American Public Policy Promise and Performance 10th Edition Peters Test Bank Download

American Public Policy Promise and Performance 10th Edition Peters
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Chapter 11 Test Bank
Title: Ch11-01
1. In the U.S., approximately one person in _______ does not have regular access to medical care.
*a. five
Cognitive Domain: Knowledge
Answer Location: page 260
Question Type: FIB
Title: Ch11-02
2. The public sector composes a smaller proportion of total health-related expenditures in the United
States, compared to most other industrialized democracies.
*a. true
b. false
Question Type: TF
Title: Ch11-03
3. The American health care system is primarily a private health care system.
Cognitive Domain: Comprehension
Question Type: TF
Title: Ch11-04
4. CHOOSE ALL THAT APPLY. Which of the following are ways in which the U.S. government
spends money on health care?
*a. Medicare
*b. Veterans Administration hospitals
*c. SCHIP
*d. Medicaid
Question Type: MS
Title: Ch11-05
5. The United States spends a much larger proportion of its economic resources (as measured by gross
domestic product) on health care than does any other industrialized nation.
*a. true
b. false
Question Type: TF
Title: Ch11-06
6. CHOOSE ALL THAT APPLY. Which levels of government are involved in health care?
a. taxing districts
*b. local
*c. federal
*d. state
Question Type: MS
Title: Ch11-07
7. List four ways that the federal government was involved in health care prior to the implementation of
the Affordable Care Act.
*a. Varies. Students can list any four of the following: Medicare, Medicaid, SCHIP, Veterans
Administration hospitals, funding of medical research, regulating aspects of medical care.
Cognitive Domain: Application
Answer Location: page 260-261
Question Type: SA
Title: Ch11-08
8. What is the central feature of the Affordable Care Act?
a. universal coverage
b. nationalized health system
c. state exchange systems.
*d. individual mandate
Question Type: MC
Title: Ch11-09
9. Surveys of the American public find that Americans want universal access to medical care via large-
scale government programs.
a. true
*b. false
Question Type: TF
Title: Ch11-10
10. The U.S. ranks ______________________ in the world in infant mortality rates.
*a. forty-eighth
Question Type: FIB
Title: Ch11-11
11. How does the U.S. compare to other industrialized nations in the cost of health care and quality of
health care provided?
*a. Varies. The U.S. spends a much larger proportion of its economic resources (as a proportion of
GDP) on health care than does any other industrialized nation. However, the public sector comprises a
much smaller proportion of total health expenditures in the U.S. than other industrialized nations. The
U.S. infant mortality rate is 48th in the world. Infant mortality rates in the U.S. are different among
different races. The U.S. ranks 11th and performs well in the category of effective care. Disparities to
access to medical care in the U.S. exist based on race, economic status, and geographical location.
Answer Location: pages 264-265
Question Type: SA
Title: Ch11-12
12. CHOOSE ALL THAT APPLY. Which factor(s) contribute to the vast disparities that exist in access
to health care?
*a. economic conditions
b. gender
c. self-identity
*d. race
Question Type: MS
Title: Ch11-13
13. Which are problems that Americans confront with regard to health care?
*a. difficulty accessing health care
*b. inconsistent quality of health care services
*c. increasing cost of health care
d. more employer-provided insurance programs
Question Type: MS
Title: Ch11-14
14. Despite the existence of several health care programs, medicine is still not as available to the poor as
it is to the more affluent.
*a. true
b. false
Question Type: TF
Title: Ch11-15
15. As of 2008, approximately ____% of all those with income below the official poverty line were not
eligible to receive Medicaid benefits, primarily the working poor.
a. 20
*b.30
c. 40
d. 50
Question Type: MC
Title: Ch11-16
16. The most commonly cited barrier to access to health care is ________________.
*a. economic
Question Type: FIB
Title: Ch11-17
17. Discuss ways in which access to medical care has been limited among the working poor and middle
classes in the U.S.
