Test Bank For Jonas' Introduction to the U.S. Health Care
System 9th Edition By Raymond L. Goldsteen, DrPH, MA;
Karen Goldsteen, PhD, MPH; Benjamin Goldsteen, MBA
9780826174024 Chapter 1-13 Complete Guide .
What are the basic components of a Health Services Delivery System? - ANSWER: 1. Financing - how
services are paid for
2. Insurance - protects against catastrophic risks
3. Delivery - provision of health care services by various providers
4. Payment - reimbursement to providers for services delivered
What are 5 key components of the Affordable Care Act (ACA)? - ANSWER: 1. Individual mandate
2. Insurance plans must cover "essential health benefits"
3. Insurance available for purchase on a web-based exchange
4. Expansion of Medicaid
5. Employer mandate to provide insurance for employees
What does managed care seek to achieve? - ANSWER: 1. Seeks to achieve efficiencies by integration
of the 4 functions of health care.
2. Employs mechanisms to control utilization of medical services.
3. Determines the price at which the services are purchased and how much providers get paid.
What is the iron triangle of healthcare delivery? - ANSWER: Access, cost, quality
Describe health care in the Pre-Industrial Era (Mid-18th to late 19th century) - ANSWER: The
consumer was sovereign in the market and healthcare was delivered under free market conditions.
Medical practice was in disarray, medical procedures were primitive, the institutional core was
missing, demand was unstable, and medical education was substandard.
What are 5 reasons medical practice was insignificant during the Pre-Industrial Era? - ANSWER: 1.
Medical practice was in disarray
2. Medical procedures were primitive
3. Institutional core was missing
4. Demand was unstable
5. Medical education was substandard
Why was demand for medical care unstable in the Pre-Industrial Era? - ANSWER: Opportunity cost of
time spent and money spent traveling to the doctor were too high. Demand was limited by economic
conditions and the traditional practice of medicine in rural eras.
Describe health care during the Post-Industrial Era (late 19th to late 20th century). - ANSWER: 1.
Growth of professional sovereignty - as tech/meds advanced, status of physicians rose.
2. Physicians succeeded in retaining private practice of medicine and resisting national healthcare.
3. Employers took on a well-defined role in providing health care.
4. Growth of private health insurance.
5. Development of public health
Why did physicians rise to positions of power in the 1920s? - ANSWER: 1. Urbanization
2. Science and technology / cultural authority
3. Institutionalization / pooling of resources
4. Dependency
5. Autonomy and organization (professional cohesiveness)
,6. Licensing
7. Educational reform
Describe organized medicine. - ANSWER: The concerted efforts of physicians through the AMA which
equated to professional cohesiveness.
What 3 factors prompted the general need for health insurance? - ANSWER: 1. Technological -
advanced treatments that were desirable but expensive.
2. Social - desirability of medical treatments.
3. Economic - risk of catastrophic loss.
What 3 reasons led to the growth of employer-based health insurance? - ANSWER: 1. Wage freeze
during WWII - employers offered insurance as a benefit in lieu of more money.
2. 1948 Supreme Court ruling - employee benefits were legit part of union-management negotiations.
3. 1954 IRS tax code revision - made employer-paid health insurance tax deductible for employers,
tax-exempt for employees.
Describe the 4 parts of Medicare. - ANSWER: Part A - hospital and limited nursing home coverage
(automatic).
Part B - Covers physician bills. Pay separate from part A.
Part C (1997) - Medicare managed care.
Part D (2006) - Prescription drugs.
Describe Medicaid. - ANSWER: - Helps indigent populations pay for health care.
- Eligibility determined via a means test.
- A state run program, funded in part by federal government to match state contributions (Kerr-Mills
Act).
What is the role of medical technology in health care delivery? - ANSWER: A tool to improve the
efficiency, effectiveness, safety, and patient health. Excessive use of technology must be balanced
with cost - what is the point of diminishing returns?
What are some applications of IT and informatics in the delivery of health care? - ANSWER: - Decision
support systems (Often embedded in EHR)
- Clinical information systems (Pharmacy data systems, Radiology & lab reporting systems)
- Administrative information systems (Personnel management & scheduling)
What factors influence the creation, dissemination, and utilization of technology? - ANSWER: 1.
Anthro-cultural beliefs and values
2. Medical specialization
3. Financing & payment
4. Technology-driven competition
5. Expenditures on research & development
6. Supply-side controls
7. Government policy
What is the government's role in technology diffusion? - ANSWER: Government funds 46% of medical
technology R&D in the US. Aside from development, they have a responsibility to intervene and
ensure safety measures are in place as technology is introduced into the marketplace (via the FDA).
technology diffusion. - ANSWER: The spread of technology into society once it is developed.
