience. 28. Discuss why our health care system is so important to American life. Answer: Our nation is built on the idea expressed in the Declaration of Independence that society should ensure an opportunity for “life, liberty, and the pursuit of happiness.” Ensuring life is the core goal of the health system, and health is among the core needs to live a viable life, to participate in the political and social system, to work to support ourselves and our families, and to pursue happiness and a good life. This pursuit of life not only has resulted in a set of social and poli tical norms about the value of good health to everyone in the nation. It has also spurred the growth of a huge health industry that both affects and is affected by society’s economic activity and decisions. To understand the health system, we need to under stand not only the art and practice of medicine and public health but also the economic, organizational, and management issues we must address to keep the health system effective, efficient, and affordable. The way we organize and manage this system and change it over time can help or hurt both our health status and our economy. Jonas & Kovner’s HEALTH CARE DELIVERY IN THE UNITED STATES , 12th Edition TEST BANK Chapter 2, Organization of Care MULTIPLE CHOICE 1. What feature of many other countries’ health care systems does the U.S. system lack? *A. A central government agency to control the delivery of health care B. Specialized health care providers C. Prevention services D. Community health centers 2. Which organization defines health as a “state of complete physical, mental and social ‘wellbeing’ and not merely the absence of disease or infirmity?” A. The United Nations B. The American Medical Association *C. The World Health Organization D. The Institute of Medicine 3. The Patient Protection and Affordable Care Act of 2010 has increased the health system’s focus on which of the following? A. Cures *B. Prevention C. Palliative care D. Rehabilitation 4. Programs to help people lose weight or stop smoking are examples of which type of prevention? *A. Primary B. Secondary C. Tertiary D. Acute 5. Which of the following is not a type of secondary prevention service? A. Blood pressure screening B. Pap smear C. Mammogram *D. Immunization for childhood diseases 6. According to the Centers for Disease Control and Prevention, what percentage of emergency room visits in 2015 were actually urgent, requiring medical attention within A. 15 to 60 minutes? B. 0.7% C. 7.4% *D. 29.8% E. 61.2% 7. The emergency severity index (ESI) defines “immediate” as a patient whose condition needs to be seen within what time span? *A. Less than 1 minute B. Between 1 and 14 minutes C. Between 15 and 60 minutes D. Between 61 and 120 minutes 8. You drive your friend to an urgent care center for treatment of a suspected sprained ankle. There she will receive which type of care? A. Prehospital care B. Chronic care C. Tertiary care *D. Ambulatory care 9. What percent of U.S. health care costs is attributable to the treatment of patients who have multiple chronic conditions? A. 15% B. 25% *C. 66% D. 80% MULTIPLE RESPONSE 10. Which of the following are purposes of tertiary prevention services? Select all that apply. *A. Preventing damage from an existing disease B. Treating an urgent episode of illness or injury *C. Slowing the progression of a disease *D. Preventing complications of disease 11. Acute care encompasses which of the following functions? Select all that apply. *A. Emergency care *B. Trauma care *C. Prehospital emergency care *D. Acute care surgery E. Immunization 12. Which of the following help define a medical emergency according to the prudent layperson standard? Select all that apply. *A. Serious jeopardy for the health of an individual or unborn child *B. Serious impair ment of bodily functions C. Exposure to an infectious disease *D. Serious dysfunction of any bodily organ or part 13. Which of the following are among the health care professionals who typically provide primary care? Select all that apply. *A. Physicians B. Dentists *C. Physician assistants *D. Nurse practitioners 14. The idea behind the Triple Aim is for health care organizations to simultaneously pursue three goals. Which of the following are they? Select all that apply. *A. Reduce the per-capita cost of health care B. Apply the principle of triage in delivering care *C. Improve the health of populations *D. Improve the patient experience of care MULTIPLE CHOICE 15. Which of the following is a collaborative network of providers who work together in a coordinated fashion to provide a continuum of care to a particular patient population or community? *A. An integrated delivery system B. An urgent care center C. A public health agency D. A home health care organization 16. Which of the following is a type of care provided to terminally ill patients? A. Subacute care B. Rehabilitative care *C. Hospice care D. Long -term care 17. Encompassing about 42% of practicing U.S. physicians, the most common type of physician practice today is which of the following? A. Multispecialty group practice B. Solo practice *C. Single specialty group practice D. Corporate medical practice 18. According to the American Telemedicine Organization, how many U.S. hospitals are participating in some form of telemedicine? A. About 10% B. More than a quarter *C. More than half D. About 80% 19. The ACA created health care facilities to give states an option for providing patient - centered, medical home -type services to Medicaid beneficiaries with severe or multiple chronic conditions. These facilities are called A. Patient -centered medical homes *B. Health homes C. Assisted -living facilities D. Accountable care organizations 20. As of 2016, three -quarters of all retail medical clinics in the United States were operated by CVS and which other company? A. Walmart *B. Walgreens C. Target D. Duane Reade SHORT ANSWER 21. Describe the five system components necessary for health care organizations to fulfill the Triple Aim’s goal. Answer: To fulfill the Triple Aim’s goal of improving the patient experience, improving the health of populations, and reducing the per -capita cost of health care, health care organizations must focus on individuals and families by customizing care at the individual level and engaging families and caregivers as partners; redesign primary care services and structures; promote population health management in partnerships within the community; establish a cost control platform; and develop integrated systems t o coordinate services across the continuum of care. 22. Discuss the purpose of patient -centered care as defined by the Institute of Medicine (IOM) and identify its six dimensions. Answer: Providing patient -centered care means giving patients the information they need to actively participate in decision making about their care to achieve the most desirable outcome. The likelihood that the patient’s desired outcome can be achieved increases when patients and family members are actively involved in decision making about the delivery of care. The six dimensions of patient -centered care identified by the Institute of Medicine (IOM) are respect for patients’ values, preferences, and expressed needs; coordination and integration of care; info rmation, communication, and education; physical comfort; emotional support; and the involvement of family and friends. 