*a. Varies. While the very poor have access to medical care via Medicaid, the working poor are not
sufficiently poor enough to qualify for Medicaid. Further, they are often employed in jobs without
health care benefits. Only a quarter of any poor have any privately financed health insurance. Even the
elderly poor who have Medicare must still pay for some components of their insurance and poverty may
deter some from taking full advantage of the program. Members of the middle class who have health
insurance often worry that a catastrophic illness can lead to medical indigence. Most medical insurance
plans have limits and may not completely cover lengthy and complicated illnesses. Members of the
middle class are not immune from a lack of health insurance. One third of families without health
insurance had incomes over $50,000 per year. In addition private health insurance coverage declined
from 1995-2007. Workers who receive medical insurance through their employers are required to pay
more for the same coverage. Having medical insurance also limited the ability of workers to move jobs
as they feared losing coverage as a result of a job change.
Cognitive Domain: Analytical
Question Type: ESS
Title: Ch11-18
18. Having health insurance can increase labor mobility in the economy.
a. true
*b. false
Question Type: TF
Title: Ch11-19
19. The 1996 ___________________________ bill required the portability of medical insurance so that
fewer people would lose coverage if they changed jobs.
*a. Kennedy-Kassebaum
Question Type: FIB
Title: Ch11-20
20. What part of the Affordable Care Act requires insurers to provide medical coverage regardless of the
current the health of the insured?
a. all-health provision
b. no-denial provision
*c. pre-existing conditions provision
d. portability provisions
Question Type: MC
Title: Ch11-21
21. Eliminating economic barriers to health care insures that all classes of people will have equal or
near-equal health outcomes.
a. true
*b. false
Question Type: TF
Title: Ch11-22
22. CHOOSE ALL THAT APPLY. Which are noneconomic barriers to equal access to health care?
a. portability
*b. transportation
*c. communication
d. pre-existing conditions
Question Type: MS
Title: Ch11-23
23. CHOOSE ALL THAT APPLY. Which is true of communication in a system of managed care?
*a. Doctors are more likely to pay serious attention to the description of symptoms coming from a
middle-class patient than a poor patient.
*b. Doctors do not pay adequate attention to concerns of the elderly.
*c. More affluent and educated citizens know better how to get what they want from professional
organizations than the poor.
d. The poor are good at getting doctors to listen to their needs.
Question Type: MS
Title: Ch11-24
24. What is a health care system in which gatekeepers try to limit expenditures generally?
a. portable care
b. limited care
c. accessible care
*d. managed care
Question Type: MC
Title: Ch11-25
25. Identify two health care problems that vary by race.
*a. Varies. Students can choose two of the following: maternal mortality is three times higher among
African-American women than the rest of the population. The incidence of tuberculosis is three time
higher among African Americans. Deaths related to diabetes occur at double the rate in African
Americans.
Question Type: SA
Title: Ch11-26
26. What are two geographic concerns that affect access to health care?
*a. Varies. Student can answer with two of the following: 1) urban areas are generally better served by
doctors and hospitals than rural areas, 2) there are regional differences in health care, with those living
in the mid-Atlantic and Far Western states better served by physicians and hospitals, 3) residents of poor
and rural state do not receive the same quality of medical care even when services are available
Question Type: SA
Title: Ch11-27
27. Which is the health care “problem that won’t go away”?
a. access
*b. cost
c. patient–doctor ratio
d. quality
Question Type: MC
Title: Ch11-28
28. Identify two factors associated with cost of medical care in the U.S.
*a. The first factor driving medical cost upward is the number of medical procedures conducted. The
second factor is the general increase in price for all medical procedures. Medical costs as a whole have
increased more rapidly that consumer costs.
Question Type: SA
Title: Ch11-29
29. Hospital costs have increased how much more than consumer prices over a 40-year period?
a. 200%
b. 245%
*c. 315%
d. 400%
Question Type: MC
Title: Ch11-30
30. What effect has the Affordable Care Act had on medical costs to date?
*a. Early indications are that there has been some slowing of price increases in health care costs. There
also appears to be a decline in consumption slowing price increases. Expensive visits to emergency
rooms have declined as more people are covered.
