MEDICAL SOCIOLOGY FINAL EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS LATEST VERSION 2025/2026.
Chap 8 - Blue Cross/Blue Shiel –
•Designed to protect doctors and hospitals
•Fee-for-service insurance
Community rating: Each person charged based on average risk of entire community
Health Maintenance Organizations (HMOs) - ANS •Designed to provide affordable health care
•Salaried doctors, monitored for unnecessary care
•Emphasis on prevention
Medicare (1960) - ANS •For persons over 65 and permanently disabled
•Funded and organized by the federal government
•"Entitlement"
Medicaid (1960) - ANS •Primarily for poor persons
•Funded jointly by states and the federal government
•"Charity"
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Commercial insurance - ANS •For-profit rather than nonprofit
•Actuarial risk rating: Individual premium based on individual risk
•Avoid insuring unhealthy persons
Managed Care (revolution) - ANS •Any system that controls costs by monitoring and
controlling provider decisions
-Price schedules
-Utilization review
-Formularies
•Response to increasing health care costs
•Managed care itself has little impact on health care outcomes
•Backlash against managed care
•President Clinton's 1993 Health Care Security Act - ANS •Not passed due to political
opposition
•State Children's Health Insurance Program - ANS •Passed
•Extended coverage for children under 18 via Medicaid
President Obama's ACA - ANS •passed in 2010
•To gain support from stakeholders, worked within existing neoliberal system
•Individual mandate
•Employer mandate
•Limits put on insurance deductibles and copayments
•BUT Supreme Court ruled that states did not have to expand Medicaid
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, myths of US health care costs - ANS •Myth 1: It's the malpractice suits.
•Myth 2: It's our aging population.
•Myth 3: It's our advanced technologies.
•Myth 4: It's because we receive more and better care than do others.
ACA under attack - ANS •Numerous attacks against it by Congress and in courts.
•Eligibility restricted, premiums raised, subsidies reduced
•Individual mandated dropped
•More to come...
Impact of ACA - ANS •20 million gained insurance coverage
•Increases financial security and physical health
•More economic growth and less unemployment in states that expanded Medical coverage
Health Care Costs - ANS •Administrative costs of fragmented system
•Health care providers largely set prices
•The for-profit basis of the US health care system
Health care costs and the ACA - ANS •ACA is unlikely to lower costs:
•Multitude of insurers so continues administrative inefficiency
• Limited efforts to add cost controls
•Many health care expenses are still not covered
•Preserves the for-profit system
"Big Pharma" and rising cost - ANS •New patent regulations entice researchers and increase
profits
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
QUESTIONS WITH 100% CORRECT
ANSWERS LATEST VERSION 2025/2026.
Chap 8 - Blue Cross/Blue Shiel –
•Designed to protect doctors and hospitals
•Fee-for-service insurance
Community rating: Each person charged based on average risk of entire community
Health Maintenance Organizations (HMOs) - ANS •Designed to provide affordable health care
•Salaried doctors, monitored for unnecessary care
•Emphasis on prevention
Medicare (1960) - ANS •For persons over 65 and permanently disabled
•Funded and organized by the federal government
•"Entitlement"
Medicaid (1960) - ANS •Primarily for poor persons
•Funded jointly by states and the federal government
•"Charity"
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Commercial insurance - ANS •For-profit rather than nonprofit
•Actuarial risk rating: Individual premium based on individual risk
•Avoid insuring unhealthy persons
Managed Care (revolution) - ANS •Any system that controls costs by monitoring and
controlling provider decisions
-Price schedules
-Utilization review
-Formularies
•Response to increasing health care costs
•Managed care itself has little impact on health care outcomes
•Backlash against managed care
•President Clinton's 1993 Health Care Security Act - ANS •Not passed due to political
opposition
•State Children's Health Insurance Program - ANS •Passed
•Extended coverage for children under 18 via Medicaid
President Obama's ACA - ANS •passed in 2010
•To gain support from stakeholders, worked within existing neoliberal system
•Individual mandate
•Employer mandate
•Limits put on insurance deductibles and copayments
•BUT Supreme Court ruled that states did not have to expand Medicaid
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, myths of US health care costs - ANS •Myth 1: It's the malpractice suits.
•Myth 2: It's our aging population.
•Myth 3: It's our advanced technologies.
•Myth 4: It's because we receive more and better care than do others.
ACA under attack - ANS •Numerous attacks against it by Congress and in courts.
•Eligibility restricted, premiums raised, subsidies reduced
•Individual mandated dropped
•More to come...
Impact of ACA - ANS •20 million gained insurance coverage
•Increases financial security and physical health
•More economic growth and less unemployment in states that expanded Medical coverage
Health Care Costs - ANS •Administrative costs of fragmented system
•Health care providers largely set prices
•The for-profit basis of the US health care system
Health care costs and the ACA - ANS •ACA is unlikely to lower costs:
•Multitude of insurers so continues administrative inefficiency
• Limited efforts to add cost controls
•Many health care expenses are still not covered
•Preserves the for-profit system
"Big Pharma" and rising cost - ANS •New patent regulations entice researchers and increase
profits
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