What are some landmark pieces of legislation in the regulation of drugs and devices? - ANSWER: 1906
Food and Drugs Act
1938 Food, Drug, and Cosmetic Act
1962 Kefauver-Harris Amendments
1976 Medical Devices Amendments
, 1983 Orphan Drug Act
1990 Safe Medical Devices Act
1992 Prescription Drug User Fee Act
1997 Food and Drug Administration Modernization Act
What is the impact of technology on various aspects of domestic and global delivery of health care? -
ANSWER: - Increased longevity and degreased mortality for people around the world.
- Greater effectiveness
- Greater costs
- Improved diagnosis and treatment (MRI, CT)
- New treatments (total artificial organs)
- Less invasive and safer procedures (laser surgery)
- Molecular and cell biology (genetic research)
Describe Health Technology Assessment (HTA). - ANSWER: Any process of examining and reporting
properties of a medical technology used in health care, such as safety, effectiveness, feasibility, and
indications for use, cost, and cost-effectiveness, as well as social, economic, and ethical
consequences, whether intended or unintended.
What is the current and future directions of HTAs? - ANSWER: - Mainly private sector initiatives
(VA/DoD in public sector).
- Information needs to be shared with providers and policy makers.
- Standardization of methods is needed to make results comparable.
- Balance between efficacy and economic worth will require a change in the American mindset.
What provisions of the ACA pertain to medical technology? - ANSWER: 1. The Biologics Price
Competition and Innovation Act of 2009 - authorizes FDA to regulate biosimilars (parallel to generic
drugs).
2. Biosimilar User Fee Act of 2012 - authorizes the FDA to charge a user fee for the premarketing
review of biosimilars
3. A 2.3% excise tax on certain medical devices
What are the benefits of the EHR? - ANSWER: 1. Interoperability
2. Safety
3. Efficiency
What does "meaningful use" describe? - ANSWER: Part of HITECH Act - EHR must improve quality,
safety, efficiency, and reduce health disparities.
What is the HITECH Act of 2009? - ANSWER: Provides financial incentives for providers seeing
Medicare & Medicaid patients to adopt EHR systems ($19 million earmarked).
What are the legal uses of personal medical information per HIPAA (1996)? - ANSWER: 1. Health care
delivery
2. Operations
3. Reimbursement
What does the National Institutes of Health (NIH) do? - ANSWER: Conducts and supports basic and
applied biomedical research.
What does the Agency for Healthcare Research and Quality do? - ANSWER: Focus on quality, cost
reduction, and better access.
What is the role of health services financing? - ANSWER: Payment for health insurance premiums. Can
influence the supply and distribution of health services professionals.
System 9th Edition By Raymond L. Goldsteen, DrPH, MA;
Karen Goldsteen, PhD, MPH; Benjamin Goldsteen, MBA
9780826174024 Chapter 1-13 Complete Guide .
What are the basic components of a Health Services Delivery System? - ANSWER: 1. Financing - how
services are paid for
2. Insurance - protects against catastrophic risks
3. Delivery - provision of health care services by various providers
4. Payment - reimbursement to providers for services delivered
What are 5 key components of the Affordable Care Act (ACA)? - ANSWER: 1. Individual mandate
2. Insurance plans must cover "essential health benefits"
3. Insurance available for purchase on a web-based exchange
4. Expansion of Medicaid
5. Employer mandate to provide insurance for employees
What does managed care seek to achieve? - ANSWER: 1. Seeks to achieve efficiencies by integration
of the 4 functions of health care.
2. Employs mechanisms to control utilization of medical services.
3. Determines the price at which the services are purchased and how much providers get paid.
What is the iron triangle of healthcare delivery? - ANSWER: Access, cost, quality
Describe health care in the Pre-Industrial Era (Mid-18th to late 19th century) - ANSWER: The
consumer was sovereign in the market and healthcare was delivered under free market conditions.
Medical practice was in disarray, medical procedures were primitive, the institutional core was
missing, demand was unstable, and medical education was substandard.
What are 5 reasons medical practice was insignificant during the Pre-Industrial Era? - ANSWER: 1.
Medical practice was in disarray
2. Medical procedures were primitive
3. Institutional core was missing
4. Demand was unstable
5. Medical education was substandard
Why was demand for medical care unstable in the Pre-Industrial Era? - ANSWER: Opportunity cost of
time spent and money spent traveling to the doctor were too high. Demand was limited by economic
conditions and the traditional practice of medicine in rural eras.
Describe health care during the Post-Industrial Era (late 19th to late 20th century). - ANSWER: 1.
Growth of professional sovereignty - as tech/meds advanced, status of physicians rose.
2. Physicians succeeded in retaining private practice of medicine and resisting national healthcare.
3. Employers took on a well-defined role in providing health care.
4. Growth of private health insurance.
5. Development of public health
Why did physicians rise to positions of power in the 1920s? - ANSWER: 1. Urbanization
2. Science and technology / cultural authority
3. Institutionalization / pooling of resources
4. Dependency
5. Autonomy and organization (professional cohesiveness)
,6. Licensing
7. Educational reform
Describe organized medicine. - ANSWER: The concerted efforts of physicians through the AMA which
equated to professional cohesiveness.
