File: chap14, Chapter 14 - Community Health



Community Health Chapter 14, Test Notes

Multiple Choice

1. The primary factors that limit the access to health care in the United States are:

A. lack of health insurance and inadequate insurance.

B. poverty or low family income.

C. lack of physicians and hospitals.

D. just A and B

E. just B and C

Ans: D

Page: 411-412

2. Those medically indigent who are working full time at low paying jobs that provide no health care benefits are referred to as:

A. no access people.

B. Medicaid recipients.

C. the down and out.

D. the working poor.

E. all of the above are correct

Ans: D

Page: 413

3. Eight out of ten uninsured persons are:

A. living in poverty.

B. American Indians/Alaskan Natives.

C. members of working families.

D. farm families.

E. Hispanics.

Ans: C

Page: 413

4. The uninsured usually do not have access to:

A. public health care.

B. primary health care.

C. secondary health care.

D. continuing care.

E. restorative care.

Ans: B

Page: 413

5. Spouses often lose health insurance coverage under a family policy through:

A. separation or divorce.

B. retirement.

C. death of a policy holder.

D. all of the above

E. A and C only

Ans: D

Page: 413

6. In 2006, health care expenditures were expected to consume what percentage of the Gross Domestic Product (GDP)?

A. 8%

B. 10%

C. 12%

D. 14%

E. 16%

Ans: E

Page: 414

7. We pay for health care through:

A. our taxes.

B. health care premiums and out-of-pocket expenses.

C. supplemental insurance.

D. the many products we buy.

E. all of the above

Ans: E

Page: 414

8. The largest single expenditure faced by the United States each year is:

A. defense.

B. housing.

C. health care.

D. education.

E. none of the above are correct

Ans: C

Page: 414

9. Approximately what percentage of the United States health care bill is paid for by governmental insurance programs?

A. about 75%

B. about 65%

C. about 55%

D. about 45%

E. about 35%

Ans: D

Page: 415

10. The maximum amount an insurer will pay for a certain service is referred to as:

A. deductible.

B. co-insurance.

C. fixed indemnity.

D. exclusion.

E. none of the above are correct

Ans: C

Page: 419

11. In health insurance coverage, pre-existing conditions often become

A. deductibles.

B. co-insurance.

C. fixed indemnities.

D. exclusions.

E. none of the above are correct

Ans: D

Page: 419

12. The established amount of money that the insured must pay before the insurer will reimburse for services is called the:

A. fixed indemnity.

B. deductible amount.

C. exclusion amount.

D. co-insurance.

E. major medical.

Ans: B

Page: 419

13. When a policy requires that you and the insurance company share the costs of certain services, usually on a percentage basis, this is called:

A. an exclusion.

B. a fixed indemnity.

C. a deductible.

D. co-insurance.

E. no free lunch.

Ans: D

Page: 419

14. A specific health condition not covered by your health insurance is called:

A. an exclusion.

B. an omission.

C. a deductible.

D. a fixed indemnity.

E. none of the above

Ans: A

Page: 419

15. The portion of Medicare that covers hospital costs and is referred to a contributory program is:

A. Part A.

B. Part B.

C. Part C.

D. Part D.

E. none of the above are correct

Ans: A

Page: 422

16. Which of the following is (are) problems(s) associated with Medicare and Medicaid?

A. non-acceptance and fraud

B. deductibles too high

C. based on DRGs

D. too many exclusions

E. B and D

Ans: A

Page: 415

17. Medicare consist of:

A. one part—Part A.

B. two parts—Parts A and B.

C. three parts—Parts A, B, and C.

D. four parts—Parts A, B, C, and D.

E. five parts—Parts A, B, C, D, and E.

Ans: D

Page: 422

18. Part B of Medicare provides coverage for:

A. medical insurance.

B. hospital insurance.

C. long-term care insurance.

D. disability insurance.

E. pharmaceutical expenses.

Ans: A

Page: 422

19. Which part of Medicare is mandatory?

A. Part A

B. Part B

C. Part C

D. Part D

E. all are mandatory

Ans: A

Page: 422

20. Which part of Medicare has a coverage gap known as a “donut hole?”

A. Part A

B. Part B

C. Part C

D. Part D

E. Part E

Ans: D

Page: 424

21. Medicaid provides health insurance for:

A. those in federal prisons.

B. the poor.

C. the elderly.

D. those in uniformed services.

E. none of the above

Ans: B

Page: 425

22. In which of the organizational models of HMOs do physicians provide services to only those enrolled in the HMO?

A. staff model

B. unit model

C. network model

D. independent practice association model

E. all of the above are correct

Ans: A

Page: 432

23. Which of the following is (are) true concerning the independent practice association model?

A. providers are free to contract other HMOs

B. providers are free to maintain fee-for-service patients

C. it is the most common form of HMO in the United States

D. all of the above are true

E. none of the above are true

Ans: D

Page: 432

24. Attempts at national health care legislation were made during all of the following presidential administrations except:

A. Truman.

B. Kennedy.

C. Nixon.

D. Carter.

E. Clinton.

Ans: D

Page: 434

25. Which of the following is (are) a strength(s) of the Canadian health care system compared to the United States?

A. all citizens have health insurance

B. administrative costs are lower

C. less expensive to run

D. emphasis placed on prevention and primary care

E. all of the above

Ans: E

Page: 436

26. The new Oregon health care plan provides quality, affordable health care to all Oregonians by all of the following except:

A. providing eligibility to all residents with incomes under the federal poverty level.

B. providing options to small businesses to offer health insurance to their employees.

C. creating a high-risk insurance pool coordinated by state government.

D. using Medicaid dollars to pay for health care that may not improve health status of the population.

E. all of the above are true statements

Ans: D

Page: 437

True/False

27. True or false? Those who are unable to receive primary medical care because they cannot afford it are referred to as medically indigent.

Ans: T

Page: 413

28. True or false? Many times the medically indigent have full-time jobs that provide no health care benefits.

Ans: T

Page: 413

29. True or false? Sweden spends more per capita annually on health care than any other nation in the world.

Ans: F

Page: 414

30. True or false? The most traditional system of health care financing in the United States is referred to as a fee-for-service system.

Ans: T

Page: 415

31. True or false? Health Maintenance Organizations are an example of prepaid health care.

Ans: T

Page: 416

32. True or false? The State Children’s Health Insurance Program (SCHIP) provides health care for children whose parents are covered under Medicaid.

Ans: F

Page: 418

33. True or false? As health care costs rise, the percentage of employers who offer health care insurance to their employees declines.

Ans: T

Page: 421

34. True or false? When we buy a new, American-made car, we are paying for the cost of health insurance for an employee of the automobile industry.

Ans: T

Page: 421

35. True or false? Those health care providers willing to accept Medicare patients must agree to accept the Medicare-approved amount as payment in full.

Ans: T

Page: 424

36. True or false? Eligibility for enrollment in Medicaid is determined by the federal government.

Ans: F

Page: 425

37. True or false? Like Medicare, Medicaid is a contributory health insurance program.

Ans: F

Page: 425

38. True or false? Most people covered by Medicaid are enrolled in managed care plans.

Ans: T

Page: 433

39. True or false? Catastrophe health coverage is a part of Medicare.

Ans: F

Page: 425

40. True or false? Under federal law there is a national standardization of Medigap policies.

Ans: T

Page: 425

41. True or false? Medigap is a supplemental insurance program specifically designed for those on Medicaid.

Ans: F

Page: 425

42. True or false? Those who need long-term care insurance the most are those with low incomes and few assets because Medicaid will not cover long-term care costs.

Ans: F

Page: 428

43. True or false? The majority of Americans are impoverished within the first few years of making long-term health care payments.