Question Type: SA
Title: Ch11-31
31. Governments pay about _____ percent of the total medical care bill in the United States.
a. 25
*b. 50
c. 75
d. 90
Question Type: MC
Title: Ch11-32
32. Identify and explain four reasons why medical costs have been increasing rapidly.
a. For hospitals, a rapid rise in the cost of supplies and equipment—including large capital investments
such as magnetic resonance imaging (MRI) scanners, as well as more mundane items such as dressings
and surgical gloves—has been a factor. Labor costs for hospitals have been increasing rapidly, as many
professional and nonprofessional employees unionize to bargain for higher wages. Further, good
medical care is labor intensive, and although technology can make some aspects of care more efficient,
patients value personal contacts with health providers. There also may be too many hospital beds for the
number of available patients. Empty hospital beds imply capital costs and even some running costs that
must be spread among the patients who do occupy beds. As health insurers (including government)
attempt to constrain their costs by limiting hospitalizations, the hospitals find their average costs rising.
The same consideration applies to overinvestment in technology. Every hospital that buys an MRI
scanner, for example, must pay for it whether or not it is used very often. The United States has over
3,000 MRI systems (at several million dollars each), whereas Canada is able to get by with fewer than
100. With a population approximately eleven times as large as Canada’s, the United States has
approximately a hundred times as many MRI units. The complex system of funding medical care in the
United States contributes significantly to the costs of medical care. Physician costs also have been
rising, although not as rapidly as hospital costs. In addition to the general pressures of inflation in the
economy as a whole, doctors’ fees have been affected by increases in the cost of equipment and
supplies, the rising cost of medical malpractice insurance, and the need to practice “defensive medicine”
to protect against malpractice suits by ordering every possible diagnostic procedure.
Question Type: ESS
Title: Ch11-33
33. CHOOSE ALL THAT APPLY. Which are factors contributing to the rise in physician costs?
*a. increase in cost of equipment and supplies
*b. general pressures of inflation in the economy as a whole
*c. rising cost of medical malpractice insurance
*d. the need to practice “defensive medicine”
Question Type: FIB
Title: Ch11-34
34. What is a reason that doctors are leaving some areas of specialization, such as obstetrics?
a. preferred provider plans
*b. high cost of malpractice insurance
c. the Affordable Care Act
d. managed care restrictions
Question Type: MC
Title: Ch11-35
35. The high cost of physicians’ services in the United States is not related to the high level of
specialization of American doctors.
a. true
*b. false
Question Type: TF
Title: Ch11-36
36. Explain the “tragedy of the commons” and how it relates to medical insurance.
a. Well over 90 percent of all hospital costs and approximately 80 percent of all medical expenses are
paid by third-party payers, which may be private (e.g., Blue Cross) or public (Medicaid or Medicare).
As a result, neither doctors nor patients have an incentive to restrict consumption of medical care; it has
often been perceived as “free.” Individuals may, in fact, want to use all the insurance benefits they can
to recover the amount they have paid as premiums over the years. This is a phenomenon known as the
“tragedy of the commons,” in which the rational behavior of individuals creates irrationality for society
as a whole.
Question Type: SA
Title: Ch11-37
37. The use of copayments is a tool to accomplish what?
a. Assist in the high cost of medical malpractice.
b. Eliminate emergency room visits.
c. Encourage greater specializations by physicians.
*d. Make the consumer conscious of medical costs.
Question Type: MC
Title: Ch11-38
38. What is first-dollar coverage?
*a. It describes the scenario that managed care programs provide medical care coverage from the
beginning of the first dollar spent for treatment.
