Test Bank Health Care Delivery in the United States, 12th edition James R. Knickman A+

Description

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

1. What percent of all jobs in the United States are in the health sector?

A. 8%

*B. 11%

C. 15%

D. 27%

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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. Universal health care

C. Recognition of the role of social connections in maintaining health

D. Safe neighborhoods

1. The relatively new concept of public healthis 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

1. 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

1. 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

1. 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

1. 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

1. Which stakeholder often plays the role of referee in the U.S. health care system?

A. Legislators

B. Employers

*C. Insurers

D. Providers

1. 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

1. 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. Definition of health care access as a universal right

SHORT ANSWER

1. 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, who seldom know the cost of a service until after the service has been delivered.

1. 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.

1. 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.

1. 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 organizations 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.

1. 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 associated 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

1. 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 and 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 the 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 prevention 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 health 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 relationships 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.

1. 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 treatment 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 healthy. 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 responsibility 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 how 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 quality and the patient experience.

1. 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 political 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 understand 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.