Chapter.10 Health Care Financing Complete Test Bank

Jonas & Kovner’s Health Care Delivery in the United States, 12^th Edition

Test Bank

Chapter 10, Health Care Financing

MULTIPLE CHOICE

1. Which of the following is the basic principle behind health insurance?

A. Pooled risks

B. Copayments

C. Subsidies for low-income patients

D. Health care for all

1. Which of the following is true of health care in most other industrialized countries but not in the United States?

A. Health care is treated as a commodity

B. All citizens are entitled to health care substantially paid for by the government

C. Only those who can afford health care receive it

D. Health outcomes are generally poor

1. The largest share of total U.S. health care expenditures usually pays for which of the following?

A. Personal health care services provided to individuals

B. Public health services

C. Medical research

D. Administrative costs of running the health care delivery and financing system

1. Enrollment in Medicare has doubled since its passage, but annual expenditures have

A. Doubled

B. Tripled

C. Fallen to half

D. Increased 40-fold

1. Which of the following agencies operates the largest integrated health care system in the United States?

A. Centers for Disease Control and Prevention

B. Veterans Health Administration

C. Social Security Administration

D. Indian Health Service

1. The Snyder Act of 1921 established a program of health services for which of the following?

A. Military veterans and their families

B. People with disabilities

C. Members of federally recognized Indian tribes and their descendants

D. Undocumented immigrants

1. Which of the following is true of the workers’ compensation program?

A. Employer and employee are expected to share the burden of loss from job-related injuries

B. Only union employees are covered

C. The federal government administers the program

D. Only injuries are covered, not illness

MULTIPLE RESPONSE

1. Public insurance programs include which of the following? Select all that apply.

A. Medicare and Medicaid

B. CHIP

C. Programs for veterans and Native Americans

D. United Healthcare

1. Which of the following are required to quality for Medicare? Select all that apply.

A. An individual must be a U.S. resident for a specified number of years

B. An individual must pay the Federal Insurance Contributions Act (FICA) payroll tax for at least 10 years

C. An individual must have disabilities and severe kidney disease

D. An individual must have annual income below the federal poverty line

1. Which of the following are parts of the Medicare program? Select all that apply.

A. Part A, covering hospitalization

B. Part B, covering physician services and outpatient care

C. Part C, covering dietary needs

D. Part D, covering many pharmaceutical costs

1. Which of the following contributed to the development of for-profit insurance companies during and after World War II? Select all that apply.

A. Unions fought for medical insurance to be included in employee benefit packages

B. Wartime wage controls limited monetary increases in employee compensation

C. The Internal Revenue Service allowed employers a tax deduction for the cost of providing employee health insurance

D. Employees began filing insurance claims in record numbers

1. Which of the following are forms of managed care? Select all that apply.

A. Prepaid health plans

B. Preferred provider organizations (PPOs)

C. Out-of-network providers

D. Accountable care organizations (ACOs)

MULTIPLE CHOICE

1. In the first year after the Affordable Care Act’s insurance exchanges began operation in 2014, the number of people buying health insurance for themselves

A. Increased to 8 million

B. Increased to 24 million

C. Stabilized

D. Declined

1. Which of the following requires employers to extend health insurance benefits to former employees for up to 18 months?

A. The Affordable Care Act (ACA)

B. The Consolidated Omnibus Budget Reconciliation Act (COBRA)

C. The Snyder Act

D. The Social Security Act

1. Which of the following explains why a number of providers have stopped serving Medicare or Medicaid patients in recent years?

A. Too many patients are using these programs

B. Payment rates have not kept up with health care costs

C. Private insurers negotiate provider payments for each type of service

D. The demand for physician services has not increased since the 2008-2010 recession

1. Which of the following is an out-of-network health care provider?

A. A provider that does not negotiate rates with an insurer through a contract

B. A provider that treats only COBRA patients

C. A provider that does not accept Medicare or Medicaid

D. A provider in a preferred provider organization (PPO)

1. Which of the following ranks payers in order from highest amounts paid to lowest?

A. Medicaid, Medicare, private insurer

B. Private insurer, Medicaid, Medicare

C. Medicare, private insurer, Medicaid

D. Private insurer, Medicare, Medicaid

1. When do most hospital patients find out what their care will cost?

A. When they first become ill

B. When they check into the hospital

C. After they have received care

D. Never

1. The requirement that primary care physicians provide patients with referrals for diagnostic tests and specialty care is a feature of which of the following?

A. HMOs

B. COBRA plans

C. Preferred provider organizations

D. Medical savings accounts

1. Which of the following are fixed monthly or annual payments for each person regardless of the amount and kind of services needed?

A. Fees for service

B. Capitated payments

C. Patients’ deductibles

D. Copayments

SHORT ANSWER

1. Briefly state the reasons health care in the United States is not a normal commodity or service.
2. Briefly describe the groups that were originally covered by Medicaid and those that have been added to the program over the years. Which group or groups now account for the largest Medicaid expenditures?
3. Describe the relationship between Medicaid and the Affordable Care Act (ACA).
4. Briefly discuss the reasons payers are seeking new payment approaches for health care services, and characterize the ideal solution.
5. List some of the reasons that consumers have come to dislike managed care plans.

ESSAY

1. Give a simple explanation of the way health insurance works, and then discuss several complicating factors in the actual financing of care.

Complicating factors in the actual financing of care include these: (1) There are many types of health insurance, some publicly paid through taxes, some paid by employers, and some paid by individuals directly. (2) Insurance pays only a share of the costs of an individual’s care, and the individual pays the rest. The way this copayment arrangement is structured varies from plan to plan and can be complex. (3) Insurers set rules about which services they will pay for, and how much they will pay. These rules can also be complex and confusing and can lead to conflict between insurers and providers. (4) Because people do not directly and fully pay for medical services, some fear they will use more than they need or that a provider will deliver more care than needed. An insurance system must create incentives to avoid overuse and oversupply, or expenditures could skyrocket.

1. Discuss the way reference pricing works and its goals.
2. Outline what will likely happen if federal health care reform does not achieve the goals of expanding access and reining in costs.