Question Type: SA
Title: Ch11-39
39. The federal government has the primary responsibility for administering Medicaid.
a. true
*b. false
Question Type: TF
Title: Ch11-40
40. Which concerns of citizens is reflected in the increased number of malpractice suits and complaints
filed against physicians and hospitals?
a. access
b. cost
c. patient–doctor ratio
*d. quality
Question Type: MC
Title: Ch11-41
41. Explain how both overtreatment and under treatment can be caused by financial incentives.
a. Overtreatment has appeared in a number of studies documenting excessive use of medical technology
and drugs as a means of generating more income for physicians and hospitals. For the public sector,
overtreatment means increased costs for Medicare and Medicaid patients, as well as the human costs
imposed on the patients. This problem appears to be declining, as fewer and fewer patients have
indemnity insurance, which pays providers on a fee-for-service basis. Rather, the current quality
problem in health care is under treatment, as managed care places pressures on providers not to provide
services. Government regulators have begun to intervene to ensure that patients receive adequate care by
regulating the length of hospital stay for some procedures. Because they have an economic interest in
not providing services, health maintenance organizations and other managed care providers use
screening devices—such as prohibiting doctors from informing patients about expensive treatments that
might be beneficial—to prevent patients from receiving certain types of care. These “gag rules” have
now been largely eliminated because of pressures from government and the medical providers, and
many states make insurance companies and HMOs liable if they do not provide information and needed
care.
Question Type: ESS
Title: Ch11-42
42. What is a tool used by managed care providers to prevent doctors from informing patients about
expensive medical treatments?
a. shut down order
b. first-dollar coverage
*c. gag rule
d. specialization rule
Question Type: MC
Title: Ch11-43
43. What is meant by the phrase “we all have the duty to die”?
*a. It concerns the philosophical question concerning care for the terminally ill. The issue is that
perhaps terminally ill patients should not be kept alive by heroic means when such intervention only
prolongs dying rather than saves a life. The physician’s oath has long been interpreted to require
preserving life at all cost. Modern technology has made that concept an expensive and possibly
inhumane interpretation.
Question Type: SA
Title: Ch11-44
44. The question of what care is appropriate for the very old and terminally ill leads to what
conversation in providing health care?
*a. rationing of health care
b. denial of health care
c. expense of health care
d. quality of health care
Question Type: MC
Title: Ch11-45
45. Proposals for a patient’s bill of rights are focused around the idea of improving what?
a. doctors’ abilities to specialize
*b. quality of services under managed care
c. affordability of services under managed care
d. affordability of malpractice insurance under managed care
Question Type: MC
Title: Ch11-46
46. Which part of Patient Protection and Affordable Health Care Act does not have the potential to
reduce medical costs?
*a. requirement that the uninsured purchase insurance
b. Accountable Care Organizations
c. the creation of the Independent Payment Advisory Board
d. requiring insurers to reveal publicly the level of overheads and profits
Question Type: MC
Title: Ch11-47
47. As envision in the Affordable Care Act, the task of identifying available and affordable insurance
would be addressed through ________ _________.
*a. state exchanges
Question Type: FIB
Title: Ch11-48
48. The Affordable Care Act designed what group to review levels of payments to physicians in order to
find means of controlling these payments?
a. Accountable Care Organization
b. Center for Medicare and Medicaid Services
c. State Payment Exchange Boards
*d. Independent Payment Advisory Boards
Question Type: MC
Title: Ch11-49
49. What are two major provisions of the Affordable Care Act that require state action or at least permit
the states to act?
*a. The first is the development of insurance exchanges. States can run their own exchange and set
some of their own procedures for its operation. Second was state expansion of Medicaid coverage to a
larger proportion of the population so that people for whom minimal insurance would be a problem
would be able to have some coverage. The federal government agreed to pay almost all the costs of
expanding the program through 2020.