23. What is telemedicine? Describe the providers who offer telemedicine and the services they offer. Answer: Telemedicine uses electronic communications to exchange medical information between sites to improve a patient’s clinical health status. Hospitals, specialty clinics, home health agencies, and physicians’ offices all use telemedicine. The service may be offered within a single health care organization or between health care organizations. Services include primary care and specialist referral services, remote patient monitoring, consumer medical and health information, and medical education. 24. Describe the role of the biopharmaceutical industry in the U.S. health care system. Answer: The biopharmaceutical industry, sometimes referred to as Big Pharma, comprises the pharmaceutical and biotechnology industries. Biopharmaceutical companies develop, manufacture, market, and distribute drugs and vaccines used to prevent and treat diseases. This segment is made up of four sectors: pharmaceutical and medicine manufacturers, pharmacy wholesalers, research and development services, and management of companies and enterprises. Biopharmaceutical companies spend up to $135 billion annually on research and development, and it is estimated that it takes up to 15 years to develop a medicine or vaccine. The biopharmaceutical industryaccountsfornearly 20% of all research and development investment in the United States. 25. Describe the role of pharmacies in the U.S. health care system. Answer: Licensed pharmacies include retail pharmacies in the community setting and hospital or other institutional pharmacies. Community pharmacies include chain pharmacy organizations (CVS, Walgreens); pharmacies located within other l arge retail organizations (Walmart, Kroger); and independent, locally owned and operated pharmacies. The community pharmacy provides the public with access to medication, including flu shots, and serves as a source of advice on health issues. Approximately 6 of 10 licensed pharmacists work in the community setting. Institutional pharmacies control drug distribution within a health care facility and help to ensure each patient receives the appropriate drug and dosage. A hospital or health system may also operate a retail pharmacy within its facilities in addition to its clinical pharmacy operation. ESSAY 26. Distinguish between the fields of public health, community health, and population health and explain the purpose of each. Answer: Traditionally, public health has been viewed as a function of federal, state, and local public health departments to address health concerns affecting the public at large, such as by preventing epidemics, containing environmental hazards, and promoting healthy living. Community health improvement is a more expansive view of public health that focuses on collaboration among public health departments, health care delivery organizations, social service agencies, and government entities to address issues that affect the health of a particular community. Interest in ways health care and public health activities could be coordinated accelerated in the mid-1990s. The Association for Community Health Improvement serves as a national association for community health, community benefit, and population health professions, providing educational resources, tools, networking opportunities, and professional development. Th e ACA mandates that all nonprofit hospitals complete a community health needs assessment every three years. The concept of population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” This field focuses on health status indicators for a defined group of people, and the goal of population health is to improve the health of the population and reduce inequities or disparities between population groups. 27. Describe integrated delivery systems (IDS) and the two types of integration. Answer: An integrated delivery system (IDS) is a collaborative network of providers who work together in a coordinated fash ion to provide a continuum of care to a particular patient population or community. Within an IDS, providers work together through information sharing, shared responsibility, and collaborative resource utilization. Many believe integrated delivery systems can help address some of the problems associated with the United States’ fragmented health care delivery system and improve the quality and accessibility of care while reducing or containing costs. Horizontal integration links organizations that provide the same level of care, such as a multispecialty group practice. Vertical integration links organizations that provide differ ent levels of care, such as preventive, primary, secondary, tertiary, and long - term care. One of the goals of an IDS is to provide continuity of care for the patient, which includes continuity of information (shared medical records), continuity across primary and secondary care (discharge planning from specialist to generalist care), and provider continuity (having the patient see the same provider each time). 28. Discuss some of the means for measuring and improving health system performance in the United States. Answer: The Institute of Medicine (IOM) released a landmark 2001 report called Crossing the Quality Chasm that issued a mandate for improvement in U.S. health system performance. A portion of the ACA is dedicated to improving quality and performance through funding for research, the alignment of financial incentives with performance outcomes, and the identification of a national quality strategy. Organization such as t he IOM, the Institute for Healthcare Improvement (IHI), and the National Committee for Quality Assurance (NCQA) promote quality improvement initiatives including patient centeredness, the Triple Aim, and the patient -centered medical home. The CMS is financially incentivizing providers’ “meaningful use” of electronic health records to promote quality improvement in health care through collaboration among providers, payers, the government, and other stakeholders. The IHI promotes a framework called the Triple Aim proposing that organizations simultaneously pursue three goals: improve the patient experience of care, improve the health of populations, and reduce the per -capita cost of health care. Organizations would do this by focusing on indiv iduals and families, redesigning primary care services and structures, using population health management to promote prevention and wellness, controlling costs, and coordinating services across the continuum of care. Patient -centered care is another way to define quality care. Its six dimensions are respect for patients’ values, preferences, and expressed needs; coordination and integration of care; information, communication, and education; physical comfort; emotional support; and involv ement of family and friends. Finally, population health management aims to manage the network of providers patients see to help ensure they are receiving the most efficient and effective care. For instance, hospitals can manage the transition of care by pr oactively planning for a patient’s discharge with the patient, family, and home health service; hospitals can use outreach such as phone calls, telemedicine, or home visits to embed resources in the homes of high-risk patients to ensure they comply with me dication protocols; and providers can recognize that chronic diseases are the primary drivers of death and disability in the United States and thus use data analytics to help identify chronically ill patients and manage their conditions.