Ans: T

Page: 428

44. True or false? Preferred Provider Organizations (PPOs) are considered fee-for-service units.

Ans: F

Page: 430

45. True or false? In theory, an HMO does not make money on treating ill people but on keeping people healthy.

Ans: T

Page: 431

46. True or false? Presently among all the developed countries of the world, the United States stands alone in not having a national health care plan for its citizens.

Ans: T

Page: 434

47. True or false? The health care system in Canada is considered a national health service model of health care.

Ans: F

Page: 435

48. True or false? The major complaint of the Canadian health care system has been long wait lists for procedures associated with the use of high technology equipment and specialty physicians.

Ans: T

Page: 436

49. True or false? The Oregon health plan was developed to restructure its Medicare plan.

Ans: F

Page: 437

Short Answer

50. What are the three ways the National Committee on Quality Assurance (NCQA) evaluates health care?

Ans: (1) through Accreditation, (2) through the Health Plan Employer Data and Information Set (HEDIS), and (3) through the Consumer Assessment of Health Plans Study (CAHPS).

Page: 414

51. What is meant by the phrase fee-for-service-system?

Ans: Under this type of health care system people select a provider, receive a service (care), and incur expenses (a fee) for the care.

Page: 415

52. What is meant by the statement that health insurance is a risk-and-cost—spreading process?

Ans: All in the group share the cost of one person's injury or illness. Each person in the group has a different chance (or risk) of having a problem and needing health care. The concept of insurance has everyone in the group, no matter what their risk, helping to pay for the collective risk of the group. The risk of costly ill health is spread in a reasonably equitable fashion among all persons purchasing insurance, and everyone is protected from having to pay an insurmountable bill for a catastrophic injury or illness.

Page: 416-417

53. What are the advantages of organizations becoming self-insured?

Ans: (1) The organization sets the parameters of the policy—deductibles, co-insurance, fixed indemnities, and exclusions; (2) the organization holds on to the cash reserves in the benefits account instead of sending them to a commercial carrier, and thus gets to accrue interest off of them; (3) the self-insured organizations have been exempt from the Employee Retirement and Income Security Act of 1974 (ERISA); and (4) generally the administrative costs of self-insured organizations have been less than traditional commercial carriers and health insurance costs to these groups have risen at a slower rate.

Page: 421-422

54. What are two major problems that plague both Medicare and Medicaid? Describe each.

Ans: (1) Some physicians and hospitals do not accept Medicare or Medicaid patients because of the tedious and time-consuming paperwork, lengthy delays in reimbursement, and insufficient reimbursement. (2) A few physicians and hospitals file Medicare and Medicaid paperwork for care or services not rendered or rendered incompletely. This is known as Medicare/Medicaid fraud.

Page: 425

55. How have Medigap policies been standardized by federal laws?

Ans: (1) Companies can offer no more than 10 standardized plans; (2) each plan must have a core set of benefits; (3) plans are identified by letters A through J; (4) if a company sells Medigap policies, it must offer plan A.

Page: 425-428

56. How do preferred provider organizations and exclusive provider organizations differ?

Ans: EPOs have stronger financial incentives for enrolled members to use the exclusive (only) provider.

Page: 430-431

57. How do preferred provider organizations and exclusive provider organizations cut health care costs?

Ans: The organizations contract with providers to offer services to organization enrollees at a fixed (discount) rate.

Page: 430-431

58. What four items must each provincial and territorial authority in Canada ensure about its health care plan?

Ans: (1) All residents have access to care regardless of cost; (2) necessary hospital and physician services are available; (3) residents have continuous coverage as they travel from one province to another; and (4) the provincial programs are run as nonprofit organizations.

Page: 435

59. What are some of the strengths of the Canadian health care system?

Ans: Everyone is covered; there is equity in coverage; administrations costs are one-third of those under the U.S. system; the Canadian system places emphasis on prevention and primary care.

Page: 436

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