Question Type: SA
Title: Ch11-50
50. Medicare is a program designed to provide medical care to largely what group?
a. the indigent
b. children
*c. the elderly
d. the working poor
Question Type: MC
Title: Ch11-51
51. Medicare was adopted as part of the ____________ ______________ _________________ of 1965.
*a. Social Security Amendments
Question Type: FIB
Title: Ch11-52
52. Part A of Medicare is concerned with what aspect of medical care?
*a. hospitalization
Question Type: SA
Title: Ch11-53
53. Which part of Medicare is a supplementary insurance program covering physicians’ fees and other
outpatient services?
a. Part A
*b. Part B
c. Part C
d. Part D
Question Type: MC
Title: Ch11-54
54. Which part of Medicare provides assistance in purchasing prescriptions drugs?
a. Part A
b. Part B
c. Part C
*d. Part D
Question Type: MC
Title: Ch11-55
55. Medicare covers long-term nursing home care.
a. true
*b. false
Question Type: TF
Title: Ch11-56
56. Describe the working of Medicare. What advantages does it provide to the elderly? What are some
problems with the services provided by Medicare?
*a. Varies. Medicare was passed as part of the Social Security Amendments of 1965. It is medical
insurance for the elderly and disabled who are eligible for Social Security or Railroad Retirement
benefits. Part A which finances through payroll taxes is a hospitalization plan. It provides coverage for
some of the costs of hospitalization but does require that the Medicare recipient pay some of the cost as
well. Part B of Medicare is a supplementary insurance program covering doctors’ fees and other
outpatient services. These expenses are subject to deductibles and copayments. This portion of
Medicare is financed by enrollees who pay a monthly premium. Medicare Part D provides for
prescription drug coverage. This portion of Medicare uses private insurers to provide coverage.
Participants must pay a portion of the cost of the prescription drugs. Medicare is a better program than
would be available to most of the elderly under private insurance. It requires not physical examination
and it covers preexisting conditions. Medicare is uniformly available throughout the country. It provides
some services that might not be available in private plans. However, Medicare does require that the
insured pay a significant amount in copayments and deductibles. Further, it does not cover all medical
expenses needed by the elderly, such as, eye or dental examinations, eyeglasses, dentures,
immunizations, or long-term care. They are gaps in services that affect the health status between the less
affluent and more affluent elderly populations.
Question Type: ESS
Title: 11-57
57. The cost of Medicare places a burden on which group(s)?
*a. The working age population and government resources.
Question Type: SA
Title: 11-58
58. Hospitalization under Medicare is financed through what means?
a. 6.4% payroll tax
*b. 1.45% payroll tax
c. 7.65% payroll tax
d. private insurance carriers
Question Type: MC
Title: 11-59
59. ___________________ ________ is a form of prospective reimbursement of medical costs to
hospitals in which the hospitals are reimbursed for services to Medicare and Medicaid patients according
to a fixed amount recommended.
*a. Diagnosis-related groups
Question Type: FIB
Title: 11-60
60. Under the DRG plans, hospitals who manage to treat Medicare and Medicaid patients for a cost that
is less than the fixed amount guaranteed reimbursement, can do what with the difference?
a. return it to the federal government
b. reimburse the patient
*c. retain the difference
d. add it to a state exchange
Question Type: MC
Title: 11-61
61. What program was created at the same time as Medicare to provide federal matching funds to state
and local governments for the medical care of welfare recipients and the “medically indigent”?
a. Medicare
b. Part D of Medicare
c. Diagnosis-Related Group
*d. Medicaid
Question Type: MC
Title: 11-62
62. Since Medicaid is run by the states, eligibility requirements and benefits provided are consistent
throughout the country.
a. true
*b. false
Question Type: TF
Title: Ch11-63
63. Identify fives services that Medicaid regulations dictate that states must provide to recipients.
*a. Varies. Students can identify five of the following: hospitalization, laboratory and other diagnostic
services, X-rays, nursing home care, screening for a range of diseases, physicians services
Question Type: SA
Title: Ch11-64
64. Which is the most commonly cited problem that besets Medicaid?
a. fraud and abuse by patients
*b. fraud and abuse by service providers
c. lack of public resources
d. reduced coverage of primary physician care
Question Type: MC
Title: Ch11-65
65. Medicare is aimed primarily at providing medical care for _____, Medicaid for _____, and SCHIP
for _____.