What 3 factors prompted the general need for health insurance? - ANSWER: 1. Technological -
advanced treatments that were desirable but expensive.
2. Social - desirability of medical treatments.
3. Economic - risk of catastrophic loss.
What 3 reasons led to the growth of employer-based health insurance? - ANSWER: 1. Wage freeze
during WWII - employers offered insurance as a benefit in lieu of more money.
2. 1948 Supreme Court ruling - employee benefits were legit part of union-management negotiations.
3. 1954 IRS tax code revision - made employer-paid health insurance tax deductible for employers,
tax-exempt for employees.
Describe the 4 parts of Medicare. - ANSWER: Part A - hospital and limited nursing home coverage
(automatic).
Part B - Covers physician bills. Pay separate from part A.
Part C (1997) - Medicare managed care.
Part D (2006) - Prescription drugs.
Describe Medicaid. - ANSWER: - Helps indigent populations pay for health care.
- Eligibility determined via a means test.
- A state run program, funded in part by federal government to match state contributions (Kerr-Mills
Act).
What is the role of medical technology in health care delivery? - ANSWER: A tool to improve the
efficiency, effectiveness, safety, and patient health. Excessive use of technology must be balanced
with cost - what is the point of diminishing returns?
What are some applications of IT and informatics in the delivery of health care? - ANSWER: - Decision
support systems (Often embedded in EHR)
- Clinical information systems (Pharmacy data systems, Radiology & lab reporting systems)
- Administrative information systems (Personnel management & scheduling)
What factors influence the creation, dissemination, and utilization of technology? - ANSWER: 1.
Anthro-cultural beliefs and values
2. Medical specialization
3. Financing & payment
4. Technology-driven competition
5. Expenditures on research & development
6. Supply-side controls
7. Government policy
What is the government's role in technology diffusion? - ANSWER: Government funds 46% of medical
technology R&D in the US. Aside from development, they have a responsibility to intervene and
ensure safety measures are in place as technology is introduced into the marketplace (via the FDA).
technology diffusion. - ANSWER: The spread of technology into society once it is developed.
What are some landmark pieces of legislation in the regulation of drugs and devices? - ANSWER: 1906
Food and Drugs Act
1938 Food, Drug, and Cosmetic Act
1962 Kefauver-Harris Amendments
1976 Medical Devices Amendments
, 1983 Orphan Drug Act
1990 Safe Medical Devices Act
1992 Prescription Drug User Fee Act
1997 Food and Drug Administration Modernization Act
What is the impact of technology on various aspects of domestic and global delivery of health care? -
ANSWER: - Increased longevity and degreased mortality for people around the world.
- Greater effectiveness
- Greater costs
- Improved diagnosis and treatment (MRI, CT)
- New treatments (total artificial organs)
- Less invasive and safer procedures (laser surgery)
- Molecular and cell biology (genetic research)
Describe Health Technology Assessment (HTA). - ANSWER: Any process of examining and reporting
properties of a medical technology used in health care, such as safety, effectiveness, feasibility, and
indications for use, cost, and cost-effectiveness, as well as social, economic, and ethical
consequences, whether intended or unintended.
What is the current and future directions of HTAs? - ANSWER: - Mainly private sector initiatives
(VA/DoD in public sector).
- Information needs to be shared with providers and policy makers.
- Standardization of methods is needed to make results comparable.
- Balance between efficacy and economic worth will require a change in the American mindset.
What provisions of the ACA pertain to medical technology? - ANSWER: 1. The Biologics Price
Competition and Innovation Act of 2009 - authorizes FDA to regulate biosimilars (parallel to generic
drugs).
2. Biosimilar User Fee Act of 2012 - authorizes the FDA to charge a user fee for the premarketing
review of biosimilars
3. A 2.3% excise tax on certain medical devices
What are the benefits of the EHR? - ANSWER: 1. Interoperability
2. Safety
3. Efficiency
What does "meaningful use" describe? - ANSWER: Part of HITECH Act - EHR must improve quality,
safety, efficiency, and reduce health disparities.
What is the HITECH Act of 2009? - ANSWER: Provides financial incentives for providers seeing
Medicare & Medicaid patients to adopt EHR systems ($19 million earmarked).
What are the legal uses of personal medical information per HIPAA (1996)? - ANSWER: 1. Health care
delivery
2. Operations
3. Reimbursement
What does the National Institutes of Health (NIH) do? - ANSWER: Conducts and supports basic and
applied biomedical research.
What does the Agency for Healthcare Research and Quality do? - ANSWER: Focus on quality, cost
reduction, and better access.
What is the role of health services financing? - ANSWER: Payment for health insurance premiums. Can
influence the supply and distribution of health services professionals.
