Welcome to Essentials of the U.S. Health Care System

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Title: Essentials of the U.S. ealth Care System

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Quiz

Instructor's Manual

Please read each question and select your answer from the choices provided. You must complete all of the questions in order to view your results. At the end of each exam, you have the option to e-mail your results to your instructor.

1: Once premiums have been collected, an MCO functions like
	A: a specialty group practice
	B: an insurance company
	C: a health network
	D: an independent practice association

2: Capitation
	A: Fixed premium
	B: Fixed services per member
	C: Costs do not exceed a predetermined limit
	D: Fixed monthly payment per enrollee

3: Under capitation, an MCO shares risk with the
	A: employer
	B: insured person
	C: government
	D: provider

4: Under discounted fee arrangements
	A: MCOs discount the premiums to attract more enrollees
	B: employers discount the premiums to enable more of their employees to purchase health insurance
	C: MCOs offer discounted services to reduce health care costs
	D: providers agree to discount their regular fees in exchange for the volume of business an MCO brings

5: The concept of managed care evolved out of earlier
	A: prepaid plans
	B: commercial insurance
	C: industrial settings
	D: physician practices

6: During the 1980s, employers started switching from traditional health insurance to managed care plans because
	A: health insurance had become less and less affordable
	B: the Health Maintenance Organization Act of 1973 had mandated a managed care option
	C: many insurance companies started dropping their health insurance business
	D: employees wanted more choice

7: Compared to publicly insured beneficiaries in the Medicare and Medicaid programs, a greater proportion of privately-insured individuals are enrolled in managed care plans.
	A: TRUE
	B: FALSE

8: Gatekeeping
	A: Appropriateness of services provided
	B: Coordination of health care services by a primary care physician
	C: Utilization management of institutional patients
	D: Prior approval by a managed care plan

9: In concurrent utilization of review
	A: appropriateness of needed care is determined before the delivery of services
	B: decisions regarding appropriateness are made during the course of health care utilization
	C: a primary care physician determines whether or not the patient should be hospitalized
	D: a patient is discharged from the hospital as soon as a bed is available in a skilled nursing facility

10: Underutilization
	A: Medically necessary care is not delivered
	B: A patient is treated in an outpatient instead of inpatient setting
	C: Less costly services are substituted for more costly services
	D: Early discharge from a hospital

11: Commerical insurance companies have been forbidden by law from developing managed care plans.
	A: TRUE
	B: FALSE

12: HMOs were the first type of managed care plans to appear on the market.
	A: TRUE
	B: FALSE

13: Compared to other types of managed care plans, HMOs place considerable emphasis on preventive services.
	A: TRUE
	B: FALSE

14: ____ require that services be obtained from in-network providers.
	A: PPOs
	B: Point-of-service plans
	C: HMOs
	D: Exclusive provider organizations

15: Physicians are salaried employees and deliver services to the enrollees.
	A: Preferred provider organization
	B: Independent practice model
	C: Staff model
	D: Exclusive provider model

16: In the group model HMO, physicians are employed by
	A: a hospital
	B: the HMO
	C: an independent practice association
	D: a group practice

17: An independent practice association (IPA) is
	A: an intermediary between physicians and HMOs
	B: employs a large number of physicians and contracts their services to HMOs
	C: a separate corporation formed by an HMO
	D: an insurance company that functions like an HMO

18: PPOs allow their members to obtain services from out-of-network providers.
	A: TRUE
	B: FALSE

19: Comprehensive research shows that health care quality has declined in managed care.
	A: TRUE
	B: FALSE

20: Health networks have been formed mainly by
	A: HMOs
	B: various types of managed care organizations
	C: hospitals
	D: physicians

21: One critical management challenge in health networks has been
	A: cost control
	B: physician relations
	C: managed care contracting
	D: affiliation with hospitals

22: In a merger, the acquired company ceases to exist as a separate corporation.
	A: TRUE
	B: FALSE

23: In a joint venture, two or more institutions continue to conduct their main businesses independently.
	A: TRUE
	B: FALSE

24: Resource sharing while assets remain independently owned.
	A: Joint venture
	B: Alliance
	C: Virtual organization
	D: Merger

25: A virtual organization
	A: is the first step toward an anticipated merger
	B: requires sharing of existing assets
	C: is an independent organization based on contracts
	D: links services that are at different stages in the production process of health care

26: The main objective of horizontal integration is to
	A: form an alliance
	B: achieve geographic expansion
	C: deliver a variety of services
	D: form networks based on contractual arrangements

27: To increase the comprehensiveness and continuity of services, the appropriate strategy is
	A: vertical integration
	B: horizontal integration
	C: virtual integration
	D: formation of alliances

Optional: Enter your name and your instructor's E-mail address to have your results E-mailed to him or her.
Your Name:
Instructor's E-mail Address:
Your E-mail Address:

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