a. the elderly . . . the children . . . the poor
*b. the elderly . . . the poor . . . children
c. the poor . . . the children . . . the elderly
d. the poor . . . the elderly . . . children
Question Type: MC
Title: Ch11-66
66. State Children’s Health Insurance Program is managed by the ________ governments with
________ support.
a. local . . . state
b. local . . . federal
*c. state . . . federal
d. state . . . private insurance
Question Type: MC
Title: Ch11-67
67. The Affordable Care Act provided for expansion of which health care program?
*a. Medicaid
b. SCHIP
c. Medicare
d. Diagnostic-related Groups
Question Type: MC
Title: Ch11-68
68. What fundamental criticism of U.S. medical care led, in part, to the creation of health maintenance
programs (HMOs)?
a. It is beset by fraud and waste.
b. It discriminates against the elderly.
c. There is not adequate coverage for children.
*d. It is fee-for-service based.
Question Type: MC
Title: Ch11-69
69. Describe the criticism of fee-for-service medicine.
*a. Fee-for-service medicine is a system whereby medical practitioners are paid for each service they
perform. As a consequence, they have incentives to use their skills; e.g., surgeons made money
wielding scalpels and internists made money ordering diagnostic procedures.
Question Type: SA
Title: Ch11-70
70. Which is true of Health Management Organizations (HMOs)?
*a. A healthy member of an HMO is all profit, while a sick member is all loss financially.
b. An HMO does not allow for prepaid medical care.
c. Doctors working for HMOs have great incentives to prescribe additional treatments.
d. HMOs contribute to the rapid escalation of medical costs.
Question Type: MC
Title: Ch11-71
71. The formation of HMOs was supported by the federal government.
*a. true
b. false
Question Type: TF
Title: Ch11-72
72. Which president signed legislation supporting the development of HMOs?
a. Theodore Roosevelt
b. Franklin Roosevelt
*c. Richard Nixon
d. Barack Obama
Question Type: MC
Title: Ch11-73
73. Identify three advantages of HMOs.
*a. 1) HMOs provide prepaid medical care, thus, it is not fee-for-service based and doctors have no
incentives to prescribe additional treatments. 2) Since a healthy member of an HMO is all profit,
doctors in an HMO have an incentive to keep patients healthy by practicing preventative medicine. 3)
The practice of preventative care would slow the rapid escalation of medical costs.
Question Type: SA
Title: Ch11-74
74. Identify the 1974 act that put the federal government squarely in the center of health care regulation,
often superseding state-level regulation.
a. the Employment Retirement Income Security Act (ERISA)
Question Type: SA
Title: Ch11-75
75. What federal agency is responsible for most drug regulation?
a. Drug Enforcement Agency
b. American Medical Association.
c. Center for Medicare and Medicaid Services
*d. Food and Drug Administration
Question Type: MC
Title: Ch11-76
76. What is the basic regulatory doctrine that is applied to pharmaceuticals before they are approved for
sale?
*a. A drug must be shown to be both safe and effective.
Question Type: SA
Title: Ch11-77
77. What did the Delaney Amendment require?
a. The Delaney Amendment (passed in 1958) requires the FDA to remove from the market foods
containing any substance that “induces” cancer in human beings or animals.
Question Type: SA
Title: Ch11-78
78. Who was the first president to propose a comprehensive national health insurance program?
a. Theodore Roosevelt
*b. Harry Truman
c. Bill Clinton
d. Barack Obama
Question Type: MC
Title: Ch11-79
79. Under a “play or pay” health care system, what options are open to businesses with regard to health
care benefits for their employees?
a. Under a “play or pay” system, businesses must either provide health insurance for their employees or
pay into a system of public health insurance.
Question Type: SA
Title: Ch11-80
80. Provide two reasons that a single-payer national health care system, similar to that found in Canada,
does not currently seem politically feasible in the U.S.
*a.1) Single-payer plans are viewed as “socialist” to some in the U.S., especially conservatives. 2)
Vested interests in the insurance industry do not want to lose their businesses and so advocate using
their companies to provide medical insurance for the entire population.

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Chapter 11 Test Bank

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